KOHIMA, AUGUST 10 (DIPR): ‘If a Nagaland government employee falls ill and gets hospitalized, all the treatment (excluding any inadmissible item/facility availed by the patient) shall be cashless’. No need to worry about the cost of the treatment. The cost of the treatment will be borne by a scheme to be known as ‘State Government Health Scheme’.
Yet to regard in reality, the idea of introducing this employees’ health care scheme is now high on the agenda of the state government. A high-level committee comprising seven senior officers headed by Principal Secretary, Finance Commissioner H.K. Khulu is on the job to formulate the scheme and it will be extended to all state government employees.
Though the concept is still in the initial stage requiring more discussions to give it a concrete shape, the committee proposed that the scheme may be operated on a ‘no-profit, no-loss’ basis. Under the scheme a ‘State Level Trust’ will be established and the trust will be responsible for receiving all contributions to the scheme and for making all payment under the scheme. A ‘state health care fund’ will also be established for the purpose and the trust will be in-charge of it. The committee in its concept-note proposed that there will be a ‘state health care society’ at the state-level with its representatives in all the government hospitals within the state. The society at the state-level will be represented by medical professionals, government officials and members of the public. At the district level, the representatives will be government officials in the respective government hospitals.
All the state government employees and their family members will be registered with the society under the scheme and each of them will be issued a membership card. As and when members fall ill requiring treatment, he or she will report to the nearest government hospital where representative of the society will be available. After recording details of the patient, the society will refer to the concerned physician for further treatment. In case the patient needs to be referred to other hospitals, the case will be referred to the society at the state-level.
The state level society shall, after due consideration refer the patient to any of the hospitals for further treatment.
For this purpose, list of referral hospitals shall be maintained by the state level society, as well as by the trust. Suitable guidelines shall be worked out for referring cases for outside treatment, the committee proposed.
One of the important features of the scheme proposed by the Committee is that after completion of treatment, the patient shall be discharged from the hospital. The concerned hospita1 shall prepare the bills and submit to the representative of the society in case, treatment at government hospitals and to the state level society in case treatment at referral hospitals for necessary payment. The state level society on receipt of the bill shall, after due examination, submit the name to the Trust for necessary payment to the concerned hospital.
The Committee further proposed that “to enable the Trust to discharge the claims received by it, the state government shall make an assessment of total expenditure on medical re-imbursement claims, and pay an equivalent amount as grant to the trust. The grant to the trust shall be an annual recurring grant”.
With the introduction of this scheme, the existing facility of medical re-imbursement claims shall be done away with. As such, the in-built budget provision for medical re-imbursement claims shall also be withdrawn. However, the medical allowance of Rs. 100/- per month, given to employees will continue as it is.
The Committee further suggested that in case a patient is referred to a hospital beyond North East states, to enable the patient to meet initial expenses, an advance from salary to a maximum of two months’ salary will be admissible which will be recovered in six monthly installments after a “moratorium of two months’
The concept of the scheme prepared by the Committee was discussed at length in the meeting of the Administrative Heads and Heads of Departments on July 20. Chief Secretary, Lalhuma extended appreciation to the Committee for the relentless efforts. The idea of introducing the employees’ health care scheme was the outcome of the careful examination of Medicare Insurance Scheme as proposed by a few Insurance companies and the existing medical re-imbursement facilities extended to the employees.
It is expected that with the introduction of this scheme the state government expenditure on medical re-imbursement claims will go down considerably while at the same time, the employees will get adequate medical treatment without any hassle. The skeleton of the scheme prepared by the committee was circulated to all Administrative Heads and Heads of Departments with a request to furnish views/comments on the proposed scheme to the committee.
