Occupational Health has been recognized as being very essential for organizations growth. There have been many researches undertaken in this field mainly because work plays a central role in people’s lives. Since most workers spend their lives at the work place, it is vital that the work environment is safe and healthy. Yet there are few organizations who gravely neglect the importance of occupational health. (ILO, Occupational Health and Safety.)
Work related diseases are more over very expensive and can have many serious effects on the lives of the workers and their families especially in developing countries. The costs to the employees of occupational accidents or illness are estimated to be enormous and it could lead to a financial disaster especially at these times of recession because organizations are looking at cost cutting measures and they would not like to spend on health care costs as much as they desired as funds would be reallocated to other affected areas in the organization, This would invariably affect productivity. However organizations that have a well equipped state of the art occupational health centre will be able to cater to the needs of the employees even at times of recession. Hence the present study aims to undertake a research on a particular private welfare centre to see how they provide occupational health to their employees and at the same time increase their productivity in a manner that fit their business strategy. Thus the researcher aims to use selective studies in order to come to a better understanding of the topic.
Occupational Health – An Investment Benefit of Promoting Employee Health
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Mr. N.K Chandrasekaran indicates that more than 60% of all chronic diseases are related to unhealthy life styles but the author says these are preventable. From the study it was evident that more than 60% of morbidity and mortality in the US are directly related to lifestyles. A heart disease remain to be the number one killer and costs a staggering $ 5.2 billion a year of which $ 3 million is through indirect costs such as cost workdays. (N.K Chandrasekaran, 2003)
In the present study the researcher used six precursors which accounted for 75% of the total preventable or postponable health impact. This has been amply brought out also by Carter Centre, USA Study. These precursors were tobacco use, alcohol use, injury risk, hypertension, obesity and gaps in primary prevention. Out of these six, four precursors (i.e.) personal health behaviour, environment exposure, high blood pressure accounted for:
1 million postponed deaths per year
4 million potential years of life lost
45.5 million days of hospital care.
Mr. N.K Chandrasekaran along with Carter Centre, USA Study and study at BHEL, Tiruchirapalli(Southern country in India) goes on to justify that it is a smart thing to invest in occupational health programs. According to the author occupational health services can save the company costly injuries, valuable time and can help business comply with state and central regulations through various screenings, programs and training. The benefits are:
Enhancing workplace safety
Decreasing the risk of employee injuries
Improving employee health and morale
Minimizing workers compensation and health costs
Adhering to OSHAS 18001 regulations
The paper indicates that workplace evaluations, back injury prevention education, ergonomics, pre placement screenings and respiratory protection program also help the organization to be ethically correct and economically sound. The author in his research has clearly demonstrated the significance of establishing occupational health services in organizations and also has provided a detailed description on the need for such an investment would enable the organization to grow even further and benefit both the employees and the employer in their quest for success.
The Road Ahead: Driving productivity by investing in health
The new mantra for industries to improve productivity is to invest in their employees and their health according to a new consumer study from Hewitt Associates (2007), a global outsourcing and consulting firm. The Hewitt study of 248 managers reflected the current overall health and productivity trend and the likely strategies for the next 2-5 years.
Overall health and productivity:
From the results of the survey conducted by Hewitt Associates, it was clear that only few employers have recognized the importance of health and wellness having a direct impact on productivity and business profitability. The research also found out that there is no formulized health and productivity strategy developed in many organizations. 60% of the respondents stated that they will develop a health and productivity strategy within 2 years. From the study undertaken few key findings that emerged were: (Hewitt Associates, 2009)
Employers recognize the value of health and productivity initiatives in fulfilling stated business goals.
Employers are able to measure the direct costs associated with each program but are unable to measure indirect costs such as absenteeism.
Integration of programs is important to employees in supporting their initiatives, but the survey results suggest that little integration is actually taking place.
Although offered by few employees, onsite services that provide employee convenience and personal interaction are highly utilized and provide higher levels of satisfaction.
