October 23, 2007

Insurers offer cover for treating poor

Poor patients could soon avail of emergency treatment at the best private hospitals in the city if a proposal by an insurance company gets the nod. The government-owned Oriental Insurance Company Ltd has submitted a proposal to the Bombay High Court offering to cater to the needs of poor patients under a group medical scheme. The hospitals would pay premiums and be covered for treating the poor.

Legal experts said that if the scheme delivers what it promises, it could soon put an end to the practice of private hospitals turning away emergency cases in which patients cannot afford to pay a deposit. A division bench of Chief Justice Swatanter Kumar and Justice Dhananjay Chandrachud, which is hearing a public interest litigation on providing treatment free to poor patients, has asked the Association of Private Hospitals and the Maharashtra government for feedback on the proposal. The court is scheduled to hear the issue on October 25.

"A comprehensive group insurance policy could take care of the many problems that ail the private medical care sector," said advocate Jamshed Mistry, who was appointed as amicus curiae (friend of the court) in the PIL and who submitted the proposal to the court. The insurance policy, drawn up by K M Dastur Reinsurance Brokers (KMDRB) Pvt Ltd, is a first-of-its-kind and could help 319 private charitable hospitals in the state—70 of which are in Mumbai—meet guidelines set last year by the HC on treating the poor. The court had ordered the hospitals to reserve 20% of beds for poor patients who should get free or concessional treatment. The order had also directed each hospital to transfer 2% of its income obtained via patients’ fees to a separate fund called the Indigent Patients Fund (IPF).

As per Oriental’s plan, IPF money would be paid as an annual premium to the insurance firm, which would reimburse 100% hospitalisation expenses and 90 days post-hospitalisation expenses for patients with an annual income below Rs 25,000. A 50% reimbursement would be made for patients with an annual income below Rs 50,000.

"Its a win-win situation for everyone," affirmed Maneck Dastur, general manager, KMDRB. "While the poor can avail of free treatment, the hospital would get every rupee it spends." For the insurance company, such a scheme would also allow it to fulfil a mandate to frame policies for rural areas and the poor.

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