LAW SCHOOL

BANARAS HINDU UNIVERSITY

VARANASI – 221005

CERTIFICATE
This is to certify that Miss Mahima Jaiswal has completed her

Dissertation work on “Health Insurance as Social Security- A study on

service delivery of Employees State Insurance Corporation in Uttar

Pradesh” in partial requirement for the PG Diploma in HRM, Services

and Industrial Law, (part time) degree of 2017 of the

BANARAS HINDU UNIVERSITY.

The candidate has worked under my supervision

Dated:

(Mr. Anil Kumar Maurya)

Assistant Professor
Banaras Hindu University
Varanasi- 221005
 ACKNOWLEDGEMENT

It is a genuine pleasure to express my deep sense of Thanks and Gratitude to

my mentor and guide MR. ANIL KUMAR MAURYA, Assistant Professor,
Faculty Of Law, BHU. His dedication and keen interest & above all his over-
whelming attitude to help his students had been solely and mainly responsible
for completing my work. His timely advice, meticulous scrutiny, and scholarly
advice have helped me to a very great extent to accomplish this task.
I thank profusely all the staff of Faculty of Law, BHU for their kind help and
co-operation throughout my study period.
It is my privilege to thank my Family and Friends for their constant help and
encouragements throughout time I prepared this Dissertation.

Mahima Jaiswal
Table Of Content

CERTIFICATE
ACKNOWLEDGEMENT
TABLE OF CONTENTS

Chapter 1
INTRODUCTION
a)Meaning of Insurance

Chapter 2
EMPLOYEES STATE INSURANCE SCHEME
a) Infrastructure

Chapter 3
EMPLOYEES STATE INSURANCE SCHEME IN UTTAR PRADESH
a)Facilities
b)Benefits
i) Medical Benefit
ii) Sickness Benefit
iii)Maternity Benefit
iv)Disablement Benefit
v)Dependents Benefits
vi)Other Benefits

Chapter 4
FAMILY WELFARE PROGRAM

Chapter 5
EMPLOYEES STATE INSURANCE CORPORATION
a) ESIC : 2
b) Project Panchdeep

Chapter 6
EMPLOYEES STATE INSURANCE BENEFITS
a) Special features of ESIC Uttar Pradesh

Chapter 7
PROBLEM STATEMENT

Chapter 8
REVIEWS

Chapter 9
OBJECTIVES

Chapter 10
HYPOTHESIS

Chapter 11
ANALYSIS
a) Level of Satisfaction
b)Bed occupancy
c) Availability of Beds
d) Shortage of Beds

Chapter 12
SUGGESTIONS

CONCLUSION
BIBLIOGRAPHY
HEALTH INSURANCE AS SOCIAL SECURITY-A STUDY ON
SERVICE DELIVERY OF EMPLOYEES’ STATE INSURANCE
CORPORATION IN UTTAR PRADESH

1.INTRODUCTION:

Social Security has now become a fact of life for millions of people

throughout the world. It is a major aspect of public policy and extent of

its prevalence is a measure of the progress made by a country towards

the ideal of a welfare state. The International Labour Organization 1

(1942) defines social security as “the security that the society furnishes,

through appropriate organizations, against certain risks to which its

members are exposed. These risks are essentially contingencies against

which the individual of small means and meagre resources cannot effec-

tively provide by his own ability .These risks being sickness, maternity,

invalidity, old age and death. It is the characteristics of these contingen-

cies that they imperil the ability of the working man to support himself

and his dependents in health and decency.”

After the independence of India, the health care system has been ex-

panded and modernized to some extent, with the availability of modern

health care facilities and better training of medical personnel (Ellis, et al,

2000). At the same time, one of the arguments is that the health care

sector in India still mainly focused in urban areas only, even though

1
The International Labour Organization, Approaches to Social Security, 1942, pg 1.
majority of the people are living in rural areas.

The Indian health insurance scenario is a mix of mandatory Social

health Insurance (SHI), Voluntary Private Health Insurance and Com-

munity-Based Health Insurance (CBHI). The existing mandatory health

insurance scheme in India for Organized Sector is – Employees’ State in-

surance Scheme (ESIS) and Central Government Health Scheme (CGHS).

The Employees’ State Insurance (ESI) Scheme is more relevant because

this was the first social insurance measures introduced in India and is

executed and administered through Employees State Insurance Corpora-

tion (ESIC). ESI Scheme of India is a major multi-dimensional social in-

surance program that has over the last seven decades emerged with its

phenomenal growth in terms of geographical reach, demographic cover-

age, multi-faceted services and an infrastructure that has no parallel.

Despite all the endeavors made by the Corporation for the effective func-

tioning of the ESI Scheme in the country, public discernment of the Cor-

poration has not been very positive. The insured persons often allege

that the Corporation has not given any regard for the quality of services

and benefits provided to the beneficiaries and their dependents. Besides

the working mechanism of the corporation is also and always questioned.

The paradox is that around 73 percentages of the rural people getting 20

percentages of the health care facilities, but around 27 percentages of the

urban people getting remaining 80 percentages of the facilities. And in-

frastructure, human resources, quality inequities in availability, utiliza-

tion and affordability of health care is always a matter of concern.

There is a feeling among public that government health facilities are not

functioning well and of poor quality. Majority of people when they are
ill seek care from private sector rather than public providers for out-

patient care.

So in this context quality, availability and affordability of health care is

very important. “In the case any form of health insurance coverage in

India, percentage of persons having covered under any kind of Health

Insurance Scheme is 14.1% in rural areas while 18.1% in urban areas”

[Health Minister J.P. Nadda {Economic Times}].

In India where majority of the curative health care spending is met from

households only. Some studies revealed that around 69% of health spend-

ing is financed by out-of-pocket expenses. Consequences of the liberaliza-

tion and privatization of health care system, the health care expenses

also increased since 1994–95, health expenditures have grown at 14% and

this growth is higher for in-patient care (Govt. of India, 2005). These

financial burdens arise because the consumers are either not insured or

are insured inadequately for their health care expenses. Health

Insurance in India is not much familiar among the people, so its

coverage also not that satisfactory. But some evidences show that

gradually health insurance coverage is increasing. It may be because of

the high health care cost, entering of the private players in insurance

field, government universal health insurance policy, and intervention of

Community based health insurance schemes.

Health insurance, as we know it today, was introduced only in 1912

when the first Insurance Act was passed (Devadasan, 2004). The current

version of the Insurance Act was introduced in 1938. Since then there

was little change till 1972 when the insurance industry was nationalized

and 107 private insurance companies were brought under the umbrella

of the General Insurance Corporation (GIC). Private and foreign

entrepreneurs were allowed to enter the market with the enactment of

the Insurance Regulatory and Development Act (IRDA) in 1999 (Rao,

2004). Aftermath of the new economic policies (liberalization and

globalization), some of the major national and international private

insurance companies entered the insurance industry. But only few com-

panies are working in the field of health insurance and most of them are

working in the life insurance sector only. May be the main reasons

behind the less coverage of health insurance in India are lack of aware-

ness of health insurance among the people and the high cost of the pri-

vate health insurance premium which majority of the people couldn’t af-

ford. Before the IRDA Act, government insurance companies like LIC

and GIC were major players in the health insurance sector. The

‘Mediclaim Policy’ in 1986 from GIC is the first intervention of the health

Insurance program in India. India’s population, mainly consisting of

middle and low-income groups, necessitate the provision of social securi-

ty, although their capacities to pay insurance premiums are very low.

The Indian health insurance scenario is a mix of mandatory Social

health Insurance (SHI), Voluntary Private Health Insurance and Com-

munity-Based Health Insurance (CBHI). The Social Health Insurance

(SHI) is based on income-determined contributions from mandatory

memberships. The existing mandatory health insurance scheme in India

for Organized Sector is – Employees’ State insurance Scheme (ESIS) and

Central Government Health Scheme (CGHS). The Employees’ State In-

surance (ESI) Scheme is more relevant because this was the first social

insurance measures introduced in India.

a)Meaning of Insurance

Risk-transfer mechanism that ensures full or partial financial compensa-

tion for the loss or damage caused by event(s) beyond the control of the

insured party. Under an insurance contract, a party (the insurer) in-

demnifies the other party (the insured) against a specified amount of

loss, occurring from specified eventualities within a specified period,

provided a fee called premium is paid. In general insurance, compensa-

tion is normally proportionate to the loss incurred, whereas in life in-

surance usually a fixed sum is paid. Some types of insurance (such as

product liability insurance) are an essential component of risk manage-

ment, and are mandatory in several countries.

