AN EVALUATION OF THE EFFECTIVENESS OF MEDICAL BENEFITS: A STUDY OF THE SATISFACTION LEVEL OF INSURED PERSONS REGARDING ESI HOSPITAL & DISPENSARIES

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AN EVALUATION OF THE EFFECTIVENESS OF MEDICAL BENEFITS: A STUDY OF THE SATISFACTION LEVEL OF INSURED PERSONS REGARDING ESI HOSPITAL & DISPENSARIES
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   © 2019 IJRAR March 2019, Volume 6, Issue 1 www.ijrar.org ( E-ISSN 2348-1269, P- ISSN 2349-5138 ) IJRAR19J2837 International Journal of Research and Analytical Reviews (IJRAR) www.ijrar.org 794 AN EVALUATION OF THE EFFECTIVENESS OF MEDICAL BENEFITS: A STUDY OF THE SATISFACTION LEVEL OF INSURED PERSONS REGARDING ESI HOSPITAL & DISPENSARIES 1 Prerna Garg, 2 Dr. Dileep Singh 1 Research Scholar, 2 Associate Professor 1 Department of Business Administration 1 University of Rajasthan, Jaipur, India ABSTRACT-  The Employees State Insurance Corporation is a corporate body established by the Central Government under ESI Act 1948. The ESI Act covers certain health related eventualities that the workers are commonly exposed to, such as illness, maternity, permanent or temporary disablement, disease caused due to the hazardous nature of the occupation or death caused due to injury obtained during employment, resulting to loss of income or total or partial earning capacity. ESI is a very large social security scheme. The purpose of the study is to analyze the awareness and satisfaction among employees regarding ESI as well as to review the  benefits provided to employees. This study analyzes the functioning of ESI Scheme and the level of contentment the employees have about ESIC. For this purpose, 100 beneficiary employees are selected at random as sample for the study out of the selected establishments namely factories, shops, educational institutions, hotels and financing companies etc. An interview was structured for the data collection. For analyzing the collected data, the Statistical and Mathematical tools were employed. The findings of the study show that the beneficiaries are aware but they are not fully satisfied with the services of ESI Hospitals and Dispensaries. Index Terms- Employee State Insurance act, Social Security Benefits, Hospital Services, Corporate Body, Insured Persons 1.   INTRODUCTION- The promulgation of the ESI Act, by the Parliament was the major legislation on social security for workers in independent India. The Act is applicable to the factories employing 10 or more employees. The ESI Act is made applicable to employees covered on the basis of geographical extension. It covers only those employees who draw salary up to 21000/- (revised in January 2017). The beneficiaries of the ESI Scheme include both the insured persons and their dependents. While the insured persons are eligible for all the social security  benefits under the Scheme, their dependents are eligible only for the medical benefit. The Act absolved the employers of their obligations under the Maternity Benefit Act, 1961 and Workmen’s Compensation Act 1923. The benefits provided to the employees under the Act conform to the ILO conventions. The ESI Scheme is administered by a corporate body called the 'Employees' State Insurance Corporation' (ESIC), which has members representing Employers, Employees, the Central Government, State Government, Medical Profession and the Parliament. The Director General is the Chief Executive Officer of the Corporation. The ESI funds are primarily made from the contributions of employers and employees payable monthly at a fixed percentage of wages paid. The State Government also contribute 1/8th share of the cost of Medical Benefit. Under Section 1(5) of the Act, shops, hotels, cinemas, restaurants, news paper establishments, private educational institutions and other medical institutions are covered under ESI Act.   © 2019 IJRAR March 2019, Volume 6, Issue 1 www.ijrar.org ( E-ISSN 2348-1269, P- ISSN 2349-5138 ) IJRAR19J2837 International Journal of Research and Analytical Reviews (IJRAR) www.ijrar.org 795 2.   REVIEW OF LITERATURE: 1.   Deblina Mitra (2017) in her study- “ Effectiveness of Medical Benefits under ESI Scheme: A Study on the Employees of Organised Sector in Kolkata” analysed that Medical benefit scheme of ESIC of India  provides a full comprehensive medical care to the insured persons and their families. On the basis of study some suggestions like enhancement of the awareness about the ESI Scheme among the insured  persons and employers, improvement in the quality of services in ESI hospitals and dispensaries, simplifying the formalities to be followed for claiming benefits, etc, can be extended to create a cordial atmosphere and smooth relationship between enterprises, ESI Corporation and insured persons. 