[proposal=][/proposal]
Mixture of public and private financing
Prices controlled by a health care control board
Provisions for the poor, disabled, retired and military
Minimum guide lines for a health insurance to be set
Mandatory purchase of health insurance or penalty to be paid
1) Health care control body(HCCB):-
Functioning
State level offices to have meetings through the year with health care companies about quality and pricing of health care products
National head office to meet once a year to set out maximum prices and minimum quality standards
Composition
Comprised of 20 doctors and health care personnel with experience of over 15years in their field nominated by the health ministry after approval by the president and prime minister
Comprised of 1 national head office along with state level offices of not more the 15 people elected by the 20 board members who employ people with duties in which one person is assigned a specific hospital to check quality, over testing and administrative work
Employees to check quality, over testing and administrative work
Powers & functions
Power to block all price increases of healthcare product’s above 5 %
To find the real cost of the medical products and levy profit margin taxes accordingly
Review all healthcare expenses every 3 years and take necessary action if required
To set out minimum standards for healthcare
Distribution of funds to their respective receivers
Levy fines on malpractices
Hear complains about health insurance providers
2) Medishield healthcare plan:-
Functioning
Every recipient will be given a Medishield card with a unique id number
The Medishield cards can be swiped at the given healthcare location and the transaction slip signed by the recipient for reimbursement by the HCCB
Every eligible person can apply for this plan on the internet or at the healthcare control body offices
Benefits
100% of healthcare costs funded by the government in all hospitals and pharmaceuticals
Eligibility
House hold Income below 1000% of poverty line
Or
Member of the armed forces
Or
Life crippling disability
Or
Age above 65years with assets 50% below the national average
Or
Age below 6 months
3) Insurerhelp healthcare plan:-
Functioning
Every eligible person can select their health insurance and submit it to the HCCB where after approval the subsidy will be granted
Benefits
Subsidization of insurance premium
Individuals under this plan can avail of a subsidy for their insurance premium
Subsidy calculation
Annual household Income range - Percentage of income paid as premium above which subsidy is given
1000% of poverty line to 1500% of poverty line- 2%
1500% of poverty line to 2500% of poverty line- 3%
2500% of poverty line to 3500% of poverty line- 5%
For senior citizens
Assets - Premium as Percentage of assets above which subsidy is given
0% to 50% of national average - 0.09%
50% to 150% of national average - 0.115%
150% to 250% of national average - 0.125%
Eligibility
In case of retirees they should have been residents for the last 30 years and should have paid the tax for atleast 20years
4) Individual and employer mandate:-
Employer
Every employer must provide basic health care coverage for every employee and their family(spouse and children up to the age of 27)
The health insurance must meet the minimum standard set out by the HCCB
The employer is exempted under the following conditions
i. The business is considered a small business i.e. employ less than 10 people
ii. The business is a non-profit organisation
Failing this the employer must pay 0.0001% of profits per uninsured employee
Individual
Every individual must purchase a health insurance for oneself and family(spouse and children up to the age of 27)
The health insurance must meet the minimum standard set out by the HCCB
The individual is only exempted if he/she is covered under the Medisheild plan
Failing this the individual must pay a penalty of 5% of income per family member(including children)
5) Health insurance standards & company regulations:-
Restaurants and food outlets
Must declare the following in their menu cards
i. Addition of trans fat
ii. Amount of calories
iii. Amount of fat
Minimum health insurance
Covers pre-existing conditions
Covers critical care and hospitalization
Covers pharmaceutical expenditure
Covers family members
Covers all hospital and illness expenses
Allows 2 annual check ups
No limit on amount that can be claimed per year
Insurance and healthcare companies
A maximum of 30% of revenue the revenue can be spent on non-healthcare expenditures per year(including profit)
If 70% of the revenue is not spent on health care for a particular year it must be given back to the customers in the form of lower premiums and rebates
All new drugs and services launched by health care providers must be priced according to the HCCB
All health care companies must disclose their profit margin to the HCCB which will remain confidential
Insurance claim
Insurers must reimburse the recipient or settle the claim within 24hrs
Maximum out of pocket expenditure cannot exceed 10% of the total cost of treatment
Amenities other than healthcare which can be charged over and above the maximum out of pocket expenditure
Insurances
Insurers are prohibited from excluding pre-existing medical conditions
All new insurance plans must cover childhood immunizations and adult vaccination
Insurers are prohibited from discriminating against or charging higher rates for any individuals based on gender, age or pre-existing medical conditions
All existing health insurance plans must cover approved preventive care and check-ups without co-payment
All health insurance companies must inform the public when they want to increase health insurance rates for individual or small group policies by an average of 5% or more
Insurers are prohibited from dropping policyholders when they get sick
Insurers must cover all pharmaceutical expenses
Insurers cannot raise premiums if a condition occurs after the insurance has been purchased
The claim cannot be rejected unless it is approved by the HCCB official at the hospital
Insurers must create new plans to meet with the requirements of the customers who are unable to meet the given insurances
Insurers must give cards to the customers for recognition and easy access to the insurance
6) Funding
Income
Tax on the profit margin of all healthcare products
Individual and employer mandates of
i. individual and employer mandate
Tax on products injurious for health
Product - Tax on cost price
Tobacco - 300%
Alcohol - 200%
Outside Food with more than 100 calories per 100gms - 50%
Outside Food with more than 6gms of fat per 100gms - 50%
Income tax of 2.5%