 2. EMPLOYEES’ STATE INSURANCE (ESI) SCHEME:

The ESI Act of 1948 was the first social insurance measures introduced in

India encompasses certain health related eventualities that the workers

are generally exposed to, such as sickness, maternity, temporary or per-

manent disablement, occupational disease or death due to employment

injury, resulting in loss of wages or earning capacity-total or partial.

The ESI scheme was inaugurated in Kanpur on 24th February 1952 (ESIC

Day) by then Prime Minister Pandit Jawahar Lal Nehru. The venue was

the Brijender Swarup Park, Kanpur and Panditji addressed a 70,000

strong gathering in Hindi in the presence of Pt. Gobind Ballabh Pant,

Chief Minister Uttar Pradesh, Babu Jagjivan Ram, Union Labour Minis-

ter, Raj Kumari Amrit Kaur, Union Health Minister, Sh.Chandrabhan

Gupt, Union Food Minister and Dr. C.L. Katial , the first Director

General of ESIC.

ESIC scheme was simultaneously launched at Delhi as well and the ini-

tial coverage for both the centers was 1,20,000 employees. Our first

Prime Minister was the first honorary insured person of the Scheme.

The promulgation of Employees' State Insurance Act, 1948 (ESI Act), by

the Parliament was the first major legislation on social Security for

workers in independent India. It was a time when the industry was still

in a nascent stage and the country was heavily dependent on an assort-

ment of imported goods from the developed or fast developing countries.

The provisions made in the Act to counterbalance or negate the resulting

physical or financial distress in such contingencies are, thus, aimed at

upholding human dignity in times of crisis through protection from

deprivation, destitution and social degradation while enabling the socie-

ty the retention and continuity of a socially useful and productive man-

power. The ESI Act applies to Non-seasonal factories using power and

employing ten or more persons and Non-seasonal and non-power using

factories and establishments employing twenty or more persons. The

Employees' State Insurance Scheme is an integrated measure of Social

Insurance embodied in the Employees' State Insurance Act and it is de-

signed to accomplish the task of protecting 'employees' as defined in the

Employees' State Insurance Act, 1948 against the impact of incidences of

sickness, maternity, disablement and death due to employment injury

and to provide medical care to insured persons and their families. The

ESI Scheme applies to factories and other establishment's viz. Road

Transport, Hotels, Restaurants, Cinemas, Newspaper, Shops, and Educa-

tional/Medical Institutions wherein 10 or more persons are employed.

However, in some States threshold limit for coverage of establishments is

still 20. Employees of the aforesaid categories of factories and establish-

ments, drawing wages upto Rs.15,000/- a month, are entitled to social se-

curity cover under the ESI Act. ESI Corporation has also decided to en-

hance wage ceiling for coverage of employees under the ESI Act from

Rs.15,000/- to Rs.21,000/-.

ESI Corporation has extended the benefits of the ESI Scheme to the

workers deployed on the construction sites located in the implemented

areas under ESI Scheme w.e.f. 1st August, 2015.

The ESI Scheme is financed by contributions from employers and em-

ployees. The rate of contribution by employer is 4.75% of the wages paya-

ble to employees. The employees' contribution is at the rate of 1.75% of the

wages payable to an employee. Employees, earning less than Rs. 137/- a

day as daily wages, are exempted from payment of their share of

contribution.

In the beginning, the ESI Scheme was implemented at just two industrial

centers in the country in 1952, namely Kanpur and Delhi. There was no

looking back since then in terms of its geographic reach and demograph-

ic coverage. Keeping pace with the process of industrialization, the

Scheme today, stands implemented at over 843 centers in 33 States and

Union Territories. The Act now applies to over 7.83 lakhs factories and

establishments across the country, benefiting about 2.13 crores IP/ family

units. As of now, the total beneficiary stands at over 8.28 crores.

a) Infrastructure

Ever since its inception in 1952, the infrastructural network of the

Scheme has kept expanding to meet the social security requirements of

an ever increasing worker population. ESI Corporation has so far set up

151 hospital and 42 hospital annexes for inpatient services. Primary and

out-patient medical services are provided through a network of about

1450/188 ESI dispensaries/AYUSH units, and 954 panel clinics.

The Corporation has also set up five Occupational Disease Centers, one

each at Mumbai (Maharashtra), New Delhi, Kolkata (W.B.), Chennai

(T.N.) and Indore (M.P.) for early detection and treatment of occupa-

tional diseases prevalent amongst workers employed in hazardous indus-

tries.

For payment of Cash Benefits, the Corporation operates through a

network of over 628/185 Branch Offices/Pay Offices, whose functioning is

supervised by 62 Regional/Sub-Regional and Divisional offices.

ESIC has set up a Sub-Committee of ESIC for working out the modalities

for setting up of a new structure at the State level in the form of a sub-

sidiary Corporation in which State Govt. and Central Govt. as well as

Employees’ and Employers’ Organizations would be duly represented.

ESIC has decided to upgrade and take over ESIS Hospital, Pandu Nagar,

Kanpur (U.P.). The Dental College building/Para-Medical College build-

ing will be converted into Super Specialty Hospital at Pandu Nagar,

Kanpur. The Corporation has also approved the norms and standard for

some ESI Dispensaries being converted into 6 and 30 bedded hospitals.

Up-gradation of ESIC Dispensaries/Hospitals (held on 01.12.2016 at Par-

liament House Annexe, New Delhi) as provided in below in the pdf.

6efaf0fb0d6ca3b92007cb1c6a343551.pdf
 3. Employees State Insurance Scheme In

Uttar Pradesh

The social security program Employees State Insurance Scheme under

the Employees' State Insurance Act, 1948, was launched by the then

Prime Minister Pandit Jawaharlal Nehru on 24th February1952 from

Kanpur city. This scheme is applicable to workers of those power and

non-power run establishments having at least 10 workers in their facto-

ries and to the employees whose monthly salary is maximum Rs. 15,000/-

under this scheme an employee state insurance contribution of 1.75 per

cent from the salary of workers covered by the scheme and 4.75 per cent

of salary of workers covered by employer per month is deposited in the

account of Employees State Insurance Corporation Government of India.

Currently 13,57,146 insured persons are associated with this scheme, and

their families are being provided with medical facilities through15 Em-

ployees State Insurance Hospitals and 94 Allopathic hospitals, 11 Ayur-

veda and 11 Homeopathic clinics set up across various regions of the

state.

E.S.I. Corporation has introduced Identity Cards with family photo-

graphs of Insured Persons for smooth administration of Medical Benefits

in the E.S.I. Dispensaries and Hospitals. To compensate the erosion in

monetary value of Permanent Disablement Benefit & Dependents’

Benefit, periodical enhancement is granted in terms of percentage of

original daily rate. Cash Benefit is paid at the Branch Offices in

Cash/Money Order/ Cheque at the option of the Insured

Persons/beneficiaries. The Money Order commission is borne by the E.S.I.

Corporation. However, cash Benefit exceeding Rs.3,000.00 is paid

through account payee Cheque/demand draft or by money-order only.

The family members not residing with the Insured Person at the work

place are entitled to receive medical benefit if they reside in implement-

ed area in the State and separate family Identity Card is issued exclu-

sively for family members.

a) Facilities

 Facilities being made available by Employees State Insurance Hos-

pitals / Dispensaries through State Government under medical

benefits are:

1. 24 hour emergency services in hospitals.

2. Outdoor patient treatment facility in Hospitals / dispensaries.

3. Specific medical consultation

4.X-ray and Pathology test facility.

5.Facility of vaccination against lethal diseases.

6.Ambulance facility

7.Indoor patient facilities

8.Supply of medicines, wound dressing and artificial organs.

9.Pre-Delivery and Post-Delivery care.

10. Certification of medical leave in case of disease.

11. Instant reimbursement from constituted revolving fund for the

quick payment of funds for treatment highly specialized diseases.

12. Under the AIDS control program arrangement of

test/counseling by four STD clinics.

13. Cashless treatment facility to the insured/dependents through

tie-up private hospitals.

b) Benefits

Employees covered under the scheme and their deceased depend-

ents are entitled to get the benefit of medical treatment. In case of

wage or earning capability loss due to some specific disasters they

are also entitled to get cash benefits. An insured woman is entitled

to get maternity benefit in case of delivery. If the insured person

dies due to injury during employment or due to a disease arising

because of workplace then his/her dependents shall be entitled to

pension benefit. Out of these benefits the responsibility to provide

medical benefits rests with the state government which the state

government provides to beneficiaries through various Employees

State Insurance Hospitals and Dispensaries run under its control.

