Transcript Year Share capital Reserve Funds

ROLE OF HEALTH CARE
COOPERATIVES IN
KERALA IN EXTENDING
HEALTH CARE
SERVICES
Introduction
*Health
is regarded as a vital component in
the growth and development of any
country.
*Healthy children are said to have better
school attendance and learning, which later
translates into better earning capacity.
*Poverty caused by poor health further
reinforces ill health, poverty leads to low
food intake, nutritional deficiencies,
deprivation of basic amenities like
sanitation and clean drinking water cause
infections.
*The United Nation Organization, Government of
India and the concerned State Government in
India taking into consideration the above
situation have initiated and implemented
various schemes to extend adequate health care
facilities.
*In this connection, a cooperative as a third
sector plays vital in providing health care
services.
*An attempt in analyze the role played by the
health care cooperatives in rendering health
care services to the poor in general and the
members of the cooperatives in particular.
Percent Public Health Expenditure
Country/Region
Public Expenditure on Health as Percent of Total
Health Expenditure
India
29.20
Average of High Income Countries
65.10
Average of Low Income Countries
38.78
Average of Middle Income
Countries
52.04
World
62.76
Source: World Bank Database (http://data.worldbank.org/)
Health Care Cooperatives in
Kerala
*The first cooperative hospital known as
Surekha Hospital was formed in
Bombay.
*In Kerala the first cooperative hospital
that came into operation from 1969 in
Thrissur District.
*Kerala has often been singled out as a
paradox in having achieved ‘good
health at lower cost.
*The
State is reported to have the
lowest rural-urban inequalities in public
health status.
*India’s first ever Human Development
Report published in 2002, placed, Kerala
on the top of all the other States in
India, because of easy accessibility and
coverage of medical care facilities.
*Kerala has better health indicators such
as Death Rate, Infant Mortality (IMR)
and expectation of Life of Birth than
most States in India.
Present State of Health Care in
Kerala
*
*
*
The health infrastructure of the State
consists of 2699 institution with 50622
beds. Besides there are 5403 sub center.
Out of the total institutions 46.87 per
cent are under Allopathy, 32.01 per cent
under Ayurveda and 21.12 per cent under
Homoeopathy department.
There are 65 Hospitals with 6297 beds
under the cooperative sector in the State.
*
*
*
Kerala
State
Homoeopathic
Cooperative
Pharmacy
(HOMCO)
Alappuzha, a medicine manufacturing
unit is also functioning under the
Directorate of Homeopathy.
It is estimated that there are about 1.5
million diabetic patients in Kerala.
These
people
need
life
time
management
involving
lifestyle
modifications, drug and diet.
It is observed that one out of three
adults in Kerala is a hypertensive. Hyper
tension leads to heart attacks, stroke
and kidney failure.
* contd.
*
*
Cancer is the major disease that
affects all sections of human
population. Every year 35000 new
cases of Cancer are detected in
Kerala.
The Kerala State Control Society
plays an important role in the
prevention of HIV/AIDS. It is also
considered as one of the important
millennium development goals.
*
*
The
alcohol
consumption
is
increasing in the state. Excessive
drinks can cause a variety of
health problems. More than 72 per
cent of the accidents on the
national highways were related to
driving after taking drinks.
More than 11 per cent of the
population are aged above 65.
Role of Health Care Cooperatives in
Extending Health Care Facilities
*
There are four types of health care cooperative in
Kerala.

The first type of cooperatives is exclusively
registered as cooperative hospital by the
professionals (Doctors, Nurses
and others).
The second type of Cooperative hospital is registered
by professionals and other individuals.
The third type of cooperative hospital is floated by
any cooperative organization to fulfill their
objective.
The fourth and last type of health care cooperatives
is registered under Charitable Societies Act to
provide health care services to the members of the
holding organization.



*The most striking weakness of our public
health system has been its failure to
reach the bottom of the pyramid. The
case of SCs and STs, and OBCs, which
account for 70 per cent of the total
population, is no different.
*The
first challenge that was mounted
against the public system came in the
form of the Rajiv Gandhi Swasthya Bima
Yojana (RSBY) and similar insurance
schemes in many states.
*
*
*
contd
Schemes provided an insurance cover for Rs
30,000 for BPL families. The catch was that
institutions accredited as part of these
schemes were largely private hospitals.
In Chattisgarh the state health department
has initiated action against 22 nursing homes
against which it found prima facie evidence
of surgeries being done without legitimate
medical reasons. It is estimated that over the
last eight months, hospitals and nursing
homes have claimed Rs two crore under RSBY
scheme for removing the wombs of 1,800
women (Hindustan Times, August 14, 2012).
*
*
*
contd.
Private
organization
use
to
keep
tacit
understanding between doctors and pharmaceutical
companies and exploit the patient by prescribing
more medicine, diagnostic test etc. Since, the
health care cooperatives are providing services to
its own members (owners) the possibilities of
exploitation is limited.