2.   Dilshad Begum (2017), proposed in her PhD. thesis to study the standard infrastructural facilities to be available in Employees’ State Insurance Corporation and to examine the role of Government in infrastructural development at Employees’ State Insurance Hospitals (including Diagnostic Centre and Dispen saries), to evaluate the perception of Doctors relating to infrastructural problems in Employees’ State Insurance Hospitals, to know the perception of Nurses relating to infrastructural problems in Employees’ State Insurance Hospitals, to analyze the perce  ption of other staff relating to Infrastructural problems in Employees’ State Insurance Hospitals and to examine the perception of employees relating to infrastructural problems in Diagnostic Centre and Dispensaries. The study finds that majority of the ESI Dispensaries do not have sufficient moving area in the building and Dispensaries are not in good condition. Most of the ESI Dispensaries do not have facilities for emergency, antenatal and postnatal check up and some Dispensaries have these facilities at a lower level. It is better for the ESI Hospitals of Karnataka to be converted from being run by the State Government into ESIC that is run by the central government. The study has been done to provide insights for the future course of action for the Empl oyees’ State Insurance Corporation and the policy makers for improving accreditation guidelines and ensuring infrastructure facilities and quality control. 3.   Dr. Maiya (2016) in his study ―”Nurses‘ perception towards ESI scheme” : A study with reference to selected hospitals in Udupi district‖ showed that there was no significant association between level of satisfaction and monthly family income, there is also no association between level of satisfaction and other demographic variables as age, gender, religion, dependent members, and awareness about ESI. Hence, this study reveals that level of satisfaction is independent of selected demographic variables and monthly family income. 4.   G.Muthulakshmi (2014) conducted a study on the performance of Employees state insurance scheme with special reference to Tuticorin district, Tamil nadu. The study examines the performance of Corporation and also the awareness & satisfaction of employees on ESI hospitals. The primary data were analyzed with the help of various statistical measures such as simple percentage analysis, Averages, F-statistic, Chi-square test, Garrett ranking and percentage analysis. The study found out that ESI dispensaries & hospitals were not running up to the contentment of insured persons. The study also reveals the scope to improve its functions and turn into a highly trustful and reliable corporation, implementing better services. 5.   Divya M., Dr. B Vijayachandran Pillai   (2014) conducted a study on “An Assessment of Awareness and Satisfaction on Emplo yee State Insurance Scheme in the Service Sector in Kerala”. 90  beneficiaries were selected by employing simple Random Method as sample for the study, 30 respondents each from each of the three selected establishments namely shops, educational institutions and financing companies for the purpose. The findings of the study show that the beneficiaries of educational institutions are more aware about ESI scheme than other two classes because they are more aware about the scheme. 6.   Satpathy I, Patnaik B.C.M & Dev Padma (2012) - The Employees’ State Insurance  Scheme, formulated under the Employees State Insurance Act, 1948, provide medical care and cash  benefits to insured persons in the contingencies of sickness, maternity, disablement and death due to employment injury. Under the ESIS, medical care is also provided to families of the insured persons. In the present paper it is an attempt by the authors to understand the perception level of the staff working in the ESICs. For this purpose 76 staff members were approached out of total existing 337   © 2019 IJRAR March 2019, Volume 6, Issue 1 www.ijrar.org ( E-ISSN 2348-1269, P- ISSN 2349-5138 ) IJRAR19J2837 International Journal of Research and Analytical Reviews (IJRAR) www.ijrar.org 796 staffs and only 59 responses received from the respondents. On an average 60% satisfaction level was recorded regarding the functioning of ESIC hospitals in Odisha. 7.   