Remaining five benefits are made available in the form of cash

through the local offices of Employees State Insurance Corporation.

During the year under report, ESIC has disbursed `703.98 crores as

benefits in cash. The number of Cash Benefit payments has gone

upto 31.6 lakhs.

Six main benefits provided under the Employees State Insurance

Act are given below :

i) Medical Benefit

Liability to provide medical benefits rests with the state government.

After joining with the insurable employment the insured and his/her de-

pendents get entitled to get the benefit of medical benefit. Primary, out-

door, indoor and expert services are made available through Employees

State Insurance Hospitals/dispensaries and panel clinics while the super

speciality services are made available eminent medical institutions of

the country on referral basis. These services are made available in the

hospitals and dispensaries on immediate basis.

Eligibility Conditions

1. Full medical facilities for self and family from day one of entering

insurable employment.

Duration and Scale of Benefit

1. Full medical care till disease or disablement lasts.

2. No ceiling on expenditure.

3.Retired insured person who have been in insurable employment for at-

least five years before retirement on superannuation or under VRS or

premature retirement and Disabled Insured Persons are entitled to full

medical care for self and spouse only on payment of Rs.120/- as annual

contribution

ii) Sickness Benefit

Sickness Benefit or Disease Benefit is made available in the form of cash

by Employees State Insurance Corporation. Disease benefit is payable to

the insured person in case of diseased condition in cash. Provided that he

had been absent from the work and his absence had been certified by the

Authorized Insurance Medical Officer / Practitioner. Payment of this

benefit is made within 7 days of disease certification at standard benefit

rates and the rate of this benefit is not less than 50 per cent of daily

wage.

Benefits and Eligibility Conditions

Sickness benefits can categorized into following ways :

a) Sickness Benefit

Payment of contribution for 78 days in corresponding contribution

period of six months.

b) Enhanced Sickness Benefit

Payment of contribution for 78 days in corresponding contribution

period of six months.

c) Extended

For 34 specified long term diseases continuous insurable employment

for 2 years with 156 days contribution in 4 consecutive contribution

periods.

Duration & Scale Of Benefits

1. Upto 91 days in two consecutive benefit periods at 70% of the average

daily wages for 91 days in a year

2. 14 days for Tubectomy & 7 days for Vasectomy, extendable 0n medical

advice. Rate of payment 100% of the average daily wages.

3. 124 days which may be extended upto 2 years on medical advice dur-

ing a period of 2 years in insurable employment.

4. Rate 80% of the average daily wages approximately.

iii) Maternity Benefit

Maternity benefit is payable to insured women in case delivery or abor-

tion or associated complications and is paid by the Employees State In-

surance Corporation within 14 days of submitting the certified claim

documents.

The Ministry of Labour and Employment vide notification dated

20.01.2017 in exercise of the powers conferred by Section 95 of the Em-

ployees’ State Insurance Act, 1948, after consultation with the Employ-

ees’ State Insurance Corporation has amended the Employees’ State In-

surance (Central) Rules, 1950. The rules termed as the Employees’ State

Insurance (Central) Amendment Rules, 2017 have inserted in rule 2, after

clause (6), clause 6A which extended the concept of ‘insured woman’ and

inserts a separate category. An ‘insured woman’ would mean a woman

who is or was an employee in respect of whom contribution is or were

payable under the Act and who is by reason thereof, entitled to any of

the benefits provided under the Act. An ‘insured women’ shall include a

commissioning mother who as biological mother wishes to have a child

and prefers to get embryo implanted in any other woman as well as a

woman who legally adopts a child of up to three months of age. In what

may be called a welcome and progressive step, the Government has ex-

tended the benefit provided under the Act to women and has recognized

surrogating, surrogated and adopting women.

Further, in rule 56, in sub-rule (2),for the words “ twelve weeks of which

not more than six weeks”, the words “twenty-six weeks of which not

more than eight weeks” have been substituted and after the first proviso,

two fresh provisos have been inserted holding that the insured woman

shall be entitled to twelve weeks of maternity benefit from the date the

child is handed over to the commissioning mother after birth or adopting

mother, as the case may be and that the insured woman having two or

more than two surviving children shall be entitled to receive maternity

benefits during a period of twelve weeks of which not more than six

weeks shall precede the expected date of confinement.

Eligibility Conditions

1. Payment of contribution of 70 days in two preceding contributions

periods.

Duration & Scale Of Benefits

1. Upto 12 weeks in case of normal delivery.

2. Up to 6 weeks in case of mis-carriage.

3. Extendable up to 4 weeks on medical advice.

4. Rate: Almost 100% of the average daily wages.

iv) Disablement Benefit

Handicap benefit is payable to insured person who has become physical-

ly handicapped due to employment injury or workplace disease.

Provided that the insured should be an employee on the date when

accident occurred. This benefit is payable within one month of submis-

sion of benefit claim documents.

Benefits and Eligibility Conditions

There are following types of Disablement:

a) Temporary Disablement

From day one of entering insurable employment and Disable-

ment Benefit irrespective of having paid by contribution for disablement

due to employment injury.

b) Permanent Disablement Benefits

From day one of entering insurable employment and Disable-

ment Benefit irrespective of having paid by contribution for disablement

due to employment injury.

Duration & Scale Of Benefits

1. As long as temporary disablement lasts.

2. Rate: About 90% of the average daily wages depending upon loss of

earning capacity.

v)Dependents Benefit

Dependents benefit (family pension), is payable to the dependents of the

deceased insured in such cases where the insured dies of employment in-

jury or occupational disease. This benefit is provided to the dependents

within three months of the death of the insured and after that is paid
regularly on monthly basis.

Eligibility Conditions

From day one of entering insurable employment and irrespective of

having paid any contribution in case of death due to employment injury.

Duration & Scale Of Benefits

1. For life to the widow or until her re-marriage.

2. To dependent children till the age of 25 years.

3. To dependent parents for life.

4. Rate: about 90% of average daily wages approx. shareable in fixed.

vi) Other Benefits

Benefits and Eligibility Conditions

There are seven Different kinds of Benefits to Insured Person and they

are:

a) Funeral Expenses

Funeral expenditure of maximum up to Rs10,000 / - for the funeral

of insured is payable by the local office. From day one of entering insur-

able employment.

b) Confinement

An insured Woman or an I.P. in respect of his wife in case of

Expenses for confinement occurs at a place where necessary medical

facilities under Employees’ State Insurance Scheme are not available.

c) Vocational

In case of physical disablement due to employment injury.

d) Physical

In case of physical disablement due to employment injury.

e) Unemployment Allowance (RGSKY)

In case of involuntarily loss of employment due to non-employment

injury and the contribution in respect of him have been paid/payable for

a minimum of three years prior to the loss of employment.

f) Skill Upgradation Training under (RGSKY)

In case of involuntarily loss of employment due to non-employment

injury and the contribution in respect of him have been paid/payable for

a minimum of three years prior to the loss of employment.

Duration & Scale of Benefits

1) Up to two confinements only.

2) For defraying expenses on the funeral of an insured Person.

3) Rate: Actual fee charged of Rs.123/- a day whichever is higher.

4) As long as a person is admitted in an artificial limb Centre.

5) Rate: 100% of the average daily wages.

6) Maximum twelve months during lifetime.

7) Rate: 50% of the average daily wages.

8) For a short duration-maximum up to six months.

Various services/benefits are provided to the Insured Persons though

one Regional Office functions at Kanpur with 03 Sub-Regional Offices at

Noida, Lucknow, Varanasi and 37 Branch Offices. Presently, medical

services to the Insured Persons and their beneficiaries are provided

through 116 ESI Dispensaries, 15 ESIS Hospitals and 1 Model Hospitals

run directly by ESI Corporation. There are around 54 tie-up Hospitals in

the State of Uttar Pradesh for giving secondary and Super Speciality

Treatment. At present the Scheme is in force in 75 Districts of Uttar

Pradesh. The total number of factories and establishments in

Uttar Pradesh coming under the ambit of ESI Scheme is 49002 and the

number of Insured Persons and Beneficiaries are 14.02 lakhs and 54.4

lakhs respectively.

