Let’s say the hospital you usually visit were to charge you an annual fee of Rs 5,000 instead of charging for each consultation. Better still, you would be connected to a registered physician in your neighbourhood, who can provide routine treatment, and get health insurance for your entire family for no extra charge.
Won’t this make life simpler? This is Padma Bhushan awardee Dr R.D. Lele’s vision for the health of Mumbai’s residents. The 82-year-old doctor wants the city’s major hospitals to go beyond curing diseases and become ‘Health Maintenance Organisations’ (HMOs) that provide pre-paid care linked to health insurance.
Dr Lele sent letters, outlining the proposal, to the BMC health authorities and deans of JJ, KEM, Nair and Sion Hospitals on February 18. He is still waiting for replies. Dr Sanjay Oak, director of BMC's major hospitals, said they would consider Dr Lele’s proposal.
“The HMOs should tie-up with family physicians, who can provide preventive and curative treatment to patients for minor ailments, and insurance companies so they can be covered for major illnesses,” Dr Lele said.
Dr Lele’s proposal says patients would be required to pay a fixed amount at the beginning of each year as per their household income. (see box) Each family physician should be put in charge of 1,000 families. He/she should be paid Rs 1 lakh per month from the fund, which is accumulated by subscriptions.
“Only two per cent of the population has insurance cover and each insurance buyer is making claims. This is not viable for insurance companies so they keep hiking premiums and excluding people. But if the people take insurance and family physicians are providing preventive care, the number of hospitalisations and claims will reduce,” he said.