Rajiv Aarogyasri Community Health Insurance Scheme

Rajiv Aarogyasri Community

Health Insurance Scheme.

Presented By :Avin K

Srilata EVarsha P

Presented By:Avin K

Srilata EVarsha P

Rajiv Aarogyasri CommunityHealth Insurance Scheme

Introduction Rajiv Aarogyasri is the flagship scheme of all health initiatives

of the State Government.

Aim is to achieve “Health for All”.

This scheme is to assist poor families from catastrophic health expenditure.

The scheme is a unique PPP model in the field of Health Insurance.

Provides end to end cashless services for identified diseases.

Introduced on 1st April 2004 in three backward districts of Mahboobnagar, Anantapur and Srikakulam.

Free screening and outpatient consultation.

The scheme was formulated in field of Medicine, Health and Insurance.

Function through ICT website (www.aarogyasri.org).

Below Poverty Line

Sell

assets

12.60%

Current

Income 6.10%

Other 6.10%

Saving

12.00% Borrow

63.10%

Escalatinghealthcarecosts: leadingtoruralindebtedness

Largeproportionofpeople,especiallybelowpovertylineborrowmoneyorsellassetstopayforhospitalization

Background: Hospitalization Expenses in AP

Universal Coverage All BPL Families 2.03 cores Cashless treatment Up to Rs 2 lakhs in a year Health Workers 3394 Aarogya mithras Health camps 8058 camps so farSimple Procedure Health card/White Card Cost Borne by the Government Diseases Identified Packages For end-to-end treatment Choice of Hospital Left to patientsMonitored On-line : 24 hour basis Implementation : Aarogyasri - I through Insurance Co.

Aarogyasri – II directly by Trust

Main Features

Expansion of the scheme

Cashless Packages

Disease Coverage

Health Card, Sum Insured• BPL family covered means the group of individuals as indicated in ,

Health Card or White ration card (BPL card).

• Sum insured per family-Rs.1,50,000/- .

• Benefit on floater basis , can be availed by individual or family .

• Additional Rs.50,000/-in case of need from Buffer amount .

Patient Facilities and Beneficiary ChoiceAarogyamithra Help desk in PHCs/Government Hospitals

Assistance Counters in Network Hospitals.

24 hour call centre Toll free line for this scheme.

Implementation

Financial Model

Aarogyasri-I is funded by the tax revenue collected by the State of Andhra Pradesh and

Aarogyasri-II from the Chief Minister’s Relief Fund.

The scheme’s financial model is cost effective.

To prevent from fraudulent claims , the trust reviews the settlement history of each hospital at regular intervals.

Insurer is selected through an open, competitive bidding process.

Infrastructure and Manpower• Aarogyamithras at PHC/CHC/Area Hospital 1861• Aarogyamithras at Network Hospitals 1596• Operations team (Preauth, Claims, Health Camps, Grievance etc.) 745• Doctors (Preauth, Claims, Inspections etc.) 180• Field officers 247• Call Centre Executives 283• Work Stations/Systems ( Computer, Servers) 625• Bandwidth Usage : Internet 40 mbps• Bandwidth Usage : MPLS 105 mbps • Application Server ,Web server ,Data Base Server ,File

Server ,Back up server for Application server and Webserver ,Back up server for data base server,Application server cluster ,Web server cluster 1 Each

• TCS Professionals 55

Network Hospital-Responsibilities 365 Hospitals empanelled

• Organize Health Camps once in a week.• Separate Reception and Registration.• Dedicated Medical Coordinator (RAMCO-Doctor), Camp• Coordinator• Free Transport to and from Mandal HQ for in-patient.• Free food for in- patient• Free consultation, diagnostics and treatment, irrespective of

surgery• Cashless services• Follow-up consultation and distribution of follow-up medicines• provided by the Trust• Provide Computer, Printer, Scanner, Digital camera , Webcam and• 2mbps connectivity

Key Stakeholders

Aarogyasri Healthcare Trust

The Insurance Company

Network Hospitals

District Administration

Aarogyamithras

Software Company

Achievements

Targeting a specific health sector

Involvement of Private Sector

Wide Coverage

Quality Medical Infrastructure and Expertise

Follow-up Services

Cost Effectiveness

Effective monitoring Mechanisms

Impact on the Performance of Government Hospitals.

Reference• www.aarogyasri.org.in

• www.google.com

• Some data from Ministry of Health and Family Welfare Website.

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