The Employees’ State Insurance Corporation (ESIC) is likely to expand its

services to over 650 districts nationwide as part of its second generation

reforms. The corporation has decided to take in its fold all construction

workers, ESI Insurance Commissioner Arun Kumar was quoted as say-

ing at a PHDCCI seminar on ESIC.

ESIC is likely to propose charging financial contribution from the em-

ployers of construction workers to give them ESI benefits, which would

be drawn from the various welfare boards in which the construction

companies deposit their construction cess.

He added that the proposal is being discussed at the higher level of bu-

reaucracy within the Labour Ministry.

Elaborating on the issue of second generation reforms in ESIC, Kumar

said ESIC now has its healthcare and hospital facilities around 300 dis-

tricts where workers avail medical and healthcare facilities. These will

be extended to all districts of India and the process will begin in March

2017
 4.Family Welfare Program

There are many facilities provided under Employees’ State Insurance

scheme, but the facilities provided to the insured person and his family

in the name of family welfare program are vital part of the ESI Scheme.

The number of various vaccinations and operations in the accounting

year 2014-2015 in Employees State Insurance Corporation’s (ESIC) vari-

ous Hospitals in the state of Uttar Pradesh are presented below:

Family Welfare Program 2014-2015 (Period : April-2014 to March-2015)

S. No. Method Name Total

1 Male Vasectomy - 37

2 Women Vasectomy 763

3 Copper T 2089

4 M.T.P. 1132

5 Oral Pills 57165

6 Contraception 91551

The Corporation has been undertaking provision of family Welfare Ser-

vices to the beneficiaries of the Scheme. The Corporation has organized

these services in 180 centres besides reserving 330 beds in hospitals for

undertaking tubectomy operations. So far, 828976 sterilization operation

viz. 176197 vasectomies and 652779 tubectomies have been performed up-

to 31.3.1999. The ESI Corporation has also extended additional cash incen-

tive to insured persons to promote acceptance of sterilization method by

providing sickness cash benefit equal to full wage for a period of 7 days

for vasectomy and 14 days for tubectomy. The period for which cash

benefit is admissible is extended beyond the above limits in the event of

any complications after Family Planning operations.

Progressed Vaccination Program (Period : April-2014 to March-2015)

S. No. Method Name Total

1 Polio 14965

2 D.P.T 14955

3 T.T. 13634

4 B.C.G. 2723

5 Measles 3248

6 Vitamin-A / Iron 67243

Source- Employees State Insurance Scheme , Labour Department, Government of Uttar Pradesh

The Corporation has embarked upon a massive programme of immun-

ization of young children of insured persons. Under this programme,

preventive inoculation and vaccines are given against diseases like diph-

theria, pertusis, polio, tetanus, measles, mumps, rubella, tuberculosis etc.

5. EMPLOYEES’ STATE INSURANCE CORPORATION

The promulgation of Employees' State Insurance Act, 1948(ESI Act), by

the Parliament was the first major legislation on social Security for

workers in independent India. It was a time when the industry was

still in a nascent stage and the country was heavily dependent on an

assortment of imported goods from the developed or fast developing

countries. The deployment of manpower in manufacturing processes

was limited to a few select industries such as jute, textile, chemicals etc.

The legislation on creation and development of a fool proof multi-

dimensional Social Security system, when the country's economy was in

a very fledgling state was obviously a remarkable gesture towards the

socio economic amelioration of a workface though limited in number

and geographic distribution. India, notwithstanding, thus, took the lead

in providing organized social protection to the working class through

statutory provisions.

The ESI Act 1948 , encompasses certain health related eventualities

that the workers are generally exposed to; such as sickness, maternity,

temporary or permanent disablement, Occupational disease or death

due to employment injury, resulting in loss of wages or earning capaci-

ty-total or partial. Social security provision made in the Act to coun-

terbalance or negate the resulting physical or financial distress in such

contingencies, are thus, aimed at upholding human dignity in times of

crises through protection from deprivation, destitution and social deg-

radation while enabling the society the retention and continuity of a

socially useful and productive manpower.

The administration of the ESI Scheme as per the ESI Act has been en-

trusted to the Employees’ State Insurance (ESI) Corporation. The ESI

Corporation is a body corporate set up by the Government of India on

24th February 1952, under the provision of the ESI Act, 1948 to adminis-

ter and execute the Scheme of Employees’ State Insurance. The ESI Act

provides various powers to the Corporation for its proper functioning.

The Corporation comprises representatives of employees, employers, the

Central Government, State Governments, medical profession and the

Parliament. At the State level, Regional Boards is to constitute in each

State where the ESI Scheme is implemented and at the grass-root level,

Local Committees to be formed as advisory bodies for smooth function-

ing of the Scheme. The Regional Boards and the Local Committees

should have representation, both from employers and employees. The

main source of fund of the Corporation is the contributions raised from

employees covered under the ESI Scheme and their employers, as a

fixed percentage of wages. The Corporation may accept grants, dona-

tions and gifts from the Central Government or any State Government,

local authority or body whether incorporated or not, for all or any of

the purposes of the ESI Act. It is important to mention here that it blos-

somed as the first social security scheme in 1944, when the Govt. of the

day was still British .The first document on social insurance was "Re-

port on Health Insurance" submitted to the Tripartite Labour Confer-

ence, headed by Prof. B.P.Adarkar , an eminent scholar and visionary.

The Report was acclaimed as a worthy document and forerunner of the

social security scheme in India and Prof. Adarkar was acknowledged

as "Chhota Beveridge" by none other than Sardar Vallabhbhai Patel.

 Sir, William Beveridge, as all know, was one of the high priests of social

insurance. The report was accepted and Prof. Adarkar continued to be

actively associated with it till 1946. On his disassociation he strongly

advocated management of the Scheme by an expert from ILO. In 1948

Dr. C.L.Katial, an eminent Indian doctor from London took over as the

1st Director General of ESIC and he steered the affairs of the fledgling

Scheme till 1953.

Since the red letter day of 24th February in the annals of social security

in India , there has been no looking back. A lighted lamp which is the

logo of ESIC truly symbolizes the spirit of the Scheme, lighting up lives of

innumerable families of workers by replacing despair with hope and

providing help in times of distress, both physical and financial .During

the 65 years of its existence, ESIC has grown from strength to strength

and the Corporation owes it, most of all, to the commitment, dedication

and perseverance of persons like Prof. Adarkar and Dr. Katial.

he Employees’ State Insurance Corporation (ESIC) raised the monthly

wage limit to Rs 21,000, from the existing Rs 15,000, for coverage with

effect from 1st January 2017.

We should all now have knowledge about the figures and numbers

actually existing under Employees State Insurance Corporation, there-

fore in Table 1 various information regarding number of hospitals, em-

ployees, beneficiaries , insured persons, number of employers, inspection

offices, branch offices etc. are presented as on 31st march 2017.

The following table exhibits the ESIC at a glance as on 31-03-2017.

 Table 1: A Glance of ESIC

Items INDIA NORTHERN UTTAR PRADESH

INDIA STATE

ESI Hospitals 151 35 13

ESI Dispensaries 1459 447 116

No. of Centers 843 171 56

No. of Employees 1,89,21,250 1,04,199 59,921

No. of Insured Person 2,13,61,880 1,04,586 85,102

No. of Employers 7,83,786 87,183 46,494

Total Beneficiaries 8,28,84,094 1,29,16,288 51,22,299

Inspection Offices 360 05 04

Branch Offices/Pay 628/185 210 77

Offices

Source- compiled from Annual Report of ESIC, 2015-16

As we can see that there are only 151 ESIC hospitals in all over India ,

whereas only 13 in the state of Uttar Pradesh. It is the most populous

state in India and is home to 200 million people, 60 million of who are

poor. The pace of poverty reduction in the state has been slower than the

rest of the country. Poverty is widespread. The central and eastern dis-

tricts in particular have very high levels of poverty. The state is also
experiencing widening consumption inequality in urban areas. Growth

is slow and is driven mainly by services.

Out of main working population of 4,46,35,492 (census India) only 59,921

employees are covered under Employees State Insurance Schemes.

There are only 116 ESI Dispensaries in Uttar Pradesh which way less

than actually required.

Sensing the need for expansion of Employees’ State Insurance Corpora-

tion (ESIC), a second generation reform agenda named ESIC 2.0 was

launched by Prime Minister Narendra Modi during the Indian Labour

Conference last year. DeepakKumar(IAS),DirectorGeneral-ESIC, Minis-

try of Labour and Employment, Government Of India, in an interview

with Shailja Katyal Verma, talks about extending the social security

coverage and improving medical care under the ESI Scheme. Excerpts…

What will be implementing Agenda?

