The Hindu : Insurance premium paid in kind

Online edition of India's National Newspaper
Tuesday, Apr 08, 2003

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National

Insurance premium paid in kind

By Gargi Parsai

Wardha April 7. Long before the Union Government announced a `health insurance scheme' in the budget proposals this year, a team of dedicated doctors with the Mahatma Gandhi Institute of Medical Sciences and Kasturba Hospital, set up by Gandhi and run by Sushila Nayyar, had launched a successful health insurance scheme here based on barter system. The unique scheme is development based. Only villages which opt for developmental work are interwoven into it. The payment of insurance premium is in the form of sorghum (jowar), the major crop in this belt, the pioneer of the programme, Ullas Jaju, told The Hindu here.

The scheme has worked so well since 1981 that about 45 villages covering a rural population of nearly 40,000 have opted for it. Under the scheme, villagers who hold a health insurance card are covered free for ``acute unforeseen illnesses'' such as obstetrics labour and appendicitis. However, planned surgeries such as hernia and cataract are treated at 50 per cent cost.

Other than this, the hospital runs a doorstep service which is promotive, preventive and curative. A team of doctors with the ANMs, a woman and male worker are part of this service. "We took a village as a social unit and worked several developmental activities into it like health, sanitation, dairy development, lift irrigation, organic farming, economic education, self-employment and spinning khadi for making cloth,'' Dr. Jaju said.

A family of five contributes sorghum as per its capacity to qualify. A wage earner contributes 15 kg per annum — which is taken as the base payment for health insurance. A rich landowner gives 2.5 kg over and above the 15 kg, while a poor landowner with additional source of livelihood like a shop, has to pay six kg extra. A person with an assured income of Rs. 10,000 in addition to the land, gives 15 kg of sorghum extra.

The sorghum thus collected is sold at the rate of Rs. 4 to Rs. 5 a kg at the current market rate. On an average 10 quintals is collected in a month. This goes to pay the remuneration of the village health worker, for the Gram Kosh (Village Fund) for providing part of the medicines free and for the travel expenses of the mobile team. However, a recent shift to soyabean, which is a cash crop, is reducing payment by sorghum. Dr. Jaju said they were not interested in soyabean as it was not a preferred diet. "If it comes to that, we will take the payment in the form of cotton and use it for our ambar charkha programme for producing khadi cloth.''

Families which do not own land pay Rs. 15 per person in cash to the hospital to avail themselves of the insurance scheme. For them, there is a 50 per cent charge on hospital services. But there is no relaxation in the norm of 75 per cent villagers opting for the scheme and the village opting for developmental works.

Each family which has gone in for either of the schemes is given a card through which it can avail the hospital services. The first lot gets it free, while the other gets a 50 per cent discount. Asked what was the benefit to the hospital, Dr. Jaju said "not much'' as it has to subsidise the services for the insured villagers. But in the district Gandhi made his home, service is given precedence to profit. ``Hospital doctors don't oppose the scheme because the hospital system has agreed to it.''

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