Insuring the health of health workers: COVID-19
Harshita Kakar, Student, School of Law, CHRIST (Deemed to be University)
‘Nurses dispense comfort, compassion, and caring without even a prescription.’- Val Sainsbury
One such display of selfless service has come to light in the recent event of corona pandemic or COVID-19. As the pandemic grew universally, the doctors from all nationalities pulled up their socks to combat the virus. The plight of doctors is not only accredited to deficient resources and inadequate protective gear but also the evacuation of doctor’s quarters in certain hospital premises to build quarantine facilities.
On the evening of 26th March 2020, Indian Finance Minister, Nirmala Sitharaman announced an Rs.1.70 lakh crore relief package under the flag of Pradhan Mantri Garib Kalyan Yojana, by the name of Pradhan Mantri Garib Kalyan Package (PMGKP) for the betterment of poor in the trying times of Corona pandemic. The scheme was aimed to facilitate poorest of the poor with the means to meet essential needs. It was projected to cover health workers, poor workers, Jan Dhan account holders, poor widows, senior citizens, MNREGA families and construction workers. The scheme had six components, including an insurance scheme for health workers employed in Government hospitals and health care centres. The scope of this article is restricted to the health insurance aspect of the scheme.
Details of the Scheme
‘The Pradhan Mantri Garib Kalyan Package: Insurance Scheme for Health Workers Fighting COVID-19’ was launched on the pretext of a comprehensive personal accident cover of Rs.50,00,000 (Fifty lakhs) for 90 (ninety days) to around 22.12 lakh public healthcare providers, including community health workers, who have been in direct contact and care of COVID-19 patients who might be at higher risk of contracting the virus. This is inclusive of any accidental loss of life on account of the virus.
Further, the hospital staff of all private, Government and autonomous hospitals at Centre and States can be drafted for COVID-19 related responsibilities and shall be covered under the above relief package by the Ministry of Health and Family welfare. The term ‘staff’ does not limit to currently employed hospital workers, but also, retired employees, volunteers, local and urban employees of the hospitals, daily wagers and contract workforce employed in these healthcare centres and are prone to the virus because of direct contact with the patients.
Furthermore, the insurance provided under the relief package is to be accounted over and above any other personal insurance cover benefiting the beneficiaries of this package.
Later, at a press conference, the Finance Minister also announced that the insurance relief would include sanitation staff, doctors, ASHA workers, paramedics, nurses and other community-based health workers who have been acting as the ‘first line of defence’ to manage the pandemic. ASHA abbreviated for Accredited Social Health Activists are young female volunteers who have been assigned respective villages to bridge the gaps between community and public health system. India has faced disasters before but a biological pandemic, that too of such a contagion nature and scope like COVID-19, is one of its kind. The panic-struck among the commoners due to spread of the virus-like a wildfire could be controlled only by way of awareness, and it was for this purpose that nine lakh ASHA workers were designated by the ministry to assist with healthcare management and spreading awareness. ASHA found under the National Rural Health Mission, 2005 came handy when the workers went door to door to survey general people, their health status and travel histories. By order of Finance Minister the ASHA workers to have been covered under the relief package.
Funding of the Scheme
The Health Insurance package has been planned to be funded by through the NDRF Budget operated by the Ministry of Health and Family welfare. NDRF abbreviated for National Disaster Response Fund is a precautionary measure constituted under The Disaster Management Act, 2005 for the purpose of ‘specialist response to a threatening disaster situation’, for instance, landslides, devastating floods, cyclones and the like. The said fund is managed by the National Disaster Management Authority (NDMA), whose ex-officio chairman is the Prime Minister.
Also, essentially the disbursement of all funds by the New India Assurance Company Ltd., to the beneficiaries has to be certified and authorised by Central/ State Government officials.
The key features of the Pradhan Mantri Garib Kalyan Yojana can be outlined with ease in this component. As provided above, the scheme aims to extended support to ASHA workers. Further, the PM Garib Kalyan Yojana also includes cash transfers to the poor and immigrants under the PM Fund. Secondly, PM Garib Kalyan Anna Yojana is a food scheme to ensure availability of grains and rice to households for below poverty line (BPL) families. Thirdly, the PM-KISAN scheme has been enforced, which benefits the farmers by providing them with the first instalments of the scheme upfront. Fourthly, the Divyang scheme, another extension of PM Garib Kalyan Yojana, caters to the poor senior citizens and widows by providing them compensation. Lastly, the UJVALA scheme provides for free LPG cylinders to families below the poverty line for the next three months.
The right to health is not an express right under Article 21 of the Constitution of India, but an implied right. In-State of Punjab v Mohinder Singh Chawala [(1997) 2 SCC 83], the court held that the Constitution places an obligation on the State to provide reimbursement to the patient following the scheme provided by it. Apart from Article 21, the Directive Principles of State Policy under Article 47 imposes the obligation on the State to improve public health. The Central Government is empowered under Article 245 and Article 246 to make such laws. The Parliament can pass a law as that of Pradhan Mantri Garib Kalyan Yojana under Entry 47 of List- I.