These are the implementing agendas of newly launched ESI Scheme

Before ESIC-2.0 Reforms Agenda was launched last year, ESIC had 1.97

crore insured persons on its list. ESIC’s presence was limited to revenue

areas of 393 districts in the country. In the ESIC-2.0 Reforms Agenda,

target has been set to cover all the remaining areas of 393 districts of all

the states and union territories of the country as well as to expand this

scheme to construction workers and workers of the unorganized sector

also. Once ESIC coverage is expanded as per the plan, which we hope we

will achieve, the number of insured persons may become almost 4 times

i.e. 8 crore. When we count their family members who will also be get-

ting ESIC benefits the beneficiary number may become be over 30 crore.
Thus, the ESIC may be covering approximately 1/4th of India’s popula-

tion and providing them efficient health services and a good quality

social benefit cover. Our strategy for ESIC-2.0 Reforms and challenges we

foresee in the realization of this target are that the challenges are

providing health benefits and better management at the state level. The

system at present is that there are total of 151 ESI Hospitals, out of which

only 35 Hospitals are directly run by ESI Corporation. The state gov-

ernments run and maintain rest of the 116 hospitals and dispensaries;

some of them are managing it well, others are not. The efforts that has

ESIC made to customize its benefit schemes to the needs of different

worker groups are medical health benefits and also cash benefits that are

tailored to suit different worker groups. For the female workers there

are maternity benefits. If a worker dies, his minor dependents are paid

the benefits till they turn 18. If a person is temporarily disabled at work,

then during the disability period he continues to receive the same salary.

In case of permanent disability, till the age of 60 he is paid the salary.

The plans ESIC formulated for modernization and upgradation of medi-

cal infrastructure under the ESI Scheme are that they have adopted a

two-pronged strategy – one is improving the existing infrastructure.

They have got around 151 hospitals, including the ones being run by the

state governments. Out of these, 36 we ESI is handling and the rest are

being handled by the state government. The second aspect is creating

new facilities. They have launched a special right for their betterment &

upgradation which include provision of higher facilities. In all the new

areas, whenever they are notified, we will provide the primary care

(OPD) within a month. Other benefits like cash benefit will start from

day one. In the first 2 years of this expansion they will be given the
secondary benefits and which are available in the hospitals. If secondary

care is not available, ESI will tie-up with private hospitals. After the sec-

ond year, it will be again raised to tertiary level. The initiatives that

have been taken to promote the AYUSH systems of treatment in ESIC

hospitals and dispensaries are that they have got 1500 dispensaries, the

target is that within a year we will be having AYUSH facility and yoga

in every dispensary. The success of ESIC’s forays been in the field of med-

ical education is that they had decided to construct 12 medical colleges in

the country. Out of these five they have already started. This year they

will be starting four more and this will take the total to 9. Every doctor

passing out from these colleges will be absorbed within ESIC. Twenty per

cent of the seats in these medical colleges will be reserved for wards of

insured persons. The pitfalls in the implementation of ESIC’s IT Project

‘Panchdeep’.

The earlier contract of Panchdeep ended in 2016. Thereafter, Panchdeep

upgraded in sync with 2.0 reforms agenda. The business process engi-

neering will also be upgraded. They have already issued a tender and by

July this year the new system will be in place.

Project ‘Panchdeep’
To digitize internal and external processes and to ensure efficiency in

operations, especially services to Employers and Insured Persons, ESIC

has launched its IT Project ‘Panchdeep’.

• Employer Portal under ‘Panchdeep’: The Employer Portal permits

various transactions online without visiting any ESIC Office, saving time

and avoiding the drudgery of routine paperwork. Employer and Em-

ployee Registrations are done online. The portal enables

employers to file monthly contributions, generate Temporary Identity

Cards and create monthly

contribution challans online.

• e-Biz Platform: ESIC is the first entity to integrate its services (Regis-

tration of Employers via e-Biz portal of Department of Industrial Policy

and Promotion of DIPP) to promote ease of

business and curb transaction costs.

• Online payment of ESI Contribution by the Employer made easier via

the payment gateway of

State Bank of India and 58 other banks was launched on 01st April, 2015.

Some of the salient features of ESIC 2.0 are:-

(i) At present, ESIC Scheme is being implemented in industri-

al/commercial clusters. Now, the

target is to cover whole of the 393 districts, where these clusters are lo-

cated.

(ii) Covering all the construction workers under ESI Scheme.

(iii) Opening Health Scheme for selected group of unorganized workers

like rickshaw pullers/auto rickshaw drivers in selected

urban/metropolitan areas.

(iv) Up-grading dispensaries to six bedded hospitals in phases.

(v) Providing appropriate cancer detection/treatment facilities at dif-

ferent levels of hospitals.

(vi) Providing appropriate cardiology treatment facilities at different

levels of hospitals.
(vii) Providing dialysis facilities in all ESIC Model Hospitals on PPP

Mode.

(viii) Providing all possible pathological facilities in hospital premises by

outsourcing or by upgrading.

(ix) Tracking each and every mother and new born child of IP family to

achieve 100% immunization as well as safe delivery.

(x) Creating at least one Mother Child care hospital with higher facilities

in every State.

(xi) To start setting up State ESI Corporations/Societies in all States as

subsidiary of ESI

Corporation.

(xii) Electronic Health Record will be made available to the IP family

members on-line. The record will also include laboratory record in digi-

tal format and there will be no need to visit the hospital for getting this

information.

(xiii) In another initiative, 24x7 medical helpline No. 1800 11 3839 have

been made operational through which IP can directly talk to Doctor, in

case of emergency. This helpline will be toll free and will also be

available in regional languages.

(xiv) In an unique initiative under Swach Bharat – Swaschh Bharat

Campaign of Hon’ble Prime Minister, besides the on-going cleanliness

drive being taken up in all the ESIC hospitals, ESIC has decided that un-

der ‘Abhiyan Indradhanush’ bedsheets in Hospitals will be changed

every day and for each day of the week specific colour of bed sheet has

been fixed based on VIBGYOR pattern, as given below:-

Day Colour of Bedsheets

Sunday -Violet

Monday -Indigo

Tuesday- Blue

Wednesday - Green

Thursday- Yellow

Friday- Orange

Saturday- Red
(xv) From 20th July, 2015, every hospitals of ESIC have started to

operate Special OPD every day in the afternoon from 3.00 pm to 5.00 pm

for senior citizens/differently abled patients.

(xvi) Appropriate Queue Management System in every Hospital for

helping in registration and pharmacy.

(xvii) To provide behavioral training to para-medical and other staff of

the hospitals guiding them to provide due courtesy in dealing with the

patients/attendants.

(xviii) To provide facility for Reception and ‘May I Help You’ in each

hospital to guide the patients/attendants.

(xix) To provide for a feedback system for all indoor patients.

(xx) To put in place proper and attractive signage’s at the required

places in all ESIC Hospitals for guidance and proper communications to

the patients and beneficiaries.

(xxi) To provide yoga facilities in all ESIC Hospitals.

(xxii) AYUSH facilities to be extended up to the dispensary level in

phases.

(xxiii) To create tele-medicine facilities for the beneficiaries in phases.

Further, ESIC has set up 8 new ESI Hospitals, 7 Postgraduate Medical

Institutes & Medical Colleges, 1 Dental College, and 1 Nursing College .

6. The Employees’ State Insurance (ESI) Benefits:

The ESI Corporation provides benefits to the insured persons and

their dependents under the ESI Scheme in three categories-

a] Medical Benefits: Corporation provides full range of medical care to

insured persons and family members through a network of ESI dispen-

saries, hospitals and panel clinics set up all over the country. During

the year, an expenditure of Rs. 6112.97 crores was incurred on Medical

Benefit.

b] Cash Benefits: This benefit represents periodical payments in cash to

a registered member in case of Sickness, Maternity benefit to insured

women in case of pregnancy, confinement, premature birth of child,

Disablement Benefit or Employment Injury Benefits for suffering from

disablement as a result of an employment injury and Dependents’ Ben-

efit if an insured person dies as a result of an employment injury or

occupational disease. Contribution Income has increased to Rs. 11455.57

crores.

c] Other Benefits: Other benefits include the Funeral Expenses on death

of insured person, Rehabilitation allowance, Vocational Rehabilitation,

Medical Bonus, Un-employment Allowance and free supply of aids and

appliances etc. which are provided both in cash and kinds.

