Medical aspects of national insurance and social security scheme, Guyana

A National Insurance and Social Scheme was introduced in Guyana on the 29th September, 1969. On 1st January, 1970, injury benefit was payable to all insurable workers which virtually meant that even if a worker was not registered under the Scheme and he sustained an industrial injury, so long as he was in insurable employment he was eligible to receive injury benefit and also disablement benefit if he suffered any degree of disablement resulting from the injury. This paper will confine itself to the provisions for medical examination, certification and treatment of persons suffering industrial injuries. The programme for medical care is conceived as a vertical one, and so an industrially injured worker is not permitted to change the medical practitioner and proceed horizontally with his treatment without the permission of the general manager. From the very inception of the scheme every registered medical practioner was accepted as an examining officer and was empowered to examine, treat and issue certificates in keeping with the relevant regulations. If a claimant for injury benefit is not satisfied with the handling of his case, he could lodge an appeal, and then he would be allowed to go upwards in the organizational structure and be examined by a medical referee in order to resolve the issue. A panel of Medical referees has been appointed by the National Insurance Board. If a claimant is dissatified with the medical referee's determination, he can lodge a further appeal and his case would then be placed before a Medical Board comprised of two or more members. A panel of Medical Board members has been appointed by the National Insurance Board. A Medical Board's determination is final unless there is a disagreement between two members, when another Board will be arranged comprised of least 3 members. The decision of a Medical Board consisting of more than 2 members, if not unanimous, will be that the majority of the members. So far, no separate facility for medical care of industrially injured workers has been established. The country's existing resources in medical man-power and institution (public and private) are being fully utilized to provide all aspects of diagnosis and treatment of cases. Medical Care includes - General Medical Practitioners care, specialist care and treatment at hospitals the supply of prescribed essential pharmaceutical products and dressing, the provision, repair and renewal within limits laid down by the National Insurance Board, of orthopaedic and prosthetic appliances necessary for the rehabilitation or the reduction of incapacity for work of the injured person, arising as a direct consequences of employment injury. The main pre-occupation of the Medical Division and of physicians and surgeons, appointed under the Scheme is with refereeing and boarding of workers suffering from industrial injuries. Thus in 1972, 403 claimants appealed against determinations of Medical Referees and to date some 395 have been medically boarded. The main questions for determination by Medical Referees and Board Members are reviewed (AU)

Medical care insurance: the approach in developing a health insurance plan in the Caribbean - Part 11

For the effective financing of private and government medical services in the Caribbean, the basic needs are a prepayment scheme with a comprehensive health service for all persons, adequately trained personnel, satisfactory hospital, health centre, clinic and office facilities. In order to determine the magnitude of the financial problem involved it will be necessary to carry out income, welfare and hospital utilization surveys. The service to be provided would include general practioner and specialized care in office, home or hospital with laboratory and X-ray diagnostic services, hospital costs in ward or semi-private beds, half the cost of medicines, preventive medical care, nursing maternity and rehabilitation service. There would be a free choice of physician but group practice in clinics would be encouraged. The administrative control would be shared equally by the users and providers of the service and the scheme would be organized by a voluntary non-profit organization approved by the Government. Large industrial, agricultural and commercial organizations would be expected to co-operate by paying half of the health insurance contributions of their employees. To provide an incentive to subscribe for those already receiving free medical care from Government clinics and hospitals, cash benefits for accidents and sickness, old age pensions and death benefits would be introduced. (AU)