Arvind Kumar
There have been instances reported where in the ESI Scheme whopping crores of rupees have also been spent on treatment of eligible family members of covered employees, at no extra contribution for that! And there are many individual instances of expenditures in lacs of rupees made on the beneficiaries for cardiac interventions and surgeries, renal and liver transplants, neurosurgery, cancer treatments, etc through the aforesaid network of ESI dispensaries and hospitals as well as around 700 private corporate hospitals in tie-up under the ESI Scheme. Most of liberal considerations of the ESI Act, 1948 may be either eliminated from the commercial health insurance option or it may exact huge unaffordable cost on the employees opting for it. In certain cases, the coverage to an employee may altogether be refused on the grounds of medical conditions, which is not the case under the statutory ESI Scheme. Health of the nationals being one of the main concerns and parameter of any government anywhere in the world. Should a component of it like the facilities in ESI Scheme not be retained by the government and leveraged by providing access to other sections of the people in society at these ESI institutions? It is no secret that there are inadequate health infrastructure facilities in the government sector and there is need to put more in place. In that view, these vast infrastructure under ESI Scheme can be opened up to general public in critical areas like preventive programmes also, primary first care or pay and use by public on no profit no loss basis where general public can get the medical services at very reasonable cost to cost basis, particularly the poorer among the populace, which services at rate are becoming unaffordable in private commercial health sectors. There are other ways to properly put the surplus money to good use. The statute also provides for suitable variation of the rate of contributions of the employee and employer. However, in the present scenario that does not appear to be the case as the larger part of annual revenue of around Rs.11,000 crores obtained annually in the ESI Scheme can be gainfully deployed and ploughed back for the beneficiary base of 9.5 crore for employee base of about 1.9 crores, for overall makeover and modernisation. The employee base is also low of around 4 per cent of the work force in the country. Hence in fact, there is need to bring more workers under the social security coverage of ESI Scheme instead of reducing the same by hiving off even this meagre portion of organised sector employees for commercial sector health insurance. The inclusion can be increased by taking in all the employees of a covered institution irrespective of their monthly earnings, but only by pegging contributory ceiling at the present level of Rs.15,000 per month or by any other employee convenient formulae, which would not put consternation in the employees of higher salary brackets getting monthly salary above Rs.15,000, the present ceiling for coverage under the ESI Scheme.
These are the points that need to be gone into, and deeply, before any option in lieu of ESI Scheme is introduced, as for similar public welfare and socio-economic considerations the governments in the past nationalized the banks and insurance sectors and retained its share therein even after entry of private sectors therein.
Hence there is a strong case for expanding the net of social security for workers in the organised sectors. There is a case for governance in these social security sectors like ESI Scheme and Employee Provident Fund. Probably not a case for this sovereign or sovereign like function to be handed over to the commercial sectors even in part; time does not seem to be ripe for that. Yes, there could be no two opinions to reach the accumulated EPF money to the right owners and to plough back such funds of ESI Scheme on improvements through strong governance. Some such improvements can be upgrading of all the aforesaid infrastructure of ESI Scheme to defined modern standard and requirements, removing the ceilings and hurdles for the beneficiaries that might have crept from time to time but which might not be meeting the statute strictly, putting best and adequate general and technical manpower in place to provide the services ordained by the statute, reaching out to newer areas and newer sections having a threshold and demanded by Regional ESI Boards of the states and so on, including the hilly areas in Jammu and Kashmir like Rajouri, Poonch, Ramban, Doda, Kistwar, Pehalgam, Gulmarg, Leh, etc. that may be found meeting the liberalized norm of availability of 1000 coverable employees for rolling out ESI Scheme, to provide socio-economic security to more employees more areas.
(Concluded)
(The author isRegional Director, ESI Corporation, Jammu)