Special Features of ESIC Uttar PRADESH

E.S.I. Corporation has introduced identity cards with family photographs

of insured persons for smooth administration of medical benefits in the

E.S.I. dispensaries and hospitals. to compensate the erosion in monetary

value of permanent disablement benefit & dependent’s benefit, periodical

enhancement is granted in terms of percentage of original daily rate.

Cash benefit is paid at the branch offices in cash/money order/ cheque at

the option of the insured persons/beneficiaries. the money order commis-

sion is borne by the E.S.I. Corporation. however, cash benefit exceeding

rs.3,000.00 is paid through account payee cheque/demand draft or by

money-order only. The family members not residing with the insured

person at the work place are entitled to receive medical benefit if they

reside in implemented area in the state and separate family identity

card is issued exclusively for family members.

Medical Benefit under E.S.I. scheme is provided mainly through state

government except in Noida areas where medical benefit is provided to

the i.ps and their family members directly by E.S.I.C. one modal hospital

at Noida is also functioning under direct control of E.S.I. Corporation .

Entire expenditure of this model hospital is borne by the E.S.I. Corpora-

tion . in other areas, medical treatment and attendance to insured per-

sons and their family members is provided through a network of dispen-

saries and hospitals run by director, E.S.I. scheme, Govt. of U.P. Sarvo-

daya Nagar, Kanpur under the overall control and superintendence of

the Labour Department, govt. of U.P. the total expenditure in adminis-

tering the medical benefit is shared by the corporation and the state

government in the ratio of 7:1. Outdoor treatment is provided in E.S.I.

dispensaries and in-patient treatment through hospitals. In case any,

super specialty treatment is required which is not available in E.S.I.

Hospitals , the insured person, family members are referred to super

specialty hospitals having tie-up arrangement with the State Govern-

ment. A ceiling of Rs.1200 per insured person per annum has been fixed

with effect from 01.04.2009 towards medical care. E.S.I. Corporation and

the State Government share the expenditure on medical care at an

agreed ratio of 7:1 and excess expenditure beyond the ceiling is borne by

the State Government public grievance redressal cell cabinet secretariat

, govt. of India vide Gazette Notification no. a-11013/1/88 dated 02.08.98

has extended the jurisdiction of directorate of public grievances to E.S.I.

Corporation Ministry of Labour. Accordingly E.S.I. Corporation U.P. re-

gion has established “ public grievance redressal cell” at regional office ,

Kanpur. Shri S. Prasad Rao, Joint Director has been nominated as com-

plaint Officer . He , with the help of one Deputy Director and other cler-

ical staff is looking after the complaint cell . This cell is monitoring the

complaint related to branch offices and other E.S.I. Institutions.

In the financial year 2015-16, the Zonal Vigilance Inspection Units con-

ducted inspections of 125 factories and detected Omitted wages to the

tune of Rs.95,09,50,409.00/-. Further 214 Branch Offices of ESIC and 28

Dispensaries/Hospitals functioning under the ESI Scheme were also in-

spected. During the period under report 134 complaints were disposed of.

The Disciplinary Authorities issued 65 Charge Sheets comprising 61 cases

under major penalty procedure and 4 cases under minor penalty proce-

dure. During the year, 83 Major Penalties have been imposed out of

which 63 cases of Major penalties are in respect of Group ‘C’ employees

and 20 cases of Major Penalties are in respect of Group ‘A’ & ‘B’ Officers.

Minor penalties have been imposed in 12 cases out of which 11 penalties

imposed on Group ‘C’ employees and 1 penalty imposed on Grade ‘A’

employee. Vigilance Awareness Week was organized from 26.10.15 to

31.10.15 in all the offices of the Corporation across the country.

 7. THE PROBLEM STATEMENT :

ESI Scheme of India is a major multi-dimensional social insurance pro-

gram that has over the last six decades emerged as the largest social se-

curity setup in South-East Asia with its phenomenal growth in terms of

geographical reach, demographic coverage, multi-faceted services and

an infrastructure that has no parallel. Despite all the endeavors made

by the Corporation for the effective functioning of the ESI Scheme in the

country, public discernment of the Corporation has not been very posi-

tive. Such as

1. They felt that the Corporation has not given any regard for the quality

of services and benefits provided to the beneficiaries and their depend-

ents.

2.Further, no adequate steps are being taken to improve and popularize

the Scheme among the beneficiaries and employers.

3. Besides the working mechanism of the corporation is also and always

questioned.

Therefore, a study on the perception of insured persons as to delivery of

services by ESIC is vital for success of ESI schemes and to cure the vari-

ous maladies that are afflicted.

 8. REVIEWS OF LITERATURE:

Pachman, J.A. et.al, studied the major aspects of the social security

system in the U.S. , its benefits, structure, and its relationship to the

retirement decision, methods of determining costs and its financing.

They also presented explicit or implicit recommendations for changing

the system. These recommendations comprise an agenda for reform. The

proposal was presented in three dimensions. The first dimension regards

the historical development and the present institutional setting of social

security. The second dimension was the modest proposal to improve so-

cial security within the present framework. Finally, a list of immediate

and urgently needed changes that could be consistent with the longer

terms goals was presented for consideration in the next round of social

security legislation, more modest changes should be enacted to move the

system in the desired direction. Such changes would stress adjustments in

the minimum benefits and in the benefits paid to widows and survivors.2

James H. Dulebohn and Brian Murray of Michigan State Univer-

sity and College of Business, University of Dallas, in an article stated

that, many have noted the lack of human resource management

research on employee benefits, which is surprising because employer-

sponsored benefits are a primary concern of executives and employees

alike. Moreover, of special interest to scholars, benefits provide a unique

opportunity to examine fundamental theoretical and empirical ques-

tions about employee behavior and contemporary employment

2
Pachman, J. A. and others, Social Security Perspective for Reform, The Brookings Institutions, Washington, D.C.
1968.
relationships. They laid a foundation by providing an overview of the

context from which U. S. employer- provided benefit programs evolved

and the contemporary state of benefits research like the ESI Corporation

in India in human resources management3.

International Labour Organization monograph concerned primari-

ly with the five principles of social security schemes, now in force in

Great Britain, these consist of National Insurance, Industrial Insurance,

Family Allowances, National Assistance and the National Health Ser-

vice.4

Speaking on the occasion of the golden jubilee celebration of the Employ-

ees’ State Insurance Scheme, Atal Bihari Vajpai5, the then Prime Minis-

ter emphasized the need to increase the reach of social security to the

large number of workers in the unorganized sector. He stated that the

Employees’ State Insurance Scheme should endeavor for providing social

security umbrella to the poorest of the poor workers and people in the

unorganized sector for achievement of national goals set by Mahatma

Gandhi.

Dr. C.S. Kedar, IAS, Director General, E.S.I. Corporation said that

the improvements in the performance of E.S.I.C. are attributable to the

valuable cooperation and active participation received from its various

stakeholders i.e. Insured Persons, Employers, State Governments, Corpo-

ration members and the employees of the Corporation. The Corporation

has made several provisions like Self-Certification, Amnesty Scheme for

3
www.esic.com available online 25th November, 2010
4
International Labour Organization of Social Security-Great Britain, ILO, Geneva, 1957.
5
Employees’ State Insurance Scheme Golden Jubilee Celebration, 2002, New Delhi.
settlement of Legal Disputes, relaxation in inspections policy to meet the

needs of the Employers. The burden on State Govt. has also been eased

out in certain cases like in Super Speciality treatment. He further said

that, E.S.I. Corporation during this Diamond Jubilee Year would like to

extend coverage to other States of the North Eastern Region namely

Sikkim, Manipur, Mizoram and Arunachal Pradesh.6

The first social insurance measures introduced in India was the Employ-

ees’ State Insurance (ESI) Scheme which is more relevant and imple-

mented and administered through Employees State Insurance

Corporation (ESIC). Over the last six decades ESI Scheme of India is a

uppermost multi-dimensional cordial indemnity and medical care

program that has emerged with its exceptional growth in lieu of

geographical & demographic coverage, multi-faceted services and an

infrastructure that has no analogous. Despite all the efforts made by the

Corporation for the efficient performance of the ESI Scheme in the coun-

try, public perspicacity of the Corporation has not been very positive.

