aarogya scheme - patel
TRANSCRIPT
-
7/31/2019 Aarogya Scheme - Patel
1/20
Rajiv Aarogyasri HealthInsurance Scheme
-
7/31/2019 Aarogya Scheme - Patel
2/20
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.
-
7/31/2019 Aarogya Scheme - Patel
3/20
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.
-
7/31/2019 Aarogya Scheme - Patel
4/20
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
-
7/31/2019 Aarogya Scheme - Patel
5/20
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 -
7/31/2019 Aarogya Scheme - Patel
6/20
-
7/31/2019 Aarogya Scheme - Patel
7/20
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
-
7/31/2019 Aarogya Scheme - Patel
8/20
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
-
7/31/2019 Aarogya Scheme - Patel
9/20
ORGANIZATION Centralized
OVERSIGHT RESPONSIBILITY State Government
OPERATIONS RESPONSIBILITY State GovernmentCommercial insurers
COLLECTIONS RESPONSIBILITY State Government
-
7/31/2019 Aarogya Scheme - Patel
10/20
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
-
7/31/2019 Aarogya Scheme - Patel
11/20
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
-
7/31/2019 Aarogya Scheme - Patel
12/20
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
-
7/31/2019 Aarogya Scheme - Patel
13/20
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
-
7/31/2019 Aarogya Scheme - Patel
14/20
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.
-
7/31/2019 Aarogya Scheme - Patel
15/20
-
7/31/2019 Aarogya Scheme - Patel
16/20
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
-
7/31/2019 Aarogya Scheme - Patel
17/20
-
7/31/2019 Aarogya Scheme - Patel
18/20
-
7/31/2019 Aarogya Scheme - Patel
19/20
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
-
7/31/2019 Aarogya Scheme - Patel
20/20