Editorial 1: Doctors must embrace Right to Health Bill, not protest against it
Recent Context:
- Recently, Rajasthan became the first state in India to pass the Right to Health (RTH) bill. The bill allows free access to out-patient and inpatient services in all government and selected private hospitals in the state.
- Ever since the bill was passed, the medical fraternity started protest against certain provisions of the bill.
- In a nutshell, the majority of doctors feel that the RTH bill is an assault on their “business model”. This needs to be seen in context of a nation reeling under the broken moral compass across various spheres of life be it political, social or professional and not merely limited to health care providers.
Health situation of Rajasthan:
- In 2022, in a report titled “Healthy states, progressive India”, the NITI Aayog, World Bank and the Union Ministry of Health and Family Welfare, had placed Rajasthan at 16th position among 19 big states.
- As per the National Family Health Survey -5 (2019-21), the infant mortality rate and the neonatal mortality rate in the state are 30.3 per 1,000 live births and 20.2 per 1,000 live births respectively.
- Such high rates of childhood mortality speak poorly of the healthcare infrastructure of the state.
- It is one of the states with highest levels of nutritional anaemia among women and children. The doctor-population ratio of the state is at an astoundingly low level of five doctors per 10,000 population (in comparison, it is 21 per 10,000 population in Jammu and Kashmir).
- With such a dismal health picture, Rajasthan was the ideal state to formulate and implement the RTH bill.
Arguments against the protest of the bill:
- As per official data, more than 78 per cent of healthcare in India is now delivered by private players. The private physician has thus nearly completely replaced the conventional government doctor and it is this private physician who is most unhappy with the RTH bill in Rajasthan.
- The Indian Medical Association (IMA) has threatened to organise a national level protest against the RTH bill in days to come.
- It is a known fact that most of the office bearers of IMA are private practitioners and the election to various posts of the organisation are keenly fought on the basis of regional, political and monetary clout.
- As, RTH bill of Rajasthan was formulated after a series oRasaaf meetings between the doctors and government officials. The bill underwent significant modifications from its original form which was introduced in the assembly in September 2022. It is thus not a bill designed without keeping the stakeholders in the loop.
Key provision which is reason of the protest:
- The main grudge of the protesting doctors of Rajasthan is the clause in the bill according to which any resident of the state will have the right to emergency treatment and care without prepayment at all hospitals and healthcare centres.
- The anxiety of the doctors about this clause is twofold:
- First, who decides what can be classified as a medical emergency, and
- second, the bureaucratic and political control and arm twisting when it comes to admitting or reimbursing payment for these patients.
- Both the apprehensions are justified but are not enough to be grounds to oppose a unique, first of its kind initiative by any Indian state in safeguarding the health of its citizens.
- The doctors should have appeared to be siding with the patient in a matter which is so clearly benefiting them.
- Both the above-mentioned issues are not problems due to the RTH bill but rather a problem arising out of the doctors’ mistrust of the system.
- It may be interesting to note that Rajasthan also has one of the highest incidences of violence against healthcare professionals in the country.
- Violence against healthcare professionals is multifactorial but at the heart of this violence lies the deep mistrust of the patient or his kin of the system in general and the doctor in particular.
- Embracing a patient friendly bill would have been an opportunity for the doctors of Rajasthan to douse this mistrust to some extent.
Conclusion:
- The physician is in direct contact with people. Society and the physician are mirrors to each other. If the physician of today has to look good in the mirror, he/she has to help society look good.
- The easiest way to make society look good is to bring equality and justice and this may be at the cost of the physician’s ability to earn money.
- We doctors should not seem to be gathered under the canopy of organisational privileges. Rather, we should look like men working under the sun, hand-in-hand with the poor and the have-nots. Even if we don’t look rich, we should at least look kind.
Editorial 2: IRDAI removes commission limit for agents: How will it benefit consumers?
Recent Context:
- Recently, The Insurance Regulatory and Development Authority of India (IRDAI) has lifted limits on the payment of commissions to insurance intermediaries. With this, life and non-life players will have more freedom in offering commissions – the compensation paid to and received by an insurance agent from an insurer for soliciting and procuring an insurance policy.
- However, the commission will have to be within their overall Expenses of Management (EOM) and insurers can have board-approved limits for paying commissions to their agents.
Who are insurance intermediaries?
- Insurance intermediaries include corporate agents, insurance brokers, web aggregators, insurance marketing firms and a common public service centre SPV
What do Expenses of Management mean?
- Expenses of Management (EOM) include all expenses in the nature of operating expenses of general or health Insurance business and commission to the insurance agents or insurance intermediaries.
- It also includes commission and expenses on reinsurance inward, which are charged to the revenue account.
What does the new IRDAI rule say?
- IRDAI has asked insurance companies, including life and non-life, to fix an overall cap on commission to agents, brokers and other intermediaries, giving more flexibility to insurers in managing their expenses.
- This means the regulator has replaced the earlier cap on different commission payments to various types of intermediaries with an overall board-approved cap which should be within the allowed expenses.
What is the objective?
- This rationale of the regulation is to enable and provide flexibility to the insurers, both life and general insurers, to manage their expenses within the overall limits based on their gross written premium to optimally utilize their resources for enhancing benefits to policyholders.
What benefit will consumers get?
- Post the changes in regulations, insurance agents are likely to be more interested in selling insurance products and explain policy details to consumers beforehand. The claim ratio of these agents will also be better.
- When claim outgoes are within the overall manageable limit, an insurance company may not increase the premium, which will be beneficial for consumers, Star Health Insurance’s Jagannathan explained.
- The move will also help in increasing insurance penetration as agents will get higher commissions.
How will this move benefit insurance companies and agents?
- The insurance sector participants have welcomed the change in the regulation and termed it a major reform. They said the removal of the cap on commission payments will positively impact the sector.
- As currently, the insurance companies are paying insurance intermediaries a commission of 15 per cent of the total premium business they are bringing in. The new regulation has removed the cap. However, the overall limit of EOM will remain.
- With the new regulations, an insurance company can pay a higher commission to an agent if the business brought in is good and claim-free
- “It will also increase insurance penetration and provide flexibility to insurers in managing their expenses. Overall, it will smoothen adherence to compliance norms