Therefore, this study examines the perception of medical insured persons

for the delivery of services by ESIC at Pithampur. The findings suggest

that the insured persons covered under the ESIC scheme benefits are

moderately satisfied with services particularly medical care benefits and

still a lot of efforts are to be made in this regard for improvement which

is vital for success of ESI schemes and to cure the various drawbacks

that made a great impact on the satisfaction level of beneficiaries.

6
Addressing the National Conclave at Guwahati on 23-06-2011, on the occasion of celebrating The Diamond Jubi-
lee of the ESI Corporation.
 9. THE OBJECTIVES:

In the light of above statement of problems and review, this paper tries

to examine the perception of insured persons in Uttar Pradesh Region

regarding efficiency of ESIC in delivering various services as mandated

by E.S.I. Act. More specifically, the objective of this paper is-

a. To study the level of satisfaction of insured persons on the benefits

provided by the ESI Dispensaries

b. To study the level of satisfaction of insured persons on the benefits

provided by the ESI Hospitals

c. To study the level of satisfaction of insured persons on the cash ben-

efits provided under ESI Scheme.

10. HYPOTHESIS:

H01: There is no significant difference in the level of satisfaction

among the insured persons in factories and establishments with regard

to the services and facilities provided in the E.S.I. Dispensaries.

H02: There is no significant difference in the level of satisfaction

among the insured persons in factories and establishments with regard

to the services and facilities provided in the E.S.I. Hospitals.

H03: There is no significant difference in the level of satisfaction

among the insured persons in factories and establishments with regard

to the cash benefit provided under E.S.I. Scheme.

 11.ANALYSIS:

Under the ESI Scheme, all insured persons and their dependents

are entitled to free, full and comprehensive medical care. The package

covers all aspects of health care from primary to super-specialty ser-

vices. Whereas, the primary, outpatient, inpatient and specialist services

are provided through a network of ESI dispensaries and hospitals. Super

specialty services are provided through a large number of empaneled

medical institutions on referral basis.

Since the medical benefit is the kingpin of the ESI benefits, the

effectiveness of the benefits under the ESI scheme can best be judged by

the level of satisfaction on medical benefits (medical care) as perceived

by the beneficiaries. The level of satisfaction is assessed in terms of

services/facilities provided in ESI DISPENSARIES and ESI HOSPITAL.

It is found, during the study that 225 Insured Persons have visited

various ESI Dispensaries located in the state during the year 2016-17 for

medical care. The responses of these people as to level of satisfaction is

depicted in the Table 2.

 Table 2: Level of Satisfaction of the Insured Persons in the

Services/Facilities in E.S.I. Dispensaries

Level of Services of Ailment of Quality of Laboratory Family Wel-

Satisfaction Doctors Drugs & Drugs Tests fare
Nos. Dressing Nos.
% Nos. % % Nos. % Nos. %
Strongly 5 2 14 06 14 06 6 03 6 03
Satisfied

Satisfied 25 11 31 14 37 16 31 14 34 15

Neither 45 20 46 20 53 24 58 25 57 25
Satisfied
nor Dissat-
isfied

Dissatisfied 140 62 125 56 113 51 124 55 121 54

Strongly 10 05 09 04 8 03 6 03 7 03
Dissatisfied

TOTAL 225 100 225 100 225 100 225 100 225 100

In any medical institutions the services delivered by the doctors are re-

garded as the main indicator for the development and growth of the

institutions. The above table reveals that 62% of the insured persons

(respondents) are Dis-satisfied in the services of doctors in ESI dispensa-

ries.

The availing of drugs and dressing at an easiest and also at a rea-

sonable rate gives priority for a medical institutional for treatment. In

ESI Dispensaries there are provisions of drugs and dressing, some of

them are free of cost and some them are a reasonable rate. Regarding
the availability of drugs and dressings in ESI dispensaries, most of the

insured persons were Dis-satisfied. The insured persons opined that the

qualities of drugs that are provided in the ESI dispensaries are not satis-

factory [51%]. During the study, the insured persons expressed that,

sometimes they were receiving the drugs that are beyond expiry date.

The availability of laboratory tests facility is an integral part of health

care management and ESI dispensaries also provide such facility. While

examining satisfaction level of beneficiaries, it is found that majority

are not satisfied with the facilities in terms of quality of test and service

delivery within stipulated time.

Further, efforts have been made in the study to know about the satisfac-

tion level of the insured persons regarding the family welfare programs

like promotion of small family norms, immunizations programs, promo-

tion of Indian System of Medicine etc. found that the level of dissatisfac-

tion is appears to be highest [54%].

Thus, from the above, it is observed that a large number of insured

persons were not satisfied in the various services and facilities provided

in ESI dispensaries for medical care.

It signifies that in the level of satisfaction among the insured persons

with regard to the services and facilities is found to be not significant.

Thus, the hypothesis that there is no significant difference in the level of

satisfaction among the insured persons with regard to the services and

facilities provided in the ESI Dispensaries may be accepted.

Level of Satisfaction of the Insured Persons in the Services/Facilities in

ESI Hospitals :

The insured persons who are under treatment in ESI dispensaries

may be referred to ESI hospitals for further treatment especially for in-

patient treatment, which is not provided in ESI dispensaries.

During the study, it is found that 143 (63.55%) of total insured per-

sons visited to ESI Dispensaries were referred to ESI Hospitals for

further treatment. Of these, only 92 (64% of referred) Insured Persons

have taken further treatment in ESI Hospitals. Here, an attempt has

been to assess the level of satisfaction of the insured persons regarding

services in the hospitals in terms of services of doctors, quality of drugs,

laboratory services, specialty treatment etc. as exhibited in Table 3.

Table 3: Level of Satisfaction of the Insured Persons in the

Services/Facilities in ESI Hospital.

Level of Services of Specialty Quality of Laboratory Family

Satisfac- Doctors Services Drugs Tests Welfare
tion Nos. % Nos. % Nos. % Nos. % Nos. %
Strongly 3 3 2 2 2 2 6 7 5 5
Satisfied

Satisfied 15 16 18 20 20 22 7 8 21 23

Neither 21 23 17 18 23 25 33 35 22 24
Satisfied
nor
Dissatis-
fied

Dissatis- 53 58 49 53 44 48 42 46 38 41
fied

Strongly - - 6 7 3 3 4 4 6 7
Dissatis-
fied

TOTAL 92 100 92 100 92 100 92 100 92 100

The table reveals that, 58% respondents are found to be dis-satisfied in

the services of doctors in ESI hospital. Regarding specialists’ service in

ESI hospitals, a large majority was found to be dis-satisfied. They re-

vealed that only a few specialist departments and doctors were there in

the hospital. Moreover, in some serious and critical case the patients

were referred to some other hospital (other than ESIC Hospital) with

whom they have a tie-up.

Further it is observed that, the insured persons were mostly dis-satisfied

with the quality of drugs provided in ESI hospitals, even

revealed that they had even got the medicines, after the expiry-date as

well as after long formalities. Similar is the case of laboratory facilities

where, they had to go to the private laboratories for most of the tests,

though expensive. Regarding family welfare measures, the effort of ESI

hospitals are not found to be satisfactory as opined by the beneficiaries.

An enquiry was also made among the insured persons to find out the

reasons for not taking treatment from ESI hospitals and reveals that

Lack of doctors, inadequacies of medicines & medical facilities, lack of

confidence and Inconvenience to go to ESI hospitals are some of the

reasons.

From the above, it is observed that a large number of insured persons

were not satisfied in the various services and facilities provided in ESI

Hospitals for medical care. This signifies that in the level of satisfaction

among the insured persons with regard to the services and facilities is

found to be not significant. Thus, the hypothesis that there is no signifi-

cant difference in the level of satisfaction among the insured persons

with regard to the services and facilities provided in the ESI Hospital

may be accepted.

Level of Satisfaction among the Insured Persons Regarding Cash Benefits

Providing Cash Benefit in certain cases within the scope of ESI Schemes

to the insured persons as per entitlement, is consider as an important

coverage under the insurance scheme. An attempt has been made to as-

sess the level of satisfaction of beneficiaries as to Cash Benefits with ref-

erence to Sickness Benefit, Maternity Benefit, Disablement Benefit and

Other Benefit, as shown in Table 4.

