ESI Scheme

 
E.S.I. SCHEME UNDER LABOUR AND EMPLOYEMENT DEPARTMENT GOVERNMENT OF ORISSA

Introduction:

The ESI Act.1948 envisages an integrated social insurance scheme to provide social security to the industrial workers in certain contingencies such as sickness, maternity, temporary or permanent physical disablement and death due to employment injury resulting in loss of wages or earning capacity. The act also guarantees full medical care to the workers and their dependent family members.

The act was first implemented at Kanpur and Delhi on 24.2.1952 and in the mean time it has been implemented in all States and Union Territories of India.

Coverage under the ESI Act.

All non seasonal factories using power and employing 10 or more persons and non-power using factories employing 20 or more persons are coverable under the ESI Act.The Act. has also been extended to establishments like shops,hotels,restaurants,cinema halls, road motor transport agencies and news paper establishment employing 20 or more persons.All employees in such factories and establishments getting wage upto Rs.6500/-P.M. are coverable under the Act.

Benefits under the Act:

The following benefits are provided to the insured persons(I.Ps.)and their family members under the provisions of ESI Act.
  1. Medical Benefit.
  2. Sickness Benefit
  3. Maternity Benefit
  4. Disablement Benefit.
  5. Dependant’s Benefit.
  6. Funeral benefit.
The First benefit i.e medical Benefit is provided by the State Government through the ESI Scheme and the remaining five benefits, which are cash benefits are provided by the ESI Corporation directly.

The Medical benefit consist of the following items:
  1. Out patient and in-patient treatment in ESI Hospitals/Dispensaries, referral Hospitals inside and outside the state hospitals.
  2. Specialist consultation.
  3. Supply of Drugs, dressing, artificial limbs, aids & appliances.
  4. Investigation facilities.
  5. Services under National Health Programmes.
  6. Payment of RCM cost of medical expenses incurred by I.P.s
  7. Medical Certification.
ESI SCHEME IN ORISSA:

The E.S.I Scheme was implemented in Orisa in January’1960 with 6 Despensaries at Brajrajnagar, Rajgangpur, Choudwar, Barang, Rajabagicha and Khapuria covering a total number of 23,000 industrial workers. I initially “expanded medical care” was provided.The full medical care was introduced with effect from 1.9.1976.In the intervening years ,the ESI Scheme has been expanded by implementing in new areas. At present there are 50 Dispensaries,5 Hospitals and 2 Annexees with 297 beds and one Specialist Center spreading over 20 Districts to provide full medical benefit to 1,30,350 I.Ps/Family units.

One Ayurvedic clinic and one homeopathic clinic is also been functioning at ESI Hospital,Choudwar and at ESI Hospital,Bhubaneswar.

One 50 bedded modern Hospital at rourkela is proposed to be commissioned by ESIC very shortly.The hospital will be managed directly by the ESI Corporation at their sole cost.

ORGANISATIONAL SETUP

The Director of ESI Scheme is the HEAD of the Department and is in over all charge of the Scheme under the administrative control of Labour and Employment Department.He is assited by one Joint Director,one Deputy Director,One Assistant Director,One Accounts Officer, One Establishment Officer, four Section Officers and 55 other staff. Besides one Central medical Store managed by one Deputy Director, one Medical Officer, one Store Manager, one Store Superintendent and 11 other staff is also functioning in the ESI Directorate.

The ESI Dispensaries and Hospitals are grouped under 3 zones(Central, Northern, Southern)each headed by a joint Director-Cum-Superintendent. They also work as Medical Superintendents of the Hospital where they are stationed i.e ESI Hospital,Choudwar, Kansbhal and J.K.Pur. In addition there are two Superintendents at ESI Hospital,Bhubaneswar and Brajrajnagar.The Dispensaries are headed by Insurance Medical Officer Incharge either in Class-II or Junior Class-I rank. Administrative and financial powers have been delegated to the Joint Directors, Superintendents and Insurance Medical officer Incharge for smooth management of the Hospitals/Dispensaries.

STAF POSITION IN THE HOSPITAL AND DISPENSARIES:

There are 3 joint Directors ,2 medical Superintendents,4 Junior Class-I Specialist including Dentist,14 Junior Class-I I.M.Os,36 Class-II Specialist ,136 Class-II Insurance Medical Officers including Dentist, 165 Nursing personnel, 102 Pharmacists, 55 Laboratory Technicians, 14 other Technicians,62 Dressers,132 other Class-III and 427 Class-IV staff in the 5 ESI Hospitals and 50 ESI Dispensaries.

LPs COVERED UNDER THE ESI SCHEME:

As on 31.3.1998 =1,54,700.
As on 31.3.1999 =1,44,350.
As on 31.3.2000 =1,28,350.
As on 31.3.2001 =1,30,350.

REFERRAL SERVICE AND SUPER SPECIALIST TREATMENT FACILITIES:

A).Inside the State:
The ESI hospital function as referral Central in respect of Dispensaries under the zone. The District Headquarter Hospitals and 3 Medical College Hospitals are also recognized as referral hospitals. Besides I.G.H., Rourkela, Nalco Hospital, Anugul and M/s .Kallinga Hospital,Bhubaneswar are recognized as referral hospital where credit facility is provided for investigation, specialist/super specialist treatment and hospitalisation.