In cases where the public health system of the host country is inadequate, private health insurers can be relied on as partners to achieve health policy goals. In the present case, the health insurer partner being the New India Assurance Company Ltd. Though outsourced private health insurance is an effective tool for boosting the health system by its customised benefits, government intervention is mandatory, considering the large public interests involved. It is foreseeable that the private insurer may resort to a monopoly set up and manipulate the beneficiaries or misappropriate government funds in the absence of governmental supervision. Major fallout in the option of having resorted to a private insurer is the non- accounting of legitimate claims. The already in place, Insurance Regulatory and Development Act (IRDA), 1999 strives to ‘protect the interests of holders of insurance policies to regulate, promote and ensure orderly growth of the insurance industry.’
The said Act regulates various kinds of private insurances in the Indian financial sector. The Act restricts the participating companies from pursuing operations other than insurance, regulates their conduct, monitors various insurance plans and grants licences to agents.
On a magnified scope, health insurance is covered under The Insurance Regulatory and Development Authority (Third Party Administrators – Health Service Regulations), 2001. The regulations stipulate the eligibility, scope of services, capital requirements, and solvency margins, operating guidelines and code of conduct for Third Party Administrators. The regulatory framework aims at balancing competing claims of accessibility, affordability and efficiency of health care providers to a significant segment of the population with variable purchasing powers.
Global stance on the Insurance of Health Workers
F.W. Taylor, one of the first theorists to stress upon the enhancement of work-productivity, devised the incentive-based model of motivation. Both monetary and non-monetary incentives can extensively produce dramatic results in worker productivity. On similar lines, the motivation of doctors is the need of the hour. Health insurance schemes constitute a form of non-monetary incentive. Let us consider various incentivisation techniques followed by countries throughout the globe in trying times like these.
In the United States, the Federation of Resident Doctors’ Association (FORDA) has sought insurance cover from the Central Government to be extended to frontline doctors and medico staff in the event of morbidity and mortality while fighting the Coronavirus as there exists a high risk of infection and the disease has no cure till date. Further, it was also brought to light that the Personal Protective Equipment (PPE) in many healthcare centres was inadequate.
In India, the country’s medico staff and police officials were praised for their efforts by a nationwide movement of clapping and cheering. New Delhi’s chief minister, Arvind Kejriwal announced an insurance cover of Rs. 1 crore for loss of lives of frontline healthcare personnel and sanitation workers employed at the city for fighting COVID-19. Mr Kejriwal compared the service of health workers to that of the soldiers.
In Indonesia, Government in addition to providing extra masks, goggles, hazmat suits and other protective equipment. The Government announced incentives up to Rp 15 million for medical doctors and nurses, in addition to compensation of Rp 300 million health insurance for death due to virus.
The Malaysian Government through its Ministry of Health (MOH) declared special monthly allowance RM 400 (Malaysian Ringgit) for the permanent and contract government doctors and other healthcare workers who are serving as front liners fighting COVID-19. This scheme also includes the Rapid Assessment Teams and Rapid Response Teams, Ambulatory Treatment Units and their drivers. These special allowances began in February 2020 and will continue till the outbreak concludes.
The Chinese Government has a unique system of incentivising the healthcare workers in the province of Hubei. The family-based model was employed where; the children of medico staff applying for high schools will receive additional points in their entrance exams and the younger children to be prioritised for admissions at public kindergartens.
Bangladeshi Prime Minister, Sheikh Hasina has declared a special insurance and stimulus package for government hospital’s doctors and nurses, health officials, field administrative officers, law enforcers and relief workers for their frontline roles in the fight against COVID-19. In addition, she also highlighted the health insurance of Tk 5-10 lakhs according to the ranks.
The World Health Organization declared COVID-19 outbreak as a Public Health Emergency of International Concern on 30th January 2020. Certainly, with the Pradhan Mantri Garib Kalyan Package (PMGKP), the Modi administration is taking a bold step in providing India’s medico staff and other front liners much need protection against the foreseeable risk of lives and medical expenditures resulting out of the treatment of COVID-19 patients, the disease is highly contagious. Nevertheless, the Modi administration is well aware that the PMGKP is only part of the solution. To his credit, the Prime Minister has repeatedly stressed the importance of social distancing and sanitisation and personal hygiene as a precursor to safety. As the virus spreads manifold, the nationals resort to the doctors, as the ultimate life saviours. On one hand where tireless efforts are being put to place to find the cure for the pandemic, meanwhile, the medical professionals are requested to take charge. It is for this highly contagious disease that the doctors in service are being appreciated and prompted to deliver extensive care to the patients in need. The onus is thus, on the Government to make sure that the health risks to such front liners are covered in state expenditure and loss of life if any, mandatorily be insured.
The PMGKP is an excellent step to provide comprehensive health insurance to the in-service medical professionals at all levels. However, as provided in an account in the last segment of the article inferences can be drawn from world models, and better policies can be employed to motivate the medicos further and derive the highest potential possible. Lastly, it is recommended that a higher level of pandemic preparedness is required in future. There might be a number of economic, policy and legal barriers to achieving this level of preparedness. However, as the saying goes, “You cannot predict, but you can prepare.”
 https://www.thejakartapost.com/news/2020/03/23/covid-19-indonesia-to-provide-financial-incentives-for-frontline-doctors-nurses.html  https://www.malaymail.com/news/malaysia/2020/02/27/malaysias-special-allowance-for-covid-19-heroes-rm400-for-doctors-rm200-for/1841549  https://www.channelnewsasia.com/news/asia/covid19-hubei-province-reward-doctor-children-extra-exam-points-12447336  https://tbsnews.net/coronavirus-chronicle/covid-19-bangladesh/pm-holding-videoconference-coronavirus-situation-66124