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Pol_E Eern India Pol_E
Showing posts with label Social issues. Show all posts
Showing posts with label Social issues. Show all posts

Monday, 18 June 2012

Rashtriya Swasthya Bima Yojana RSBY

Context  - Universal Health Coverage in Twelfth Five Year Plan, on recommendations of K Srinath Reddy Committee
Sub-topics - Regulating Ministry, Beneficiaries, Terms and Conditions, Objectives, Performance, Problems/Issues



  • Min of labor and employment, BPL households coverage of 30,000 for hospitalisation, cashless hospitalisation in empanelled hospitals with Health Cards, family of 5
  • Nominal registration fee from user, premium paid 50:50 by centre and state max 750 rs per family per year, access to quality care, demand driven program
  • Highly flexible and convenient
    • Givens users option to public or private facilities of his choice, covers ALL preexisting diseases from day one, no age limit
    • IT intensive biometric smart card, all hospitals connected at district level for info gathering and updation
    • Portable, can be used in any district elsewhere
    • Business model for insurers- premium paid for each household enrolled, hospitals get greater flow into public hospitals , monitored by insurers to prevent fraud, excessive administrative expense claims - competitive bidding for insurers, claim settlement between hospital and insurer, not the consumer!
      • With greater flow ins of rural patients one hopes the RSBY money makes private sector set up hospitals in rural areas- 100bed hospital in Ballia mainly due to RSBY flux
      • Covers transportation expenses as well
    • Intermediaries like NGOs MFI compensated, strong measures like de empanelment of hospitals for fraud
  • Performance 2.76 cr cards, total 31 lakh cases, 8200 hosps empaneled , sustainable - 89% burnout ratio (cash paid put against premium) for 2nd year district, saw 6% hospitalization
  • Covers unemployed, unorganised labor, NREGA street vendors, railway portes, Kisan card holders etc
  • Problems - insurance company incentivized to enroll but not for utilization- need to introduce an efficiency in service standard , very few TPAs third party administrators leading to higher chance/possibility of collusive fraud
  • Beneficiaries  below poverty line families in unorganised sector, rickshaw pullers, domestic workers ,toddy tappers, ragpickers etc  also include NREG workers(15 day limit), mining industry
    • Domestic workers brought under law, identify domestic workers, include in central list of scheduled employment, 4.75 million. Reform crucial for migrant workers and tribals from outflow states
    • 30000 rs coverage to family of 5, treatment from empanelled private and government hospitals , smart cards may be extended for other benefits- maternity, death and disability
    • Bring in unorganized labor, since it ends next year, will start an autonomous board to regulate & look after the program 

Thursday, 31 May 2012

National Policy on Old Persons (NPOP)

The National Policy for Older Persons (NPOP) was formulated in 1999 in response to the
increasing number of persons 60 years and above.

Key Elements of NPOP


Financial Security
i. The old age pension scheme to eventually cover all older persons below poverty line
ii. Pension scheme to be broadened to include both public and private sectors
iii. Tax exemption for medical and nursing care, transportation and support services for the old or the son or daughter with whom they are staying
iv. Public distribution system to reach out to cover all persons above the age of 60 living below the poverty line



Health Care and Nutrition

i. Subsidy for the health care needs of the elderly poor and graded system of user charges for others
ii. Provision of primary health services and health insurance to address preventive, curative, restorative and rehabilitative needs of older persons and geriatric care at secondary and tertiary levels
iii. Tax relief, grants, land grant at concessional rates to NGOs and private hospitals to provide economical and specialised care for older persons
iv. Setting up geriatric wards and conducting training and orientation programmes for geriatric care
v. Expansion of mental health services and counselling facilities for the elderly having mental health problems

Shelter
i. Earmarking 10 per cent of the houses in private and Government housing schemes and easy access to
loans.
ii. Layout of housing colonies to be made sensitive to the needs of the older persons.
iii. Quick disposal of cases relating to property transfer, mutation of property, property tax, etc.

Education
The concept of wellness in old age and related health education and information needs of the elderly should receive priority so that they are well-informed about safety, security as well as the evolving changes in lifestyle and living.

Welfare
Welfare is intended primarily for the extremely vulnerable elderly who are disabled, infirm, chronically
sick and without any familial support.
i. Identify the more vulnerable among the older persons such as the poor, the infirm and those without
family support. Institutional care to be the last resort only.
ii. Provide assistance to voluntary organisations by way of grants-in-aid for construction/maintenance of
old age homes, daycare centres, multi-service citizens centres, outreach services, supply of disabilityrelated
aids and appliances, etc.
iii. Set up of welfare funds for older persons with support from the corporate sector, trusts, charities,
individual donors and others for protection of life and property, involvement of NGOs and supporting
senior citizens to realize their potential.