Dash and Muraleedharan (2011) In their study , ―How Equitable is Employees‘ State Insurance Scheme in India?: A Case Study of Tamil Nadu‖ tried to assess the utilisation pattern of the ESI facilities and to what extent the ESI Scheme helps protect the beneficiaries from the catastrophic health expenditure. The findings show that the overall utilisation level is very low due to; perceived low quality drugs, long waiting periods, insolence of personnel, unusual delays in reimbursement of money spent on treatment outside and low awareness of ESI procedures. They also suggested some remedial measures. 3.   A BRIEF OF SOCIAL SECURITY BENEFITS: Under the ESI scheme, employees contribute 1.75% of the wages and employers contribute 4.75% of the wages of eligible beneficiaries/employees towards premium payments. The contributions made by the employees and the employers are deposited in a common pool known as the ESI Fund.   This paper is concerned about Medical Benefits that’s why only one benefit is explained. The objectives of ESI scheme are to provide benefits in cash and kind which include: 1. Medical Benefit (for self and family); 2. Sickness Benefit (for self); 3. Maternity Benefit (for self); 4. Disablement Benefit, both temporary and permanent (for self); 5. Dependents‘Benefit  (for family); 6. Funeral Expenses (to a person who performs the last rites of an IP); 7. Rehabilitation Allowance (for self); 8. Vocational Rehabilitation for the IPs; 9. Old age Medicare (for self and spouse); 10. Medical Bonus (for insured women and IP‘s wife). Table 1: ESI Scheme- A Total Social Security for Workmen S.No. Social Security Benefits Features 1 Medical Care Medical care with no cap on individual expenditure, (health insurance) 2 Sickness Benefit 91 days 3 Extended Sickness Benefit 730 days (up to 2 years) for specified 34 diseases 4 Maternity Benefit 84 days+1 month (due to complications arising out to pregnancy, confinement, premature birth of child etc. 5 Permanent Disablement Benefit/ Temporary Disablement Benefit Loss of earning capacity as long as the disability lasts. 6 Dependents Benefit It is a benefit given to the wife of IP on the death, till she is alive/remarried and to family members as  per conditions w.r.t. age/marriage. 7 Rajiv Gandhi Shramik Kalyan (unemployment Allowance) 50% of daily average wages upto 12 months unemployment on account of closure of factories, retrenchment or permanent invalidity of not less than 40% arising out of non-employment injury. 8 Incentive Scheme to employers for employing persons with Disabilities The employers’ share of contribution is paid by government for 3 years for providing employment to  persons with disabilities drawing monthly wages up to Rs. 25000/- 9 Medical Care to Retired IPs Medical facility available within ESIC on payment of Rs. 120/- per annum. Source: www.esic.nic.in   © 2019 IJRAR March 2019, Volume 6, Issue 1 www.ijrar.org ( E-ISSN 2348-1269, P- ISSN 2349-5138 ) IJRAR19J2837 International Journal of Research and Analytical Reviews (IJRAR) www.ijrar.org 797 3.1 MEDICAL BENEFITS: Medical benefit includes the medical care package (free of cost) consisting of out-patient treatment, in-patient treatment, specialist consultation, X-ray and laboratory investigations, supply of drugs, dressings, artificial limbs, aids and appliances, health improvement services such as vaccination, preventive inoculations and  periodical health check up. An insured individual and his /her dependents become eligible to receive medical attention from the date he /she joins the insurable employment and entitlement continues till the time the insured person continues to be in insurable employment or is qualified to stake a claim for instances like illness, maternity or any form of disablement. Medical benefits are of two types: 1. In-patient medical care In-patient services are provided through a chain of 151 ESI hospitals spread across the country which includes 36 directly run ESIC hospitals & 115 State ESI hospitals with a total bed strength of 23188. Super specialty services for beneficiaries are mainly provided through tie-up arrangements with reputed corporate hospitals. Tie-up arrangement for super specialty treatment has been made with more than 1000 hospitals across India. 2. Out-patient medical care i. Insurance Medical Practitioner Private Medical Practitioners are appointed as panel doctors. A panel doctor should have his own consulting room and dispensary. Each panel doctor is allowed to register maximum 2000 insured person & their family units. Currently there are 1017 IMPs all over the country. ii. Service Dispensaries The out-patient medical care including essential lab investigations under the ESI Scheme is provided through dispensaries established for the exclusive use of the Insured Persons and their families, manned largely by full-time Medical Officers. There are 1418 service dispensaries under ESI scheme all over the country. iii.   