B)Out side the State:
In case of non-availability of adequate facility of investigation and treatment in State Medical College Hospitals, the patients are referred to 29 reputed outside State Hospitals at the sole cost of the ESI Scheme. In such cases usually the estimated expenditure cost is deposited with the concerned Hospitals in advance. Such advance is also deposited with the State Medical College Hospitals for costly investigation treatment.

PROCUREMENT AND DISTRIBUTION OF DRUGS:


a)Rate:
Out of total ceiling of Rs.600/- per L.P family unit per annum the ESI Corporation have earmarked Rs.170/- for purchase of drugs/dressings, payment of R.C.M claims etc.

b) Procurement
The process of procurement and distribution of medicines has been decentralized since 1991-92.The three Joint Directors are functioning as Direct Demanding Officers to procure and supply medicines in respect of their own hospital and dispensaries under their zone.The Superintendent,ESI Hospital Brajrajnagar purchases medicines for its own hospital. Besides the Central Medical Store in ESI Directorate purchases medicines for some Dispensaries and to keep emergency stock for supply wherever required.

c)Mode of purchase:
The Labour and Employment Department have formed two committees one at Directorate Level and one at Government Level. The Directorate Level Scrutiny Committee examines the annual requirements of different dispensaries and Hospitals and place the requirement with modality of purchase before the Government Level Purchase committee for approval. Medicines are purchased as per the ESIC Rate Contract. Only medicines not included in ESIC Rate Contract or the ESI Rate Contract holder firms fall to supply, it is purchased as per state EPM & DMET Rate Contract in order of preference. The Direct Demanding officers purchase the medicines after the approval of Government Level Purchase Committee.Rs.7,000/- and Rs.2,000/- per annum is placed at the disposal of the Superintendent and I.M.Os Incharge respectively for purchase of medicines from local market in emergency. d)Distribution:
Medicines are supplied on quarterly basis .In addition ,emergency supplies are made as and when required as per the indent placed.

e)Quality Control:
Concerned firms usually furnish quality test certificates for the batch, no. of medicines supplied. Besides ,random samples are collected by the drugs Inspectors of the State from Zonal Medical Store, Central Medical store, ESI Hospital/Dispensary Medicine Store on request from time to time for quality testing and analysis in laboratories inside and outside the state.

HOSPITAL AND DISPENSARIES BUILDINGS:

5 Hospitals and 11 Dispensaries function in 13 buildings constructed by ESI Corporation. The remaining 39 ESI Dispensaries function in rented building.

REVOLVING CORPUS FUND/PAYMENT OF REIMBURSEMENT CLAIMS OF I.PS.

Revolving Corpus Fund of Rs.50/- per I.P. per annum amounting to Rs. 68,17,500/-was set up for the year 2001-2002 towards payment of reimbursement claim of I.Ps for Specialist/Super Specialist treatment, costly investigations ,payment of advances and payment of credit bills to outside/inside the State Hospitals. All the R.C.M bills of I.Ps up to Feb’2002 have been cleared for which an additional amount of Rs.64,87,459.00 was spent from the State budgetary provision over and above the Revolving Corpus Fund.

EXPENDITURE ON MEDICAL CARE:

The ESI Corporation has prescribed a celling of Rs.600/- per I.P. family unit per annum on expenditure on medical care, out of which (a)Rs.170/- for medicine(b)Rs 50-for Revolving Corpus fund(c) Rs.20/- for repair ad maintenance of medical equipments(d)the balance of Rs.360/- for other expenses are ear-marked per I.P. family unit per annum. The expenditure within the above said ceiling is shared between the ESI Corporation and the State Government in the ratio of 7:1 i.e 87.5% and 12,5%.Expenditure over and above the prescribed ceiling is borne entirely by State Government. However expenditure on purchase of vechiles, costly medical equipments exceeding Rs.10,000/- and house rent of Corporation buildings ,hospital waste management, indigenous medical services are shared between the ESI Corporation and the State Government in above said ratio outside the ceiling. In newly implemented areas the entire expenditure on medical care is borne by the Corporation for the first three years.

THE EXPENDITURE ON MEDICAL CARE IN ORISSA DURING THE LAST THREE YEARS IS SHOWN IN TABLE BELOW:  
YEAR TOTAL EXPENDITURE ON MEDICAL CARE CORPORATION SHARE STATE GOVT. SHARE EXTRA BURDEN ON STATE GOVT. TOTAL PAYMENT BY THE STATE GOVERNMENT.
1999-2000 11,82,59,886 6,66,57,775 93,78,655 4,22,23,456 5,16,02,111
2000-2001 11,55,91,782 6,11,30,538 87,32,934 4,97,28,310 5,84,61,244
2001-2002 12,05,05,173 6,27,30,937 89,61,563 4,88,12,673 5,77,74,236