Table 4: Level of Satisfaction among the Insured Persons Regarding Cash

Benefits

Level of Sickness Ben- Maternity Bene- Disablement Other Benefit

Satisfac- efit fit Benefit Nos. %
tion Nos. % Nos. % Nos. %

Strongly 1 1 - - - - - -
Satisfied

Satisfied 11 5 29 67 2 2 - -

Neither 23 10 - - 14 14 15 25
Satisfied
nor Dis-
satisfied

Dissatis- 79 36 14 33 22 22 46 75
fied

Strongly 105 48 - - 64 62 - -
Dissatis-
fied

TOTAL 219 100 43 100 102 100 61 100

The analysis shows that number of Insured Persons strongly satis-

fied or even satisfied is very negligible with the amount and dis-

charge of sickness benefits provided by the Corporation under the

ESI Scheme. While the cash benefit in respect of Maternity benefits,

it is found that majority of respondent insured persons [women]

are found to be satisfied. The dissatisfaction was observed in re-

spect of Disablement Benefit and other benefits. The reason

attributable for such state of affairs, as opined by

the beneficiaries, are delay in settlement of benefits, cumbersome

procedures, requirement of frequent visits claim office at the cost

of wage cut etc. Thus the hypothesis formulated that there is no

significant difference in the level of satisfaction among the insured

persons with regard to the settlement of cash benefits stands

accepted.

The state-wise status of bed occupancy of ESI Hospitals for the year

2015-16 is given in Table 5, along with average cost per bed per day.

Average bed occupancy based on All India figure is 51%. The aver-

age bed occupancy for ESIC hospitals is 71%., whereas the average

bed occupancy for ESIS hospitals is 44.09%.

Table 5 : Percentage bed occupancy and average recurring cost per

bed per day in ESI Hospital during the year 2015-16 in

Uttar Pradesh

SI. Name of Medical Officers No. of Beds Commis- % of Cost

No Hospital sioned occu- per bed

pancy per

dur- day

ing during

the the

year year
Sanc- In- Po- Gen Ma- TB To-

tioned sition eral ter- tal

nity

1 ESI 24 17 312 0 0 312 25% 3146

Hospital

Kanpur

2 Kanpur 14 08 0 0 18 180 30% 2321

Chest 0

3 Modinagar 20 13 80 20 0 100 29% 3302

4 Naini 10 09 84 16 0 100 68% 1093

Allahabad

5 Kanpur 18 10 0 144 0 144 12% 7677

(MAT)

6 Lucknow 09 02 100 0 0 100 23% 6437

7 Sahibabad 14 09 80 20 0 100 42% 3021

8 Agra 13 13 84 16 0 100 68% 1916

9 Sa- 12 02 40 10 0 50 13% 11376
haranpur

10 Kidwai 30 08 84 16 0 100 30% 4351

Nagar

11 Bareilly 0 10 42 08 0 50 50% 3088

12 Jajmau 14 07 84 16 0 100 18% 6107

Kanpur

13 Noida 168 115 258 42 0 300 122% 12753

14 Aligarh 14 09 40 10 10 60 20% 4314

15 Pipri 12 02 30 24 06 60 10% 5319

16 Varanasi 12 08 40 04 16 60 18% 6546

Total 384 242 1358 346 212 1916

As we can see from Table 5 There are only 1358 general beds

commissioned in a state where there are 2,13,61,880 Insured

Persons, in the same way there are only 346 beds for Maternity

and 212 beds for T.B. which is way less than required number. The

State Government should see through this matter so that the Bed

requirement is as per the norms of the E.S.I Act.

Availability of Beds
As per the norms prescribed for setting up of new hospitals by

ESIC, the benchmark for opening a 100 bed new hospital is 25000

Insured Persons i.e. 250 Insured Persons per bed. The ESIC also
projects requirement of beds based on ratio of one bed for 250 IPs in

its Financial Estimates and Performance Budget every year.

Shortage of beds

Despite having equipped with all modern facilities for better

treatment of patients, the Employees State Insurance Corporation

(ESIC) Hospital in Uttar Pradesh in Noida lacks space to admit

more number of patients, mostly workers employed in various

industries in the area.

The hospital has a capacity of only 150 beds. The patients have to

wait for many days for their turn to get treatment while some oth-

ers move to private hospitals which cost them heavily.

The hospital situated at has been Sector 24, Noida catering to

medical needs of thousands of workers engaged in a number of

small and big factories. Cards have been issued to all the employees

of the factories/industries for free medical treatment.

Sources said all workers are not able to get the treatment in the

hospital owing to its limited capacity. They added that normally

wards are filled to their capacity and the patients have to wait for

days or even weeks to get the treatment.

“The treatment at the hospital is excellent as doctors and other al-

lied staff take care of the patients but the bed capacity is limited.

As there are hundreds of industries and thousands of workers, the

authorities should increase the bed capacity of the hospital,” said

Raghav, an employee of a factory.

“We have requested the hospital administration to increase its

capacity so that poor patients don’t suffer any more,” said Brijesh,

another employee of a local factory. “A majority of the workers are

earning between Rs 5,000 and Rs 10,000 per month and it is almost

impossible for them to get themselves or their family treated at

private hospitals,” he said.

A senior doctor of the ESIC admitted that the hospital had a

limited capacity. “Yes, the 150-bed capacity is not enough but we

are hopeful that it is likely to increase in near future,” he said. It

was also disclosed that new ESIC hospitals with a capacity of 100

beds were being built.

 12. SUGGESTIONS:

Since the ESI schemes are governed under self-financing mode, the

success of ESIC is largely dependent on level of satisfaction of prime

stakeholder, i.e. the Insured Persons. Hence any attempt to minimize

grievance from such stakeholder will increase the satisfaction level.

Therefore, ESIC should make effort to -

a. Enhance the awareness among the insured persons and the em-

ployers about the ESI Scheme.

b. Activate grievance handling mechanism to address effectively

and efficiently.

c. Improve health service delivery quality in terms of services of

Doctors, availability of quality medicines, adequate laboratory

testing facilities. At least in some cases, specialist care should be

provided with reimbursement facilities regarding some diseases,

where the insured persons seek treatment of their choice

hospitals.

d. Train personnel working in ESIC to deal with their clients very

sensitively as they visit ESIC for services with some expectations.

e. Improve functioning of various boards like Regional Board, Lo-

cal Board and departments like Inspectorate, Employees Insurance

Court etc. to develop better co-ordination among various stake-

holders and expedite settlement of Cash Benefits.

 CONCLUSION:

The Employees’ State Insurance Scheme is a unique multidimensional

self-financing social security scheme in which every contributor is a ben-

efactor and a beneficiary. The ESI Act, 1948 provided the conceptual

breakthrough in the development of a social security scheme that has

over the years metamorphosed into the country’s largest worker welfare

programme in terms of geographical reach, demographic coverage and

multi-faceted services. The ESI Scheme, today, is a national phenomenon

and one of the few largest social security programmes in the world.

Hence, any effort to improve service delivery quality deserves apprecia-

tion from all corners.

 BIBLIOGRAPHY:

 BOOKS:
 Ganguly, A, Insurance Management, new Age International (P) Lim-
ited, New Delhi, 2002.
 Gupta, B, K, Employer’s Guide, Employees’ State Insurance Corpora-
tion, New Delhi,1997,pg 2.
 Gupta, S. P, Statistical Methods, Sultan Chand and Sons, New Delhi,
1990.
 Malik. P. L., Employees’ State Insurance, Eastern Book Company,
Lucknow, 2001.
 Sharma, R., International Economics, Lakshmi Narain Agarwal, Edu-
cational Publishers, Agra-3, 2001-2002.

 REPORTS:
 Government of India, Report of the Committee on perspective Plan-
ning, Delhi, 1972, pg. 59-62.
 Annual Reports of ESIC

 ARTICLES (FROM NEWS PAPERS AND JOURNALS):

 Dr. Alakananda Goswami, The Assam Tribune, “Health for all in In-
dia”, Guwahati, Assam, March 11, 2010.
 Gautam Prasad Barua, The Assam Tribune, “Health Insurance must
for all family members”, Guwahati, Assam, February, 08, 2010.
 Praful Bidwai, The Assam Tribune, “Reviving the Healthcare Sys-
tem”, Guwahati, Assam, February, 21, 2010.
 S. Thomas, ESI Samachar, Employees’ State Insurance Corporation,
New Delhi, December, 2005, pg 1.

 CD ROMS
 Encyclopedia Britannica, Deluxe Edition, Britannica.com India Pvt.
Ltd, New Delhi, 2004.
 WEBSITES:

 www.esic.nic.in

www.esic.in

www.esicuttarpradesh.org

uplabour.gov.in