*Health is regarded as a vital component in the growth and development of any country. *Healthy children are said to have better school attendance and learning, which later translates into better earning capacity. *Poverty caused by poor health further reinforces ill health, poverty leads to low food intake, nutritional deficiencies, deprivation of basic amenities like sanitation and clean drinking water cause infections.

*The United Nation Organization, Government of India and the concerned State Government in India taking into consideration the above situation have initiated and implemented various schemes to extend adequate health care facilities.

*In this connection, a cooperative as a third sector plays vital in providing health care services.

*An attempt in analyze the role played by the health care cooperatives in rendering health care services to the poor in general and the members of the cooperatives in particular.

Country/RegionPublic Expenditure on Health as

Percent of Total Health Expenditure

India 29.20

Average of High Income Countries 65.10

Average of Low Income Countries 38.78

Average of Middle Income Countries 52.04

World 62.76

Source: World Bank Database (http://data.worldbank.org/)

*The first cooperative hospital known as Surekha Hospital was formed in Bombay. *In Kerala the first cooperative hospital that came into operation from 1969 in Thrissur District. *Kerala has often been singled out as a paradox in having achieved ‘good health at lower cost.

*The State is reported to have the lowest rural-urban inequalities in public health status. *India’s first ever Human Development Report published in 2002, placed, Kerala on the top of all the other States in India, because of easy accessibility and coverage of medical care facilities. *Kerala has better health indicators such as Death Rate, Infant Mortality (IMR) and expectation of Life of Birth than most States in India.

* The health infrastructure of the State consists of 2699 institution with 50622 beds. Besides there are 5403 sub center.

* Out of the total institutions 46.87 per cent are under Allopathy, 32.01 per cent under Ayurveda and 21.12 per cent under Homoeopathy department.

* There are 65 Hospitals with 6297 beds under the cooperative sector in the State.

* Kerala State Homoeopathic Co-operative Pharmacy (HOMCO) Alappuzha, a medicine manufacturing unit is also functioning under the Directorate of Homeopathy.

* It is estimated that there are about 1.5 million diabetic patients in Kerala. These people need life time management involving lifestyle modifications, drug and diet.

* It is observed that one out of three adults in Kerala is a hypertensive. Hyper tension leads to heart attacks, stroke and kidney failure.

* Cancer is the major disease that affects all sections of human population. Every year 35000 new cases of Cancer are detected in Kerala.

* The Kerala State Control Society plays an important role in the prevention of HIV/AIDS. It is also considered as one of the important millennium development goals.

* The alcohol consumption is increasing in the state. Excessive drinks can cause a variety of health problems. More than 72 per cent of the accidents on the national highways were related to driving after taking drinks.

* More than 11 per cent of the population are aged above 65.

* There are four types of health care cooperative in Kerala.

The first type of cooperatives is exclusively registered as cooperative hospital by the professionals (Doctors, Nurses and others).

The second type of Cooperative hospital is registered by professionals and other individuals.

The third type of cooperative hospital is floated by any cooperative organization to fulfill their objective.

The fourth and last type of health care cooperatives is registered under Charitable Societies Act to provide health care services to the members of the holding organization.

*The most striking weakness of our public health system has been its failure to reach the bottom of the pyramid. The case of SCs and STs, and OBCs, which account for 70 per cent of the total population, is no different.

*The first challenge that was mounted against the public system came in the form of the Rajiv Gandhi Swasthya Bima Yojana (RSBY) and similar insurance schemes in many states.

* Schemes provided an insurance cover for Rs 30,000 for BPL families. The catch was that institutions accredited as part of these schemes were largely private hospitals.

* In Chattisgarh the state health department has initiated action against 22 nursing homes against which it found prima facie evidence of surgeries being done without legitimate medical reasons. It is estimated that over the last eight months, hospitals and nursing homes have claimed Rs two crore under RSBY scheme for removing the wombs of 1,800 women (Hindustan Times, August 14, 2012).

* Private organization use to keep tacit understanding between doctors and pharmaceutical companies and exploit the patient by prescribing more medicine, diagnostic test etc. Since, the health care cooperatives are providing services to its own members (owners) the possibilities of exploitation is limited.