Research and Training
i. Encourage research and documentation on ageing.
ii. Encourage medical colleges, training institutions for nurses and paramedical institutes to introduce
courses on geriatric care.
iii. NGOs associated with such activities to get support for training and orientation of their personnel for
the provision of specialized services.

Sensitizing the Media


What is the implementation mechanism of National Policy for Older Persons?

Ans. The Government has constituted the NCOP on 10th May 1999 under the Chairmanship of Hon'ble Minister for Social Justice and Empowerment. The NCOP is the highest body to advice and coordinate with the Government in the formulation and implementation of policy and programmes for the welfare of the aged. The NCOP has been reconstituted in 2005. The present strength of NCOP is 50.

Besides, the Ministry has also set up an Inter Ministerial Committee (IMC) headed by Secretary (SJ&E) with the aim of effective implementation of the National Policy on Older Persons and for taking actions on the recommendations of NCOP. The Ministry periodically reviews progress on the implementation of the National Policy on Older Persons through meetings of NCOP and IMC.


Key issues in implementation as experienced during the last 10 years of the NPOP.
These are the need for:
(1) coordination among multi-sectoral partners with clearer accountability and measurable and time bound results;
(2) financial outlays by different stakeholders within their respective mandates, but harmonised to produce policy outcomes;
(3) a stronger role for the National Council for Older Persons with greater political and administrative power necessary to bring multiple stakeholders contribute to a common cause;
(4) enhanced income security, including social pensions for the poor vulnerable senior citizens;
(5) increased protection for older women who face socio-economic, cultural and legal barriers; and finally
(6) the need for sharpening the policy focus as it addresses multiple issues with limited resources.


Recommendations by  Smt. (Dr.) Mohini Giri Committee in Draft National Policy on Senior Citizens, 2011


The focus of the new policy:

1. Mainstream senior citizens, especially older women, and bring their concerns  into the national development debate with priority to implement mechanisms  already set by governments and supported by civil society and senior citizens‟  associations. Support promotion and establishment of senior citizens‟
associations, especially amongst women.
2. Promote the concept of "Ageing in Place‟ or ageing in own home, housing,  income security and homecare services, old age pension and access to  healthcare insurance schemes and other programmes and services to  facilitate and sustain dignity in old age. The thrust of the policy would be preventive rather than cure.
3. The policy will consider institutional care as the last resort. It recognises that  care of senior citizens has to remain vested in the family which would partner  the community, government and the private sector.
4. Being a signatory to the Madrid Plan of Action and Barrier Free Framework it  will work towards an inclusive, barrier-free and age-friendly society.
5. Recognise that senior citizens are a valuable resource for the country and  create an environment that provides them with equal opportunities, protects  their rights and enables their full participation in society. Towards achievement of this directive, the policy visualises that the states will extend their support for senior citizens living below the poverty line in urban and rural  areas and ensure their social security, healthcare, shelter and welfare. It will protect them from abuse and exploitation so that the quality of their lives  improves.
6. Long term savings instruments and credit activities will be promoted to reach both rural and urban areas. It will be necessary for the contributors to feel National Policy on Senior Citizens 2011 assured that the payments at the end of the stipulated period are attractive enough to take care of the likely erosion in purchasing power.
7. Employment in income generating activities after superannuation will be encouraged.
8. Support and assist organisations that provide counselling, career guidance and training services.
9. States will be advised to implement the Maintenance and Welfare of Parents and Senior Citizens Act, 2007 and set up Tribunals so that elderly parents  unable to maintain themselves are not abandoned and neglected.
10. States will set up homes with assisted living facilities for abandoned senior citizens in every district of the country and there will be adequate budgetary support.


Implementation Mechanism
There will be efforts to provide an identity for senior citizens across the country and the ADHAAR Unique identity number will be offered to them so that implementation of assistance schemes of Government of India and concessions can be offered to them. As part of the policy implementation the Government will strive for: 
  1. Establishment of Department of Senior Citizens under the Ministry of Social Justice and Empowerment
  2. Establishment of Directorates of Senior Citizens in states and union territories 
  3. National/State Commission for Senior Citizens
  4. Establishment of National Council for Senior Citizens
    A National Council for Senior Citizens, headed by the Minister for Social Justice and Empowerment will be constituted by the Ministry. With tenure of five years, the Council will monitor the implementation of the policy and advise the government on concerns of senior citizens. A similar body would be established in every state with the concerned minister heading the State Council for Senior Citizens.

