Rajiv Aarogyasri Health Insurance Scheme

dinesh Patel roll no 10

 Sponsored by Govt. of ANDHRA PRADESH. The State to provide medical assistance to BPL

families for the treatment of serious ailments.

The beneficiaries of the scheme are the members

of below poverty line families as enumerated and photographed on the Rajiv Aarogyasri Health Card/ below poverty line Ration Card.

 To provide financial protection to families living below

poverty line for the treatment of major ailments such as cancer, kidney failure, heart and neurosurgical diseases.
Government hospitals lack the requisite facility and

the specialist pool of doctors to meet the state wide requirement for the treatment of such diseases.

 Large proportions of people, especially below poverty line

borrow money or sell assets to pay for the treatment in private hospitals.
To improve access of BPL families to quality medical care for

treatment of diseases involving hospitalization and surgery through an identified network of health care providers

 Emergency Management and Research Institutes 108

service

Health information helpline Health insurance scheme for serious ailments free of cost to

poor people The Aarogyasri benefits package includes 942 surgical procedures and 144 medical diseases. The system is entirely cashless and there is no deductible or co-payment for seeking care. http://www.jointlearningnetwork.org/content/rajivaarogyasri

 The benefit on family is on floater basis i.e. the

total reimbursement of Rs.1.50 lakhs can be availed of individually or collectively by members of the family.
Cost for cochlear Implant Surgery is reimbursed

by the Trust up to a maximum of Rs.6.50 lakhs for each case.

Sequence of Steps
Non-effectiveness and complicated procedure involved in the CM relief fund help to BPL families

Aarogyasri Health Care Trust formation

Tailor made Insurance Scheme PPP Model Aarogyasri -I Aarogyasri -II

Pilot in 3 Districts Phase-1

Comprehensive ICT Solution Entire state in phased manner

ORIGIN & EXPANSION OF AAROGYASRI ORIGIN

CMRF (2004) DATE 01.04.2007 CHILD CARDIAC SURGERIES (Aug, 2004) DISTRICTS 3

EXPANSION
PROCEDURES 163 SCHEME Aarogyasri - I

05.12.2007

210

Aarogyasri - I

AAROGYASRI I (April, 2007)

05.04.2008

13

272

Aarogyasri - I

17.07.2008 AAROGYASRI - II (July, 2008) 14.11.2008

23

865

Aarogyasri - I (Insurance) Aarogyasri - II (Trust) CMCO Referrals (Trust)

23

942

CMCO (July, 2008)

Aarogyasri - I (Insurance) Aarogyasri - II (Trust) CMCO Referrals (Trust)

 ORGANIZATION OVERSIGHT RESPONSIBILITY OPERATIONS RESPONSIBILITY

Centralized State Government State Government

Commercial insurers
COLLECTIONS RESPONSIBILITY State Government

 POPULATION COVERED: TARGET POPULATIONS COVERAGE LEVEL Service delivery system: TYPES OF PROVIDERS EMPANELLED

Below Poverty Line 65 million people

Both Public & Non-state NUMBER OF PUBLIC PROVIDERS 98 NUMBER OF NON-STATE PROVIDERS 244

MAIN FEATURES
UNIVERSAL COVERAGE CASHLESS TREATMENT HEALTH WORKERS HEALTH CAMPS SIMPLE PROCEDURE COST DISEASES PACKAGES CHOICE OF HOSPITALS MONITORED IMPLEMENTATION All BPL Families 2.03 crores Up to Rs 2 lakhs in a year 3057 Aarogyamithras 33484 camps so far Health card/White Card Borne by the Government Identified For end-to-end treatment Left to patients On-line : 24 hour basis Aarogyasri I : through Insurance Co. Aarogyasri II : directly by Trust CMCO : directly by Trust

Salient Features
Cashless 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

 Private sector is creating health infrastructure in

remote rural areas due to the demand created by RSBY

Since public sector hospitals are competing with

private hospitals for BPL customers, they are improving as well Quality of states BPL lists improving due to exposure For expenditures above Rs. 30,000, state governments are linking with other schemes Disease profiling at district level

 Incentivizes growth and performance in Health sector.

Some public sector hospitals have also shown Performance. Provides a single health system handle to guide public and 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.

 Further Skews Public health spending towards tertiary

care. Shifts Government health care fund from public sector to private sector. Stand alone scheme, not integrated with primary and secondary health care. Over reliance on IT technology to check frauds. Absence of Gate keeping mechanism Increases state health care cost with dismal impact on population health indicators

 Map BPL health care needs. The scheme does not appropriately respond to cover

catastrophic health care needs of BPL population. Still barriers to access, specially for Marginalized groups. Authorizations & Payments designed by technology intensive procedure rather than health conditions. facilitates use by hospitals rather than patients. Promotes technology intensive health care set-up, not necessarily the best health care service or easily accessible health care service. Lacks strategic purchasing

Last 24hrs Stats

Vital statistics of last 24 hours Health Camps
Patients Screened Registered Out Patients Government Private Total In Patients Government Private Total Preauthorizations Government Private Total Surgeries/TherapiGovernment es Private Total Amount Government Preauthorized Private Total Death Cases Government Private Total 29 5473 3733 184 1619 1803 350 762 1112 350 751 1101 316 706 1022 Rs. 8017700 Rs. 19713300 Rs. 27731000 6 11 17

Since April 1st 2007