* Private health service agencies prefer to operate in urban areas to make use of all common infrastructural facilities and to make a good return on investment. Health care cooperatives use to operate where the members are not accessible to health care services at an affordable cost. They generally operate in rural areas. Hence, health care cooperative plays a vital role in replacing the rural and urban divide.

* The Kandala Cooperative Hospital is a holding organization of Kandala Service Cooperative Bank. This hospital has introduced a novel scheme known as ‘Sahakarisanthwanam’ which provides free treatment facilities to its members at up to Rs.5, 000.

* This facility ensures health security to the

member of the society and it will also increase the volume of business to the hospital. ‘Bhavansanthwanam’ scheme is an exemplary example of social commitment of the hospital which insists the doctors and other professionals to reach out the houses of bed-ridden members of the cooperative societies for providing free medical treatment at door step of the members.

*Many Health care cooperatives are doing the same services in different names and different forms. For example the Palakkad District Health and Family Welfare Hospital Consumer Cooperative Society is maintaining a “ Pain and Palliative Centre” for the old aged people who are generally not taken care by their own family members.

*Health care cooperatives ensures the availability of ambulance services to the members round the clock at an affordable cost.

Contd.

* It was observed that all the health cooperatives in Kerala are availing Neethi Medical Store facilities and provides medicines to all the patients which are generally 10 to 15 per cent less than the market price.

* Health care cooperative in Kerala are providing health insurance facilities to its members. The Government of India and the State Government has introduced a joint venture insurance scheme called “Samagra Arogya Insurance scheme (RSVY)” for the people living below poverty line (BPL).

* The health care cooperatives are providing services to the card holder of this scheme at a very concessional rate.

* E.M.S Cooperative Hospital is an outstanding example for blending social service and business objectives. It designed a new scheme for mobilizing more working capital by enrolling new members and their share holding are linked to different services to its members. It paves way to increase the share capital position.

* It also maintains a member’s desk in the front office to receive all the member patients. Members will get preferential treatment and charged nominal rates. The society provides insurance coverage and treatment to all types of diseases and thereby ensures socio-economic security.

* The Kaduthuruthi Cooperative Hospital in Kottayam District in collaboration with Bharat Sevak Samaj (BSS) is conducting the following courses for the children of the poor who passed 10th standard.- First Aid and practical Nursing - Medical Laboratory Technicians - X-ray Technicians.

* The course is exclusively for girls and helps them to get placed. A few health care cooperatives do enroll other cooperative institutions as a member of their health care cooperatives. The members of such cooperative institutions are entitled to avail a discount of 10 per cent for all the services provided by the health care cooperatives

* The number of health care cooperatives and the number of profit making cooperatives are is showing a positive trend. But the proportion of total profit making societies constitute only 15 per cent.

* It is worth mentioning here is that the membership position of the society is increasing year after year.

* The share capital position of the all the health care cooperatives are showing a positive growth and on the same line the reserve fund and other fund position of the society is also showing positive trend.

* The establishment cost of the health cooperative societies in Kerala is very high. As per the rule the establishment cost should not exceed more than 2.5 per cent of the working capital. But in case of health care cooperatives it is ranging from 8.88 per cent to 22.21 per cent. It is very high and it will affect the financial health care cooperatives to a greater extend.

* The number and amount of profit earned the health care cooperatives is decreasing in every year and on the other hand the number and the amount of profit earned by the health care cooperatives is increasing in very year and it is not an encouraging sign.

* It was observed that the health care cooperative in Kerala not having adequate infrastructure facilities.

* The patient to nurse ratio system has been effectively followed in Government hospitals and it is not effectively followed in health care cooperatives.

* Compulsory rural services for the doctors are being followed in Government hospital and it is not made applicable to health care cooperatives.

* It was observed that the Government employees availing the services of the health care cooperatives are not entitled for to reimburse the cost of medical expenditure incurred in heath care cooperatives. They are eligible for reimbursement only if they are taking treatments in Government hospital.

* The small service cooperative banks having hospital and dispensary cooperatives are facing difficulties in paying huge salaries to the Doctors working in the hospital cooperatives.

*The Kerala Nursing Council has prescribed a standard that each institution interested in commencing Nursing College should posses minimum 5 acres of land. But the Indian Nursing Council has prescribed a limit of 2 acres of land.

*The health care cooperative willing to commence Nursing College in Kerala a facing problem due the condition of 5 acres land holding.