The key findings from the survey conducted by Hewitt associates further reiterate the need for organizations to invest in the health of the employee and thereby cutting down on indirect costs like absenteeism. In order to succeed, employers need information about their employers and dependents. In this new worldview benefits and health improvements are sound business investments in what is emerging as global competitive advantage. This research would invariably attempt to prove the justification of establishing and utilization of services at the Hindu Welfare Centre. (Hewitt Associates, 2009)
W.H.O endorses Occupational Health Services and Health Promotion Programmes in the Organisation:
World Health Organization identifies that occupational health is closely linked to public health and health systems development. Consequently the Occupational Health Programmes intend at addressing a great amount of determinants of workers' health, together with risks for disease and injury in the work milieu, social and individual factors, and access to health services. (WHO, Occupational Health, 2009). This approval by WHO needs to be further analysed as it is vital for the present study. According to the recent WHO publications it is clear that Occupational health centres are the need of the hour and these figures justify that companies need to invest more on their employee’s welfare especially in developing countries such as India:
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Each year it has been reported that more than 160 million new cases of work related illness occur and it is responsible for 3% of all deaths worldwide.
It is also stated that selected occupational risks are responsible worldwide for 37% of back pain, 16% of hearing loss, 13% of chronic obstructive pulmonary diseases, 11% of asthma, 8% of injuries, 9% of lung cancer, and 2% of leukaemia and caused 850,000 deaths worldwide.
Studies in industrialized countries demonstrate that psychosocial hazards and work-related stress affect one fifth of the working population. (WHO, Occupational Health, 2009).
“Health promotion is the process of enabling people to increase control over and to improve their health.” (Ottawa Charter for Health Promotion, 1986)
Why invest in workplace health promotion?
“The workplace is one of the obvious stages on which to act out health promotion programmes.” (Cox Tom, Griffiths Amanda, 1997)
Numerous studies indicate that a healthy lifestyle improves one’s quality of life. Nearly 70% of all doctor visits are in some way related. “The most appropriate place to implement a health promotion programme may well be the worksite because of the proportionately large amount of time an individual spends working during his/her lifetime.” (Malzon, Lindsay, 1992)
“Work site health promotion programmes should be more widely adopted only if they can be demonstrated to be effective and cost effective in reducing the risk of disease and in promoting health” (Oldenburg et al. Health Education Quarterly 1995,)
Health is a basic human need, as health can deprive the individual of any capacity for agency through early death, or limit it as a consequence of chronic sickness or disability. On the other hand, good health as we know form a number of studies is seen by people to bring a sense of balance of well being. Although general health status is improving everyday on the other hand high rates of sick leave from work can still impair the efficiency of public services and cut down on profit margins of private sector business.
If medical care must be paid for, the cost may exceed an individual’s capacity to pay. A system, which provides open access to health care at the point of need, has the greatest capacity to ensure that appropriate care is received. There are a number of economic arguments for services without direct payments. There are benefits to the collectively as a whole from promoting good health and controlling diseases which are referred by economists as externalities. Public health measures such as the immunization programs can bring collective benefits through group immunity to diseases such as small pox, cholera, German measles, whooping cough, polio and so on.
Policies to prevent the spread of HIV/AIDS and efforts to prevent the resurgence of tuberculosis and the like can be justified in terms of both individual and collective benefit. To charge for such services would bring non benefits and waste human resources. Clearly the impact of improved health strategies at work and the consequent retention of staff in better physical condition until retirement would also result in greater pension costs. This means that the company may gain during employment but lose afterwards. Although this appears to be a harsh economic view, it does at least introduce the alternative options. A rigid cost analysis might argue that it is more profitable to service a high cost executive than a minimal wage earner.