      The Council would include representatives of relevant central ministries, the Planning Commission and ten states by rotation.
      Representatives of senior citizens associations from every state and Union Territory.
      Representatives of NGOs, academia, media and experts on ageing. The council would meet once in six months.
  5. Responsibility for Implementation

    The Ministries of Home Affairs, Health & Family Welfare, Rural Development, Urban Development, Youth Affairs & Sports, Railways, Science & Technology, Statistics & Programme Implementation, Labour, Panchayati Raj and Departments of Elementary Education & Literacy, Secondary & Higher Education, Road Transport & Highways, Public Enterprises, Revenue, Women & Child Development, Information Technology and Personnel & Training will setup necessary mechanism for implementation of the policy. A five-year perspective Plan and annual plans setting targets and financial allocations will be prepared by each Ministry/ Department. The annual report of these Ministries/ Departments will indicate progress achieved during the year. This will enable monitoring by the designated authority.
  6. Role of Block Development Offices, Panchayat Raj Institutions and Tribal Councils/Gram Sabhas

    Block Development offices would appoint nodal officers to serve as a one point contact for senior citizens to ease access to pensions and handle documentation and physical presence requirements, especially by the elderly women.
    Panchayat Raj Institutions would be directed to implement the NPSC 2011 and address local issues and needs of the ageing population.
    In rural/ tribal areas, the tribal council or gram sabha or the relevant Panchayat Raj institution would be responsible for implementation of the policy.
    The provisions of the 13thFinance Commission for special funding to them would be made applicable. 

Elderly popuplation in India

What are the main features of elderly population of India?
Ans. The profile of the elderly population indicates that:
  • a majority of them are in rural areas;
  • feminization of the elderly population; and
  • increase in the number of Oldest-old persons above 80 years and 
  • a large percentage (30%) of the elderly are below the poverty line.
What is the share of the older persons in the total population of the Country?
  • Currently in 2011 the share is 8.30 %, which is likely to be 12.40% in 2026.
The Maintenance and Welfare of Parents and Senior Citizens Act 2007
What are the important features of the Maintenance and Welfare of Parents and Senior Citizens Act 2007?
  • providing need-based maintenance to the parents/grand parents from their children.
  • Tribunals will be set up for the purpose of settling the maintenance claims of the parents in a time bound manner.
  • Lawyers are barred from participating in the proceedings of the Tribunals at any stage.
  • provisions like protection of life and property of senior citizens, better medical facilities, setting up of old age homes in every district, etc.
  • The Act extends to the whole of India except the State of Jammu and Kashmir and it applies also to the citizens of India outside India.
  • The Act defines "children" as son, daughter, grandson and granddaughter who are not minor.
  • The "Maintenance" includes provision for food, clothing, residence and medical attendance and treatment;
  • A "senior citizen" means any person being a citizen of India, who has attained the age of sixty years or above;
Whether a person other than claimant can file application on his/her behalf?

Ans. An application for maintenance may be made by
  • a senior citizen or a parent, as the case may be; or
  • if he is incapable, by any other person or organization authorized by him; or
  • the Tribunal may take cognizance suo motu.
What is the time limit for disposing an application for claiming maintenance?

Ans. An application filed under sub-section (2) for the monthly allowance for the maintenance and expenses for proceeding shall be disposed of within ninety days from the date of the service of notice of the application to such person. However, the Tribunal may extend the said period, once for a maximum period of thirty days in exceptional circumstances for reasons to be recorded in writing.


What is the monitoring mechanism for implementation of the Act by the States?

Ans. The Act has been enacted in pursuance of the provisions of Article 41 read with Entry 23 of the Concurrent List (Schedule VII) of the Constitution of India. State Governments are required to notify the Act and frame Rules for implementing the provisions of the Act.

However, Section 30 of the Act enables the Central Government to give directions to State Governments for carrying into execution of the provisions of the Act. Further, Section 31 of the Act provides for periodic review and monitoring of the progress of implementation of the Act by the State Governments. The Ministry will act in accordance with these provisions to ensure effective implementation of the provisions of the Act by the States.

The State Government are required to constitute for each Subdivision one or more Tribunals as per the need within a period of six months from the date of the commencement of this Act.


What are the provisions about revocation of will?

Ans. As per the provision of Act, a senior citizen can seek to revoke any property, which has been transferred in favour of children/relative on the condition that such children/relative would provide maintenance to him but are not providing the same. The tribunals are empowered to declare such transfers as void on the applications of such parent.


Is any penalty/imprisonment is for the children who abandon their parents?

Ans. Yes, imprisonment for a term of 3 months and a fine upto Rs. 5000/- or both on the children.