Contd

* The health care cooperatives in Kerala are at present classified under ‘Miscellaneous’ category. The health care cooperatives are providing unique and special types of services. Hence, a special type of classification may be accorded to health care cooperatives by the Registrar of Cooperative Societies.

*In order to develop tourism in Kerala the banks and financial institution like Kerala State Finance Corporation (KSFC) are extending financial assistance at concessional rate of interest. Health care is one of the important Millennium Development Goals.

*Hence, by considering the importance of health cares the banks and financial institution in general and the National Development Corporation in Particular (NCDC) should render financial assistance at concessional rate of interest for the development of health care cooperatives in India.

Contd

* To promote health care cooperatives the following benefits may be extended to the health care cooperatives. - Exemption from payment of income tax,- Building tax - Revenue tax- Water and electricity charges at subsidized price.

* The members having professional qualification as doctor will be given preference to work in the cooperative hospital. It will enable the society To overcome the problem of paying more salary to the doctors of the health cooperatives, the government may depute the doctors on deputation basis.

*The rate subsidy provided for purchases of Ambulance may be increased. On the same line subsidy may provided for purchase of equipments and machinery for hospital cooperatives.

*The rate subsidy provided for purchases of Ambulance may be increased. On the same line subsidy may provided for purchase of equipments and machinery for hospital cooperatives.

* There is no separate budget allocation for health care cooperative in Kerala. Hence, provisions may be made to make separate budget allocation for health care cooperatives.

* Steps may be taken by the health care cooperatives to reduce their establishment cost and borrowing. If not, it will affect the financial health of the health care cooperatives to a greater extend. Further, it will affect the quality of services rendered by the societies.

* The won fund position of the society has to be improved and in order to improve the won fund position the health care cooperatives should strength their share capital and reserve base.

*The world is marching towards for achieving the millennium development goal and one of the main millennium development goals is providing health care facilities for all. *The health care cooperatives in Kerala are joining hand with United Nations in achieving objectives of providing health care services for all. *India is having very good cooperative net work and 100 percent villages are covered by cooperatives. But still there are some areas where the cooperatives have not made a remarkable achievements is health care cooperatives and the state of Kerala is an exception to this.

*The study observed that the other cooperatives are getting more assistance from Government and other organization. But the health care cooperatives are emerging as a vital and essential sector without much patronage from Government. *It is also rendering quality services on par with other public and private hospitals. The health care cooperatives are having very good opportunities and scope for further development. Hence, the problems faced by the health care cooperatives need to be addressed on priority basis. *The cooperative health sector needs to be improved considerably in terms of availability and quality of infrastructure, human resources and services so as to meet the growing demand.

Year No. of societies

Growth rate Membership Growth rate

2005-06

174 - 1,30,694 -

2006-07

177(1.72)

1.72 1,32,251 1.19

2007-08

180(1.69)

1.69 1,26,901 (-) 4.04

2008-09

182(1.11)

1.11 1,62,445 28.00

2009-10

184(1.09)

1.09 1,69,334 4.24

Year Share capital Reserve Funds/other funds

Owned funds

2005-06 5881.16 9666.06 15547.22

2006-07 7344.96(24.88)

10891.80(12.68)

18236.76 (17.92)

2007-08 5311.53(22.68)

2401.17(77.96)

7712.70((-) 57.70)

2008-09 5941.24(11.85)

3926.80(63.53)

9868.04 (27.94)

2009-10 9897.00(66.58)

5217.50(32.86)

15114.50(53.16)

(Figures in parenthesis refer to growth rate in percentage)

(Rs. in lakhs)

Year No. of societies in

profit

Amount Average profit

No. societies in loss

Amount Average loss

2005-06 23 163.03 7.08 85 1482.26 17.43

2006-07 20 146.03 7.30 67 22150.76

330.60

2007-08 20 107.52 5.38 76 26563.58

349.52

2008-09 28 195.22 6.97 67 28276.09

422.03

2009-10 29 505.53 17.43 65 31598.56

486.13

(Rs. in lakhs)

Year Working capital Establishment cost Ratio of cost to working capital

2005-06 73160.60 7520.88 10.27

2006-07 72415.11 7582.09 1.04

2007-08 66522.91 5909.13 8.88

2008-09 59170.14 6711.70 11.34

2009-10 52585.61 11682.55 22.21

(Rs. in lakhs)