A corporate philosophy, which takes into account the health of the employees, is espoused indirectly in a quote from Sir John Harvey Jones. He states, “Increasingly companies will only survive if they meet the needs of individuals who serve them, not just a question of payment, important as this may be, but people’s true needs, which they may even be reluctant to express themselves.” (Start-ups- inspiring new business, 2005)
From being ensconced in a monopoly run from the nationalization days beginning 1956, the insurance industry has indeed woken up to a de- regulated environment, with the industry space now being populated by several private players in partnership with multinational insurance giants. (Med India- Networking for health, 2009)
The opening of the insurance sector in India has been a landmark event in India’s economic history. Gone are the days of the domination by the LIC (Life Insurance Corporation of India) and GIC (General Insurance Corporation) when ordinary citizens had to work according to their whims and fancies. Over the past one year, the traditional notion of insurance has been turned on its head. Today insurance offers complete solutions to protect health. Added to this the profile of the Indian customer is changing. Today while boundaries between carious financial products are getting blurred, people are increasingly looking not just at products but also at integrated financial solutions that can offer them stability of returns along with total protection. Insurance products will need to be customized to satisfy these myriad needs of the customers and this where the private players come in bringing with them hopes of wider options and efficient services. (Med India- Networking for health, 2009)
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Health care has always been a hitch for India, a country with a hefty population and a greater proportion of this population living below the poverty line. In such circumstances, insurance becomes a significant issue in the country. But astonishingly for a country with the 4th largest economy, insurance in India has not been a sector that has taken off, considering its enormous potential. Reasons’ being the health insurance market in India has very limited covering about 10% of the total population. Article 47 of the directive principles of State Policy, as enshrined in the Constitution of India states, "Duty of state is to raise the level of nutrition, the standard of living and to improve public health." But the health care sector in India is fragmented between the Indian states and the central government. More over the legal framework relating to healthcare services is very complex. (Amit Banerji, Vishnu Ramdeo 2007)
Current policies available in the market and the major players
When talking of health insurance in India, the first name that comes to mind is Mediclaim, which is GIG’s health insurance policy and has been the only policy of any real note in the country even thought it may seem unattractive to any person who has been used to a comprehensive health insurance policy. As of now there are only two players in this field, Life Insurance Corporation and the General insurance Corporation(with its for subsidiaries) Mediclaim is the health insurance scheme offered by GIC and Jeevan Asha is the health insurance scheme offered by the LIC.
The current scenario
Most of the foreign companies entering India have decided to focus on life insurance rather than health insurance per se. Thought there are companies like Bajaj Alliance, which has launched a Mediclaim policy with cashless clam facility. The insured under this policy can avail of cashless treatment from 41 hospitals across the country to the extent of sum insured and for ailments that are covered. The major advantage is that under such plans, the policyholder is not required to settle his hospital bills upfront and then make a claim with the insurer. Instead, the insurer settles the hospital bills on behave of the policyholder, who can leave for home without paying. (Financial Express, 2004)
It’s a precursor to the formal transition to a third- party administrator regime, which provides hassle free health insurance and also standardizes medical diagnostic procedures and hospitalization expenses. This is something that is missing in the present day Mediclaim policy of GIC, which requires you to make the payments for hospital expenses and then submit the bill to the insurance company and wait to get reimbursed which itself may take time due to the bureaucratic procedures involved.
Third Party Administrators (TPAS)
TPA’s are basically insurance mediators, which assume the complete management of health campaign for insurance companies. Apart from settling claims, TPA’s also offers customer service and technical support. Private players have taken the lead and engaged TPA’s to help them service policy holders who have taken health covers. Iffco- Tokio Marine General Insurance, ICICI Lombard General Insurance, Reliance General Insurance and Royal Sundaram General Insurance have already signed up their respective TPA’s. The idea behind hiring TPA’s is to decrease the high claim ratios by eliminating scam cases. While TPA’s network with hospital and contacts with doctors is likely to lessen claims substantially, insurers also aspire to develop customer’s relationship through their TPA’s. (Financial Express, 2004)
With medical costs running into hair-raising amounts these days and so little supply of quality health care, this remains a seller’s market. State run health care services of course are decrepit. The quality if a public health service as judged by improvement in public health indices is closely linked to public funding in the primary health sector. Currently two thirds of India relies on private services in health insurance, which accounts for 82.7% of total health expenditure. Considering that taxpayer money is proving unequal to the task, risk-pooling mechanism is the safest bet. Till recently the monopoly on health insurance in India was held by Mediclaim, which was more self-centric than consumer oriented. It treated every claim with characteristic bureaucratic suspicion, paying it only upon submission of the bill, in a classic case of reimbursement. By contrast, insurers in the UK ensure that the patient need not even open his wallet. (Karmayog, 2004)
