Jan Arogya Scheme
A Value Chain Analysis study, conducted in 2000, by a team of researcher of SNDT Womenís University on behalf of the International Labour Organisation (ILO, revealed that the waste pickers played a critical role in the Municipalís work of garbage collection and contribute substantively to lessening the work burden of the municipality. The study also, quantified this profit to be approximately, Rs. 16 million. Using this evidence the Union advocated with the Municipal Corporation to provide basic health services to the waste pickers. Officially recognizing the efforts of the waste pickers, the Pune Municipal Corporation (PMC) in 2003, decided to provide basic health insurance cover by paying for the annual premium, thus becoming the ìfirst municipality in the country to do soî.
The scheme has the following unique features:
For the first time a vulnerable and neglected group of the society (the rag pickers) made their voices heard and got it endorsed by a civic body which not only endorsed their view officially by providing them identity card but also agreed to pay for the entire annual premium for all the members for health insurance coverage
• KKPKP acts not only as an intermediary between all stakeholders (on behalf of the members) to ensure smooth functioning of the programme but also ensures that the larger goals (of recognition of the efforts of the waste pickers by the government and civic body, giving them a collective voice and ensuring provision of social security measures to address their vulnerability) is not lost sight of and continuously pursued
• The scheme is a result of solidarity among the members of the Union (majority of which are women) who, as a result of the scheme are socially and financially empowered to meet their health eventualities at the same time
• All the registered hospitals within the Pune Municipal Corporation (nearly 150) act as provider hospitals providing a satisfactory level of service, despite there being no formal agreement with the PMC or the insurer
• Most of the members coming from lower socio-economic strata, access neighbourhood/proximal smaller hospitals and nursing homes (less than 15 beds) as these hospitals are closer to them (cutting down on transport related cost), the staffs know them and also they can avail hospitalisation on a credit basis. Taking in to consideration these facts, the insurer has agreed to waive off the criteria of minimum requirement of 15 beds for a qualifying provider hospital The scheme started off with an initial enrolment of 3707 members in 2003 to 5411 members in 2007; registering a growth of 145%. While historically the claims pending ratio was low for the first time in 2006, the programme saw a total of 40 claims pending which was due to internal problems like high turn over of employee, frequent strikes and frequent transfer of staffs dealing with the insurance scheme at New India Assurance Company.
• Most of the claims were for hospitalisation due to communicable diseases much higher than the natural average. This could be due to the unhealthy working condition which the waste pickers face as part of their profession. Another key issue is the fact that there is no formal agreement between the insurer and providing hospitals. This allows for hiking of price for hospitalisation (e.g when hospitals are asked for bills for submission to insurer, they hike up the charges) and differential charges for the same disease condition among other issues. From a financial point of view, the payout to premium percentage is increasing slowly with the present payout amount coming closer to the maximum sum insured. This is because the total sum insured is clearly not sufficient to cover for the health needs of the members.
Also, in its present arrangement, the programme does not allow for schematic or programmatic modifications based on community feedback. However it is felt that the insurer can run this beneficial programme for the most deprived community like the waste pickers by internally cross subsidizing it with its other profitable portfolio in the commercial arena.
The scheme has the following unique features:
For the first time a vulnerable and neglected group of the society (the rag pickers) made their voices heard and got it endorsed by a civic body which not only endorsed their view officially by providing them identity card but also agreed to pay for the entire annual premium for all the members for health insurance coverage
• KKPKP acts not only as an intermediary between all stakeholders (on behalf of the members) to ensure smooth functioning of the programme but also ensures that the larger goals (of recognition of the efforts of the waste pickers by the government and civic body, giving them a collective voice and ensuring provision of social security measures to address their vulnerability) is not lost sight of and continuously pursued
• The scheme is a result of solidarity among the members of the Union (majority of which are women) who, as a result of the scheme are socially and financially empowered to meet their health eventualities at the same time
• All the registered hospitals within the Pune Municipal Corporation (nearly 150) act as provider hospitals providing a satisfactory level of service, despite there being no formal agreement with the PMC or the insurer
• Most of the members coming from lower socio-economic strata, access neighbourhood/proximal smaller hospitals and nursing homes (less than 15 beds) as these hospitals are closer to them (cutting down on transport related cost), the staffs know them and also they can avail hospitalisation on a credit basis. Taking in to consideration these facts, the insurer has agreed to waive off the criteria of minimum requirement of 15 beds for a qualifying provider hospital The scheme started off with an initial enrolment of 3707 members in 2003 to 5411 members in 2007; registering a growth of 145%. While historically the claims pending ratio was low for the first time in 2006, the programme saw a total of 40 claims pending which was due to internal problems like high turn over of employee, frequent strikes and frequent transfer of staffs dealing with the insurance scheme at New India Assurance Company.
• Most of the claims were for hospitalisation due to communicable diseases much higher than the natural average. This could be due to the unhealthy working condition which the waste pickers face as part of their profession. Another key issue is the fact that there is no formal agreement between the insurer and providing hospitals. This allows for hiking of price for hospitalisation (e.g when hospitals are asked for bills for submission to insurer, they hike up the charges) and differential charges for the same disease condition among other issues. From a financial point of view, the payout to premium percentage is increasing slowly with the present payout amount coming closer to the maximum sum insured. This is because the total sum insured is clearly not sufficient to cover for the health needs of the members.
Also, in its present arrangement, the programme does not allow for schematic or programmatic modifications based on community feedback. However it is felt that the insurer can run this beneficial programme for the most deprived community like the waste pickers by internally cross subsidizing it with its other profitable portfolio in the commercial arena.