Private health service agencies prefer to operate in
urban areas to make use of all common
infrastructural facilities and to make a good return
on investment. Health care cooperatives use to
operate where the members are not accessible to
health care services at an affordable cost. They
generally operate in rural areas. Hence, health care
cooperative plays a vital role in replacing the rural
and urban divide.
*
Contd.
*
The Kandala Cooperative Hospital is a holding
organization of Kandala Service Cooperative
Bank. This hospital has introduced a novel
scheme known as ‘Sahakarisanthwanam’ which
provides free treatment facilities to its
members at up to Rs.5, 000.
*
This facility ensures health security to the
member of the society and it will also increase
the
volume of business to the hospital.
‘Bhavansanthwanam’ scheme is an exemplary
example of social commitment of the hospital
which
insists
the
doctors
and
other
professionals to reach out the houses of bedridden members of the cooperative societies for
providing free medical treatment at door step
of the members.
*Many
Contd.
Health care cooperatives are doing the
same services in different names and different
forms. For example the Palakkad District Health
and Family Welfare
Hospital Consumer
Cooperative Society is maintaining a “ Pain and
Palliative Centre” for the old aged people who
are generally not taken care by their own family
members.
*Health care cooperatives ensures the availability
of ambulance services to the members round the
clock at an affordable cost.
*
*
*
*
Contd
It was observed that all the health cooperatives in
Kerala are availing Neethi Medical Store facilities
and provides medicines to all the patients which
are generally 10 to 15 per cent less than the
market price.
Health care cooperative in Kerala are providing
health insurance facilities to its members. The
Government of India and the State Government
has introduced a joint venture insurance scheme
called “Samagra Arogya Insurance scheme (RSVY)”
for the people living below poverty line (BPL).
The health care cooperatives are providing
services to the card holder of this scheme at a
very concessional rate.
* Contd
*
*
E.M.S Cooperative Hospital is an outstanding
example for blending social service and business
objectives. It designed a new scheme for mobilizing
more working capital by enrolling new members and
their share holding are linked to different services
to its members. It paves way to increase the share
capital position.
It also maintains a member’s desk in the front office
to receive all the member patients. Members will
get preferential treatment and charged nominal
rates. The society provides insurance coverage and
treatment to all types of diseases and thereby
ensures socio-economic security.
* Contd
*
The Kaduthuruthi Cooperative Hospital in Kottayam
District in collaboration with Bharat Sevak Samaj (BSS)
is conducting the following courses for the children of
the poor who passed 10th standard.
- First Aid and practical Nursing
- Medical Laboratory Technicians
- X-ray Technicians.
*
The course is exclusively for girls and helps them to get
placed. A few health care cooperatives do enroll
other cooperative institutions as a member of their
health care cooperatives. The members of such
cooperative institutions are entitled to avail a discount
of 10 per cent for all the services provided by the
health care cooperatives
Findings
*
*
*
The number of health care cooperatives and the
number of profit making cooperatives are
is
showing a positive trend. But the proportion of
total profit making societies constitute only 15
per cent.
It is worth mentioning here is that the
membership position of the society is increasing
year after year.
The share capital position of the all the health
care cooperatives are showing a positive growth
and on the same line the reserve fund and other
fund position of the society is also showing
positive trend.
* Contd
*
*
The establishment cost of the health
cooperative societies in Kerala is very high. As
per the rule the establishment cost should not
exceed more than 2.5 per cent of the working
capital. But in case of health care cooperatives
it is ranging from 8.88 per cent to 22.21 per
cent. It is very high and it will affect the
financial health care cooperatives to a greater
extend.
The number and amount of profit earned the
health care cooperatives is decreasing in every
year and on the other hand the number and the
amount of profit earned by the health care
cooperatives is increasing in very year and it is
not an encouraging sign.
*
*
*
*
Contd.
It was observed that the health care
cooperative in Kerala not having adequate
infrastructure facilities.
The patient to nurse ratio system has been
effectively followed in Government hospitals
and it is not effectively followed in health
care cooperatives.
Compulsory rural services for the doctors are
being followed in Government hospital and it
is not made applicable to health care
cooperatives.
* Contd.
*
*
It was observed that the Government
employees availing the services of the health
care cooperatives are not entitled for to
reimburse the cost of medical expenditure
incurred in heath care cooperatives. They are
eligible for reimbursement only if they are
taking treatments in Government hospital.
The small service cooperative banks having
hospital and dispensary cooperatives are
facing difficulties in paying huge salaries to
the Doctors working in the hospital
cooperatives.
Contd
*The
Kerala Nursing Council has prescribed a
standard that each institution interested in
commencing Nursing College should posses
minimum 5 acres of land. But the Indian
Nursing Council has prescribed a limit of 2
acres of land.
*The
health care cooperative willing to
commence Nursing College in Kerala a facing
problem due the condition of 5 acres land
holding.