The good news is that with the launch of the Health Maintenance Organizations, being TPA’s between the insured, hospital and the insurer change maybe at hand. The IRDA has invited applications already, with the basic criterion being a minimum paid up capital of Rs 100 crore. The insurance sector is indeed being seen in a broader frame of reference now, with companies offering various add-ons, which often overshadowed the growing increasingly aware of its rights, we find that consumers are more health-oriented and will not compromise on quality. Which is why the various private and state players are recharging their consumer service batteries through prompt and courteous response to consumers, explaining all decisions fully and pay all valid claims as soon as possible- the key brand mantra here is “customer friendly”. (Karmayog, 2004)
Mediclaim insurance policy has recently been revised. The revised policy does away with the sub-limits under the various sub-heads and offers just one sum-insured ranging from Rs 15,000 to Rs 3, 00,000. The cover provides for reimbursement of medical expenses incurred by an individual towards hospitalization/ domiciliary hospitalization for any illness, injury or disease contracted or sustained during the period of insurance. (Karmayog, 2004)
Premium is calculated on the basis of age of the proposer and the sum incurred opted for Jan Arogya Bima Policy which is first and foremost meant for the larger part of the population who cannot afford the high cost of medical treatment, was introduced with effect from 12th August 1996. The limit of cover per person is Rs. 5000 per annum. The premium payable is very low depending on the age of the person covered ranging from Rs 70 to Rs 140 per person per year and Rs 50 per dependent child below 25 years. The cover provides for reimbursement of medical expenses incurred by an individual towards hospitalization/ domiciliary hospitalization for any illness, injury or disease contracted or sustained during the period of insurance. (Karmayog, 2004)
An extensive market research commissioned by GIC indicates that the country can afford managed healthcare. A two-phase study conducted predicts that with the introduction of managed care in India, the premium potential of the insurance market will jump to a mind boggling Rs 12,000 crores. Even though the cost factor pushes a fully fledged health security programme out of India’s reach, experts maintain that with spiralling medical costs, a gradual shift towards managed care is inevitable.
Global Strategy on Occupational Health:
The WHO in collaboration with centres network met recently in China to draft the recommendations for a global strategy on occupation health mainly do to the increasing amount of work related illness that has been gripping the world for a very long time. It is the policy of WHO to include elements for occupational health such as the constitution, Alma Ata declaration, health for all strategy and several other resolutions. (WHO Report, 1995)
The main emphasis was on the need to protect and promote health and safety at work by preventing and controlling hazards in the work environment. Due to the numerous problems that grips the working environment the WHO in collaborating with centres network conducted as much as 52 researches related to the global strategy on occupational health.
From these researches WHO analysed the situation and laid the main emphasis to the training of new occupational health policies, progress and strengthening the infrastructures, information systems and consciousness of the needs and possibilities of occupational health activities, development of occupational health services for all working people, and building up the necessary sup-port services and human resources needed for implementing the new Strategy. (WHO Report, 1995)
Alma- Ata Declaration:
In 1978 at Alma-Ata, USSR, Important steps were taken in order to increase the health and development of the workers. There was a worldwide appeal made to protect and promote the health of all the people of the world and the reason for such steps was mainly due to the deteriorating health status around the world.
The Alma-Ata Declaration constitutes that health was a fundamental right and the most important worldwide social goal was to attain the highest possible level of health. It also discusses about the prevailing inequalities in the health status particularly between the developed and developing countries and this gap must be reduced. The declaration also gave people the right to practice individually and collectively in planning their health care and prompted the governments around the world to provide adequate health and social measures to its citizens. An acceptable level of health for all the people of the world by the year 2000 was formulated. It was decided that a genuine policy must be put in place so that additional resources could be devoted to the acceleration of social and economic developments.
Primary Health Care
Primary Health Care has evolved from the economic, socio, cultural and political features of the country and its communities. It is based on the application of the relevant results of social, biomedical and health services research and public health experience. It primarily addresses the prevailing health problems in the community by providing primitive, preventive, curative and rehabilitative services accordingly. At the declaration it was decided that the primary health care services must comprise at least of education relating to prevailing health problems and the methods of preventing and controlling them; promotion of food supply and proper nutrition; an adequate supply of safe water and basic sanitation; maternal and child health care, including family planning; immunization against the major infectious diseases; prevention and control of locally endemic diseases; appropriate treatment of common diseases and injuries; and provision of essential drugs. (D. J. Parikh; H. N. Saiyed; 1986)
In addition to the health sector, all related sectors and aspects of national and community development, in particular agriculture, animal husbandry, food, industry, education, housing, public works, communications and other sectors; and demands the coordinated efforts of all those sectors.
The International Conference on Primary Health Care called for urgent and efficient national and international action to develop and implement primary health care throughout the world and particularly in developing countries in a spirit of technical cooperation and in keeping with a New International Economic Order. It urges governments, WHO and UNICEF, and other international organizations, as well as nongovernmental organizations, and the whole world community to support national and international commitment to primary health care and to increased technical and financial support to it, particularly in developing countries.
