Aarogya Scheme - Patel

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    Rajiv Aarogyasri HealthInsurance Scheme

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    Sponsored by Govt. of ANDHRA PRADESH.

    The State to provide medical assistance to BPLfamilies for the treatment of serious ailments.

    The beneficiaries of the scheme are the members

    of below poverty line families as enumerated andphotographed on the Rajiv Aarogyasri HealthCard/ below poverty line Ration Card.

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    To provide financial protection to families living belowpoverty line for the treatment of major ailments suchas cancer, kidney failure, heart and neurosurgicaldiseases.

    Government hospitals lack the requisite facility andthe specialist pool of doctors to meet the state wide

    requirement for the treatment of such diseases.

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    Large proportions of people, especially below poverty lineborrow money or sell assets to pay for the treatment inprivate hospitals.

    To improve access of BPL families to quality medical care fortreatment of diseases involving hospitalization and surgerythrough an identified network of health care providers

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    Emergency Management and Research Institutes 108service

    Health information helpline

    Health insurance scheme for serious ailments free of cost topoor people

    The Aarogyasri benefits package includes 942 surgical

    procedures and 144 medical diseases. The system is entirelycashless and there is no deductible or co-payment forseeking care.http://www.jointlearningnetwork.org/content/rajiv-aarogyasri

    http://www.jointlearningnetwork.org/content/rajiv-aarogyasrihttp://www.jointlearningnetwork.org/content/rajiv-aarogyasrihttp://www.jointlearningnetwork.org/content/rajiv-aarogyasrihttp://www.jointlearningnetwork.org/content/rajiv-aarogyasrihttp://www.jointlearningnetwork.org/content/rajiv-aarogyasrihttp://www.jointlearningnetwork.org/content/rajiv-aarogyasrihttp://www.jointlearningnetwork.org/content/rajiv-aarogyasrihttp://www.jointlearningnetwork.org/content/rajiv-aarogyasrihttp://www.jointlearningnetwork.org/content/rajiv-aarogyasrihttp://www.jointlearningnetwork.org/content/rajiv-aarogyasrihttp://www.jointlearningnetwork.org/content/rajiv-aarogyasrihttp://www.jointlearningnetwork.org/content/rajiv-aarogyasrihttp://www.jointlearningnetwork.org/content/rajiv-aarogyasri
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    Sequence of StepsNon-effectiveness and complicated procedure

    involved in the CM relief fund help to BPL families

    Tailor made Insurance Scheme PPP Model

    Aarogyasri -I

    Aarogyasri -II

    Pilot in 3 Districts Phase-1

    Entire state in phased manner

    Comprehensive ICT Solution

    Aarogyasri Health Care Trust formation

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    CMRF (2004)

    CHILD CARDIACSURGERIES(Aug, 2004)

    AAROGYASRI I(April, 2007)

    AAROGYASRI - II(July, 2008)

    CMCO (July, 2008)

    ORIGIN & EXPANSION OF AAROGYASRI

    DATE DISTRICTS PROCEDURES SCHEME01.04.2007 3 163 Aarogyasri - I

    05.12.2007 8 210 Aarogyasri - I

    05.04.2008 13 272 Aarogyasri - I

    17.07.2008 23 865 Aarogyasri - I (Insurance)Aarogyasri - II (Trust)

    CMCO Referrals (Trust)

    14.11.2008 23 942 Aarogyasri - I (Insurance)Aarogyasri - II (Trust)

    CMCO Referrals (Trust)

    EXPANSIONORIGIN

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    ORGANIZATION Centralized

    OVERSIGHT RESPONSIBILITY State Government

    OPERATIONS RESPONSIBILITY State GovernmentCommercial insurers

    COLLECTIONS RESPONSIBILITY State Government

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    POPULATION COVERED:- TARGET POPULATIONS Below Poverty Line

    COVERAGE LEVEL 65 million people

    Service delivery system:-

    TYPES OF PROVIDERS EMPANELLEDBoth Public & Non-state

    NUMBER OF PUBLIC PROVIDERS98

    NUMBER OF NON-STATE PROVIDERS244

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    MAIN FEATURESAll BPL Families 2.03 croresUNIVERSAL COVERAGE

    Up to Rs 2 lakhs in a yearCASHLESS TREATMENT

    3057 AarogyamithrasHEALTH WORKERS

    33484 camps so farHEALTH CAMPS

    Health card/White CardSIMPLE PROCEDURE

    Borne by the GovernmentCOST

    IdentifiedDISEASES

    For end-to-end treatmentPACKAGES

    Left to patientsCHOICE OF HOSPITALS

    On-line : 24 hour basisMONITORED

    Aarogyasri I : through Insurance Co.Aarogyasri II : directly by TrustCMCO : directly by Trust

    IMPLEMENTATION

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    Salient FeaturesCashless treatment BPL families

    Life saving Diseases ~ 1200

    Periodic Medical camps

    Special wards in Network Hospitals

    Various Registration Channels

    24*7 Call Center

    Hospital Empanelment ~ 450

    Aarogyamitras Self Help Group

    Frequent workshops for the Users

    SLA based Pre authorizations

    Revolving fund for Government hosp

    Grading of the hospitals

    Online Money transactions

    Patient Feedback

    Complete ICT solution

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    Private sector is creating health infrastructure inremote rural areas due to the demand created by RSBY

    Since public sector hospitals are competing withprivate hospitals for BPL customers, they areimproving as well

    Quality ofstates BPL lists improving due to exposure

    For expenditures above Rs. 30,000, state governmentsare linking with other schemes

    Disease profiling at district level

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    Incentivizes growth and performance in Health sector.Some public sector hospitals have also shownPerformance.

    Provides a single health system handle to guide publicand private sector hospitals.

    204 lakh BPL families covered, 12 lakh surgeries done.80% of the population covered.

    Health on Political Agenda. BPL population empowered to Access health care.

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    Map BPL health care needs.

    The scheme does not appropriately respond to covercatastrophic health care needs of BPL population.

    Still barriers to access, specially for Marginalized groups.

    Authorizations & Payments designed by technologyintensive procedure rather than health conditions.

    facilitates use by hospitals rather than patients.

    Promotes technology intensive health care set-up, notnecessarily the best health care service or easily accessiblehealth care service.

    Lacks strategic purchasing

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    Last 24hrs Stats Since April 1st 2007

    Vital statistics of last 24 hoursHealth Camps 29Patients Screened 5473

    Registered 3733Out Patients Government 184

    Private 1619Total 1803

    In Patients Government 350Private 762Total 1112

    PreauthorizationsGovernment 350Private 751Total 1101

    Surgeries/Therapi

    esGovernment 316Private 706Total 1022

    Amount

    PreauthorizedGovernment Rs. 8017700Private Rs. 19713300Total Rs. 27731000

    Death Cases Government 6Private 11Total 17

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