Suggestions
*
The health care cooperatives in
Kerala are at present classified under
‘Miscellaneous’ category. The health
care cooperatives are providing
unique and special types of services.
Hence, a special type of classification
may be accorded to health care
cooperatives by the Registrar of
Cooperative Societies.
*In
Contd
order to develop tourism in Kerala the banks
and financial institution like Kerala State Finance
Corporation (KSFC) are extending financial
assistance at concessional rate of interest.
Health care is one of the important Millennium
Development Goals.
*Hence, by considering the importance of health
cares the banks and financial institution in
general
and
the
National
Development
Corporation in Particular (NCDC) should render
financial assistance at concessional rate of
interest for the development of health care
cooperatives in India.
* Contd.
*
*
To promote health care cooperatives the following
benefits may be extended to the health care
cooperatives.
- Exemption from payment of income tax,
- Building tax
- Revenue tax
- Water and electricity charges at subsidized
price.
The members having professional qualification as
doctor will be given preference to work in the
cooperative hospital. It will enable the society To
overcome the problem of paying more salary to the
doctors of the health cooperatives, the government
may depute the doctors on deputation basis.
* contd
*The rate subsidy provided for purchases of
Ambulance may be increased. On the same
line subsidy may provided for purchase of
equipments and machinery for hospital
cooperatives.
*The rate subsidy provided for purchases of
Ambulance may be increased. On the same
line subsidy may provided for purchase of
equipments and machinery for hospital
cooperatives.
*
*
*
* Contd.
There is no separate budget allocation for health
care cooperative in Kerala. Hence, provisions
may be made to make separate budget
allocation for health care cooperatives.
Steps may be taken by the health care
cooperatives to reduce their establishment cost
and borrowing. If not, it will affect the financial
health of the health care cooperatives to a
greater extend. Further, it will affect the quality
of services rendered by the societies.
The won fund position of the society has to be
improved and in order to improve the won fund
position the health care cooperatives should
strength their share capital and reserve base.
*The
Conclusion
world is marching towards for achieving
the millennium development goal and one of
the main millennium development goals is
providing health care facilities for all.
*The health care cooperatives in Kerala are
joining hand with United Nations in achieving
objectives of providing health care services
for all.
*India is having very good cooperative net
work and 100 percent villages are covered by
cooperatives. But still there are some areas
where the cooperatives have not made a
remarkable achievements is health care
cooperatives and the state of Kerala is an
exception to this.
* contd
*The
study observed that the other cooperatives are
getting more assistance from Government and other
organization. But the health care cooperatives are
emerging as a vital and essential sector without much
patronage from Government.
*It is also rendering quality services on par with other
public and private hospitals. The health care
cooperatives are having very good opportunities and
scope for further development. Hence, the problems
faced by the health care cooperatives need to be
addressed on priority basis.
*The cooperative health sector needs to be improved
considerably in terms of availability and quality of
infrastructure, human resources and services so as to
meet the growing demand.
* Number of Societies and Membership
Year
No. of
societies
Growth rate
2005-06
174
-
1,30,694
-
2006-07
177
(1.72)
180
(1.69)
1.72
1,32,251
1.19
1.69
1,26,901
(-) 4.04
182
(1.11)
184
(1.09)
1.11
1,62,445
28.00
1.09
1,69,334
4.24
2007-08
2008-09
2009-10
Membership Growth rate
* Share Capital, Reserve Fund and Owned funds
(Rs. in lakhs)
Year
Share capital
Reserve Funds/
other funds
Owned funds
2005-06
5881.16
9666.06
15547.22
2006-07
7344.96
(24.88)
10891.80
(12.68)
18236.76
(17.92)
2007-08
5311.53
(22.68)
2401.17
(77.96)
7712.70
((-) 57.70)
2008-09
5941.24
(11.85)
3926.80
(63.53)
9868.04
(27.94)
2009-10
9897.00
(66.58)
5217.50
(32.86)
15114.50
(53.16)
(Figures in parenthesis refer to growth rate in percentage)
* Working Result
(Rs. in lakhs)
Year
No. of
societies in
profit
Amount
Average
profit
No.
societies
in loss
Amount
Average
loss
2005-06
23
163.03
7.08
85
1482.26
17.43
2006-07
20
146.03
7.30
67
22150.76
330.60
2007-08
20
107.52
5.38
76
26563.58
349.52
2008-09
28
195.22
6.97
67
28276.09
422.03
2009-10
29
505.53
17.43
65
31598.56
486.13
* Working
Capital and Establishment Cost
(Rs. in lakhs)
Year
Working capital
Establishment cost
Ratio of cost to working
capital
2005-06
73160.60
7520.88
10.27
2006-07
72415.11
7582.09
1.04
2007-08
66522.91
5909.13
8.88
2008-09
59170.14
6711.70
11.34
2009-10
52585.61
11682.55
22.21
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