Primary health care is a universal concept and has been the most talked about concept in recent times. Each country differs in setting minimum standards and the implementation of the health care system. Therefore understanding of healthcare systems in both developed and developing countries would form the basis of accepting the emergence of Occupational Health Centres.
Understanding Healthcare in a Developed (UK) and Developing country (India):
The United Kingdom has a National Health Scheme (NHS) that provides free public health care to all its permanent residents and is paid from general taxes. Access to NHS is based on the clinical need of the person and not the ability of the person to pay. The NHS was formed from the NHS ACT of 1946.The main purpose of the Act was to provide comprehensive healthcare to all its permanent residents irrespective of age, gender, race or religion. (WHO Report, 2000). The Health system within the UK is divided into four (i.e.) England, Ireland, Scotland and Wales. The responsibility of implementing comprehensive health care services is vested with the respective governments. The services provided by the NHS have top class infrastructure and lots of resources are pumped in on a regular basis to ensure that the standard does not deteriorate. More over a country like UK is not burdened with population explosion, poverty or the urban-rural divide, hence majority of the people do have access to the services. Likewise UK also has a strong private health sector to which the people can fall back on if they are not satisfied with the NHS. People in UK do not have problems in going to a private clinic as majority of the people can afford the expenses.
Heath care in India is the responsibility of the constituent States or the Union territories. India has a population of over a billion and providing comprehensive healthcare with depleting resources is a daunting task. (National Health Policy, 2002)
Though the healthcare industry in India has grown, majority of the country’s infrastructure is very poor in standards. The country has limited resources for healthcare delivery and meeting health care needs. Most public health facilities in India lack basic infrastructure, are under staffed, lack efficient staffs, and have inadequate medical equipments. Apart from the above mentioned reasons, the urban- rural differences in accessibility to healthcare, is the major stumbling block for the growth of health care in India as 80% of specialist services are available in the rural areas. (The Economic Times, 2009) Critics are also of the view that the Government do not have a broader picture of integrating healthcare into the overall socio economic development of the country.
Accessibility of primary health care being limited and majority of the population not able to afford private healthcare, it is a boon for the working class who have occupational health centres to fall back upon.
Need for Occupational Health Services:
The Constitution of India states that 'State shall make provisions for securing just and humane conditions of work'. This provides the basis for provision of occupational health services to all citizens of the country. (Pingle S, 2009)
Nevertheless, in reality, there are abundant opportunities to offer occupational health services to all working population not only in India, but even in the developed world. Occupational health services are accessible only to 10-15% of workers worldwide and this percentage significantly drops in a developing country such as India. Though there is an extreme economic pressure on cost of production all over the world, there cannot be a change between health and productivity at work and this is where The Basic Occupational Health Services (BOHS) comes into focus. (Pingle S, 2009)
The BOHS(Basic Occupational Health Services) try to offer occupational health services for all working people in the world in spite of the size of workplace or geographic location (i.e.) these services are most needed in countries and sectors which do not have services at all. BOHS (Basic Occupational Health Services) lays stress on the significance of a national strategy to integrate occupational health in all policies. The perception of BOHS has been developed jointly in collaboration with the World Health Organization (WHO), International Labour Organization (ILO), and International Commission on Occupational Health (ICOH) and has its roots in the 'Alma Ata' declaration (1978) by the WHO. (Pingle S, 2009)
The BOHS concept focuses mainly on prevention and primary health care, which needs strong coordination between health and labour ministries. The main aim of the concept is to provide protection of health at work, endorsement of health, well being and avoidance of occupational diseases and accidents. The BOHS offers a realistic instrument in identifying priorities and putting together scarce resources to extend an integrated and efficient occupational health system and services, customized to suit the national conditions and needs of each country and organizations.
The Management at the Hindu has tried to replicate what has been advocated by BOHS through the establishment of the Welfare Centre and promoting health and well being of its employing thereby preventing occupational diseases and accidents. However even as there is a clear picture that has emerged on the importance of occupational health, India faces the twin challenge of integrating occupational health with general health services. But there is still hope for the Country as the Government has finalised the National Occupational Health and Safety Policy gives a hope that it will take the country one step closer towards BOHS for all.
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