Flaws in Medisep must be fixed

'Medisep', the health insurance scheme launched for government employees, their family members and pensioners, has taken a new turn. Those who joined the scheme by paying a premium of Rs 6,000 for a year are protesting against not getting adequate benefits. A large section of people are planning to withdraw from the scheme if it is not revised in the interest of the employees. Many of the hospitals that were earlier part of the project withdrew later. Oriental Insurance Company, the operator of the scheme, is also reeling under the impact of having to pay more than the income as medical expenses. They have repeatedly warned that they will stop the scheme if the premium amount is not increased. The government is yet to take a decision. As per the agreement, the three-year project will expire by the end of March next year. The demand is to increase the premium rate if the project is to be taken forward.

The company had estimated that it would not have to pay more than Rs 450 crore a year as medical expenses. However, medisep became a loss-making business for the company as it had to pay a claim of more than Rs 600 crore. On the other hand, the employees are also deeply dissatisfied with not getting adequate benefits. Only the ruling party organisations are welcoming the project wholeheartedly. Shrinking of the list of hospitals providing free treatment, ineffectiveness of the cashless system and denial of benefits for many serious ailments are just a few of the frequent complaints of the beneficiaries. The promise was that there was no need to pay any money first while seeking hospitalisation for treatment but the experience of many is very bitter. If the patients wanted to be discharged from the hospital after treatment, they had to pay the bill from their own pockets. This amount should then be submitted in writing for a refund. All of this will naturally take days.

The project has more than 29 lakh members. Rs 612 crore is being collected as premiums every year. There is no chance for project operators to incur losses in normal circumstances. It must be suspected that flaws in implementation and excessive claims are adversely affecting the project. Lakhs of beneficiaries are still benefiting from the scheme. Therefore, steps are needed to rectify the shortcomings and energetically take the project forward. Though a mechanism has been put in place to resolve the complaints, there is a delay in timely disposal. Many of the top hospitals that were earlier available withdrew from the scheme. The government should continue its efforts to include leading hospitals which have stayed away from the scheme to the scheme along with bringing back those who have withdrawn from the scheme. Hospitals should cooperate with this initiative of the government considering it as a social obligation.

At a time when even the cost of treatment for a common cold is skyrocketing, membership in any one health insurance scheme is a huge relief for many families. Employees and pensioners became part of Medisep by reposing faith in the government. But, what is the benefit of the scheme if it becomes an arrangement that puts the beneficiaries in trouble without providing protection? Since the project can be sustained only through the intervention of the government, a solution should be found by holding discussions with the employees' organisations on ways to do so. If the company's dispute is over premium, the government should consider revising it. What is important is that the scheme should be revamped in such a way that it will benefit the beneficiaries in every sense.