What are the provisions for medical care of senior citizens provided in the Act?
Ans. The Act provides that State Government shall ensure that, -
  • the Government hospitals or hospitals funded fully or partially by the Government shall provide beds for all senior citizens as far as possible;
  • separate queues be arranged for senior citizens;
  • facility for treatment of chronic, terminal and degenerative diseases is expanded for senior citizens;
  • research activities for chronic elderly diseases and ageing is expanded;
  • there are earmarked facilities for geriatric patients in every district hospital duly headed by a medical officer with experience in geriatric care.
National Policy on Older Persons (discussed separately)


Grant-in-Aid Schemes


What are the schemes under which financial assistance is provided for welfare of the older persons?


Ans- The Ministry of Social Justice & Empowerment supports programmes for the welfare of the elderly through financial assistance to Non Governmental Organizations under the two schemes detailed below:-
  • Scheme of "Integrated Programme for Older Persons", through which financial assistance up to 90% of the project cost is provided to NGOs for establishing and maintaining old age homes, day care centres, mobile medicare units and to provide non-institutional services to older persons.
  • Scheme of Assistance for construction of old age homes for older persons under which funds are provided for construction of old age homes. The Scheme is presently under formulation.
Which agencies are eligible for obtaining grant-in aid under the Integrated Programme for Older Persons for implementing different projects?
Ans. Under the scheme, assistance is sanctioned to the following agencies subject to terms and conditions laid down by this Ministry:-
  • Panchayati Raj Institutions/Local bodies.
  • Non-Governmental Voluntary Organizations.
  • Institutions or Organizations set up by Government as autonomous/subordinate bodies Government Recognized Educational institutions, Charitable Hospitals/Nursing Homes, and recognized youth organizations such as Nehru Yuvak Kendra Sanghathan.
  • In exceptional case, financial assistance under the Scheme shall also be provided to State Governments/Union Territory administrations.
What are the projects admissible for assistance under the Integrated Programme for Older Persons?
Ans. 
  • Maintenance of Old Age homes.
  • Running of Multi Service Centres for Older Persons
  • Maintenance of Mobile Medicare Units.
  • Running of Day Care Centres for Alzheimer's Disease/Dementia Patients
  • Physiotherapy clinics for older persons
  • Disability and hearing aids for older persons
  • Mental health care and Specialized care for the Older Persons
  • Help-lines and Counselling Centres for older persons
  • Sensitising programmes for children particularly in Schools and Colleges
  • Regional Resource and Training Centres
  • Awareness Generation Programmes for Older Persons and Care Givers.
  • Formation of Vridha Sanghas/Senior Citizen Associations.
Any other activity, which is considered suitable to meet the objective of the scheme.

Whether the government is revising the schemes for welfare of the older persons?

Ans. Yes. The Ministry has revised the 'Integrated Programme for Older Persons' by enhancing the quantum of assistance in line with the increase in CPI. Further, several new components like Helplines, Physiotherapy centres, mental healthcare facilities, etc. The revised Scheme comes into effect from 1.4.2008.

In addition, the Ministry is also in the process of converting its non-plan scheme of assistance for construction of old age homes into a plan scheme.

Schemes of Other Ministries

The Ministry of Health and Family Welfare provides the following facilities for senior citizens:
i. Separate queues for older persons in government hospitals
ii. Geriatric clinics in several government hospitals

The Ministry of Rural Development
 Indira Gandhi National Old Age Pension Scheme (IGNOAPS) under which Central assistance @ Rs. 200 per month is provided as old age pension to persons above 65 years who belong to a household below the poverty line. This in turn is meant to be supplemented by at least an equivalent contribution by the states, so that each beneficiary gets at least Rs. 400/- per month as pension. During 2008-09, about 155 lakh persons got the benefit of old age pension.

Annapurna scheme: 
  • Senior citizen eligible for pension under NOAPS but are not getting the pension are covered under this scheme
  • 10 kg of foodgrain per person free of cost is supplied.

The Ministry of Railways provides the following facilities to senior citizens:
i. Separate ticket counters for senior citizens at various Passenger Reservation System (PRS) centres, if the average demand per shift is more than 120 tickets
ii. 25 per cent and 50 per cent concession in rail fare for male and female senior citizens respectively

The Ministry of Finance provides income tax benefits to senior citizens 65 years of age and above:
i. Income tax exemption for income up to certain higher limits than regular limit.
ii. Deduction of Rs 20,000 for medical insurance premium under Section 80D
iii. Deduction of the amount incurred or Rs 60,000, whichever is less, for medical treatment (specified
diseases in Rule 11DD of the Income Tax Rules) under Section DDB

Ministry of Civil Aviation provides concession up to 50 per cent for male senior citizens aged 65 years
and above, and female senior citizens aged 63 years and above in air fares on the national carrier, Air
India.

The Ministry of Social Justice and Empowerment organises the International Day of Older Persons every
year on 1st October to increase awareness about ageing.