Hospital OPD ESI hospitals provide outpatient services under various specialties and super specialties like Medicine, Surgery, Paediatrics, Gyne.& Obst., ENT, Eye, Cardiology, Nephrology, Neurology, Urology, etc, through outpatient dispensaries all over the country . 3.2 BRIEF OF ESI HOSPITAL & THEIR SERVICES IN JAIPUR: 1. Hospital Services: a.   OPD Services in modern Medicine & Ayush are available in different ESIC Hospital such as General Medicine, Dermatology, Ophthalmology, Dental, Psychiatry, ENT, Orthopaedic, General Surgery, Paediatrics etc.  b.   OPD Timing (9:00 AM  –   4:00 PM (Monday to Friday) and (9:00 AM  –   1:00 PM on Saturday) c.   Special OPD for Senior Citizen and Differently abled Persons (3:00 PM  –   5:00 PM) d.   Specialty Clinic: e.   In-Patient Services includes OT, ICU, PICU, NICU, CSSD, Kitchen, Laundry etc. 2.   Diagnostic Services A.   Laboratory Services are available for various tests. B.   Radiological Services: a. X-rays, Doppler and Ultrasound are available.  b. In some Hospitals CT Scan / MRI Scan are also available. C.   Emergency Services: a. 24 hours emergencies Service is available.  b. Round the clock medical officer is available. D.   Kitchen and Dietary Services: a. Free Dietary Services are provided by Hospital.  b. Hygienic and healthy diets are served to the patient admitted in the wards and emergency.   © 2019 IJRAR March 2019, Volume 6, Issue 1 www.ijrar.org ( E-ISSN 2348-1269, P- ISSN 2349-5138 ) IJRAR19J2837 International Journal of Research and Analytical Reviews (IJRAR) www.ijrar.org 798 E.   Special Registration Counter: F.   Facilitation Centre: A Facilitation centre at the entrance of the Hospitals is available to guide Patients regarding treatment and availing various services provided in the Hospital. G.   ECG H.   Pulmonary Function Test 3.   Other Services a.   Physiotherapy  b.   Occupational Therapy c.   Ambulance Service d.   Bio-Medical waste management e.   Health check- up camps. f.   Academics: Periodical CMEs and case discussion are routinely held involving all Specialities. 4.   New Initiatives under Health Reform Agenda of ESIC ESIC- 2.0 : It was a new initiative on the part of government. In this scheme Electronic Health Records of ESI  beneficiaries has been made available through online method. Abhiyan Indradhanush is a manifestation of the Swachh Bharat Abhiyan in ESIC; it is implemented for changing the bed sheets in all ESI hospitals daily as  per VIBGYOR pattern. A 24x7 Toll Fee Medical Helpline No. 1800-11-3839 has been set up for attending the calls of Insured persons. Special OPD for Sr. Citizens and Differently-abled Persons in ESIC Hospitals has been started for hassle-free treatment. AYUSH:  The AYUSH facilities have been extended to all ESIC Dispensaries and Hospitals. 5.   Other salient features of Health Reforms Agenda: a.   Extending Coverage: ESI scheme is being implemented in the remaining North-East States of Arunachal Pradesh, Mizoram, Manipur and Andaman & Nicobar Islands by 31.12.2015  b.   ESI coverage has been extended to construction site workers in the implemented areas w.e.f 01.08.2015. c.   ESI Scheme is being implemented in Industrial/Commercial clusters of the whole of 393 districts of the states. 6.   Improving Patients / Attendant Care: a.   Appropriate Cancer detection/treatment, cardiology and dialysis facilities in all the ESIC Hospitals have been provided on PPP Mode.  b.   A special Focus has been made for up gradation of 24 dispensaries to 30 bedded set up for providing 24x7 services in first phase. c.   Pathological and X-ray facilities will be provided in all the Dispensaries on PPP Mode in Phases. d.   The tele-medicine project is expected to go live shortly in all the ESIC Hospitals. e.   For better management for helping in registration and Pharmacy, effective Queue management system is implemented in all hospitals. To establish better rapport between doctors and patients, doctors, Para medical and other staff is given behavioural training periodically. The System of collecting feedback from all indoor patients is already available in all hospitals.  7.   AYUSH Besides Allopathic treatment, ESIC Hospitals also provide treatment under AYUSH (Ayurveda, Yoga, Unani, Siddha and Homeopathy). Ayurveda facility is available in 30 ESIC Hospitals and 9 ESIC Dispensaries and Homeopathy in 12 ESIC Hospitals and 5 ESIC Dispensaries and Yoga in 6 ESIC Hospitals. Facility of AYUSH is to be extended to all dispensaries in phases by December, 2015 and Yoga in all ESIC Hospitals by 30th November, 2015.
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