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
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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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Documents

Aarogya Scheme - Patel