eMediNews
(Incorporating eIMA News)
25th February 2016
Editorial (Dr S S Agarwal, Dr K K Aggarwal)
IMA Stand on Life-Saving Machine, Devices, Equipment
 
Life-saving machines and devices such as pacemaker, CPAP, BiPAP, orthopedic implants, intra cardiac valve replacements, vascular stents, relevant laboratory diagnostic tests, X-ray and such similar implants and machines are often prescribed by registered medical practitioners to their patients.

As per the Indian Medical Association (IMA), all such life-saving equipments are and should be fully covered in insurance policies/Mediclaim/PSU reimbursement etc.

The IMA policy has also been validated by the following judgements:
  1. In case titled as “The New India Assurance Co. Ltd. & Anr. Versus Mrs. Sonali Sareen & Anr”, during the course of treatment in Sir Ganga Ram Hospital, the patient was recommended to purchase the CPAP/BiPAP machine.  Since the purchase of the machine was recommended by the treating doctor, the complainant purchased the same for a sum of Rs. 70,000/- and thereafter lodged the claim under the cashless insurance policy.  The Ld. District Forum had held that purchase of machine was the part of the treatment and without this machine the patient could not have been treated. Thus, denial of the payment of this price of the machine is tantamount to deficiency of service on the part of the insurance company. The said order and judgement passed by Ld. District Forum had been duly accepted by the Hon’ble State Consumer Disputes Redressal Commission vide order dated 09.12.2014.
  2. Further, in the matter titled as “New India Assurance Co. Ltd. versus Ganashyamadas A. Thakur,” vide order and judgment dated 07.02.2014, Hon’ble National Consumer Disputes Redressal Commission had held that:
                “The fact that Respondent/Complainant wife had taken treatment as an in-patient at M/s Bhagwan Mahaveer Jain Hospital for Severe Obstructive Sleep Apnea is not in dispute. It is further an admitted fact that on discharge she was advised CPAP usage at night as a continuing part of the treatment to regulate her breathing and ensure that there was adequate inflow of oxygen since the CPAP had to be used along with 1-2 litre oxygen/minute. Keeping in view this important fact, we find force in the conclusion reached by the Fora below that like the pacemaker, which is used to control abnormal heart rhythms, the CPAP device though not an implant is a continuous positive airway pressure to keep the airways open and thus like the pacemaker is not only an integral part of treatment but necessary for patient survival. No doubt Clause 2.4 of the policy does not mention CPAP but it is obviously not a comprehensive list because it talks of various devices like pacemaker. As stated above, since the CPAP device like the pacemaker is important for the patient treatment and survival, it may not be reasonable to exclude it. Apart from this, in the exclusion clause, on which the Petitioner/OP had relied before the Fora below, it is stated that the Insurance Company will not be liable to make any payment in respect of the equipments, such as braces, non-durable implants, eyeglasses, contact lenses etc. These may be important but are not life-saving equipments unlike the CPAP. So far as the hospitalization of Respondent/Complainant daughter is concerned, we also agree with the conclusion reached by the Fora below and directing the Petitioner/OP for reimbursement of the same.”
Accordingly, all members of IMA are advised to educate their patients, who have been prescribed any such life-saving equipment.
 
All members are further requested to help their patients in this regard so that they can get their treatment reimbursed.
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Health and the Union Budget: IMA’s Viewpoint
 
New Delhi, February 24, 2016: India continues to have a high burden of diseases despite the various health program and policies, which have not been able to achieve the desired goals and objectives.

A High-level expert group (HLEG) on Universal Health Coverage (UHC) constituted by Planning Commission of India submitted its report in Nov 2011 for India by 2022. The recommendations for the provision of UHC pertain to the critical areas such as health financing, health infrastructure, health services norms, skilled human resources, access to medicines and vaccines, management and institutional reforms, and community participation. Planning commission has estimated that 3.30 lakh crores has to be spent in 12th FY period (2012-2017) to achieve the goal of UHC by 2022. We are already into fourth year of the 12th FYP and yet only a meager proportion of this amount has been budgeted so far on an annual basis.
 
Public spending on health - It is believed that an important factor contributing to India’s poor health status is its low level of public spending on health, which is one of the lowest in the world. In 2007, according to WHO’s World Health Statistics, India ranked 164 in the sample of 191 countries in per capita terms. This level of per capita public expenditure on health was less than 30% that of China (WHO, 2010). Also, public spending on health as a percent of GDP in India has stagnated in the past two decades, from 1990–91 to 2009–10, varying from 0.9-1.2% of GDP. 
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IMA Updates
  
IMA Polio Dates
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  • April 11th: bOPV would be available in private market but it is not to be opened or used before 25th April.
  • April 25: IMA Polio Switch Day, when tOPV would be completely withdrawn and replaced by bOPV in both routine immunization and polio campaigns.
  • 9th May: IMA National Validation Day when India would be declared free of tOPV. 

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Topic - Immunization in Children
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