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Aarogyasri Scheme should be extended to APL Senior Citizens

The Government of Andhra Pradesh has introduced an excellent health insurance scheme for all family members in BPL category. Mere possession of Ration Card (White Cards) is enough eligibility. Government pays consolidated insurance premium to Star Health. A network of 360 hospitals has been enlisted for availing treatment. 940 surgical and other procedures, primarily taking care of operations for Kidney, brain, heart, cancer, Burns etc are covered. Accidents coming under Motor Vehicles act are out of scope in this scheme. A large number of Aarogyamithras have been appointed within the easy reach of villagers whom can be approached for information, explanations, help, liaison, complaints etc. The whole system is totally cash less. Just enter the hospital with your Ration Card and special Aarogyasri card, get treated and walk away. Operations costing about 1.5 to 2.0 lakhs are done free to members of BPL category. The website of the scheme gives a lot of details. For instance on 1st April 2011, we know how the scheme performed: 26000 medical camps were held, 4.4 million persons were screened, 40 lakh were treated, 10 lakh surgeries / procedures performed and about Rs 2920 crores worth claim disbursement (direct payment to hospitals by Insurance Company) was approved. These are cumulative data. We get monthly data also. Now the scheme covers whole of AP. It has won several acclaims and awards. Karnataka has shown interest in replicating it. Such a wonderful scheme will be a boon to senior citizens. Senior citizens under BPL are automatically already covered. Senior citizens APL (Above poverty line) are worst sufferers when it comes to health. Diseases are more, money available for treatment is less, no earnings except meager pensions are some problems faced by this group. Moreover most Health insurance schemes have become unaffordable to most senior citizens. Above a certain age (when they need it most) senior citizens are simply denied any Medical / Health insurance at all. After 85 one can not get any insurance extended. Aarogyasri should be extended to Senior Citizens in APL Above Poverty Line category too. They may be asked to pay the premiums themselves. The premium is likely to be very affordable as large numbers are involved. This will be a great boon to the silently suffering community. An authenticated, verified Voters List could form the basis for negotiating with the Insurer. Voters ID card or Aadhar card may be used for gaining access to the facilities. I wish some political parties include this in their agenda for the coming elections. They will gain the sympathy and support of senior citizens. After all senior citizens constitute more than 8% of the population. Some states like Tamilnadu and

Pudhucherry have already started recognizing Senior Citizens as a part of Vote Bank. ==========================

Extract from my email dated 25/11/2010 to Nagewara Rao


Some notes on our (RNM & PVM) meeting with Sri Babu, CEO, Aarogyasri Trust on 23rd November: 1. Aarogyasri is intrinsically an excellent scheme affording best health care at least cost. Its success depends on the fools proof systems and procedures involving best Information Technology infrastructure. 2.Political will is first and foremost necessary - Both Rajasekar Reddy and Rosaiah fully supported and somehow wanted to help middle class citizens. Hence defining BPL as a fa,ily having Rs 75000 per year -- tereby increasing coverage to about 85% in AP 3. It is a myth that costs of operating the scheme will increase year after year. As saturation levels of treatment reaches, costs actually come down (borne by three years' experience - (charts in the booklet evidence this). The total outflow for three years remained at about 900 crores. 4. Aarogyasri is procedures oriented. Out of some 940 procedures nearly a third are directly taken care of by the trust and the rest through Insurance Company (star Health of date) 5.For the portion handled by Trust directly roughly 400 crores are required.Therefore AP Govt has sought Center to give 900+400 crores subsidy. So far Aaarogyasri is fully funded by AP Govt funds chiefly from CM's fund for helping the poor. 6. We are advised to ask the Govt to introduce a scheme similar to aarogyasri for APL category on premium sharing basis. The only problem to be tackled is How to make collect premium mandatorily from all. This can not work if option is given to take it or not. 7. It would be possible to offer such a scheme for APL at about Ra 1000 per family. 8. RSBY is bound to fail as the govt washes off its hand after giving the premium to Insurance company. 9. In aarogyasri health screening camps, training camps are essential components. 10. Minute to minute online monitoring as to what is happening to each patient is possible. 11. Hospitals including govt hospitals are happy as they get payments within a week - moslty online settlements. ===========

"Indira Jai Prakash, Bangalore University" <indira313@hotmail.com>, Padmanabha Vyasamoorthy <vyasamoorthy@gmail.com>, "AM Khan, NIHFW" <m_khannihfw@yahoo.com>, "Prof.Kalluri S.Rao" <ksrsl@yahoo.com>, "Seema Puri, IHE" <dr.seemapuri@gmail.com>, Shankar Kinjawadekar <drspkinj@gmail.com>, Ramanbhai Shah <caprachimshah@gmail.com>, Krishnaswamy B <bksgerio@yahoo.co.in>, Gangadharan K R <krg.nascai@gmail.com>, Chapke D.N <dnchapke@yahoo.com>, RN Mital <rnmital@gmail.com>

Dear Members of Health Committee

Subsequent to Prof Indira Jayaprakash asking us to send our comments on Health care of the Ellery, I have not seen many replies exchanged amongst ourselves. Some may have sent their comments directly. I suggest that we try to push just one point vehemently across, as far as NPSC - 2011 is concerned. In the policy in paragraphs on healthcare only universalisation of RSBY is mentioned. The draft is already with the minister. Before it gets his final nod, we need to send in our comments. I am giving below a small table comparing important features of RSBY and Aarogyasri. A quick glance will tell us why we should push Aarogyasri against the ill advised RSBY. ==

RSBY and Aarogyasri


RSBY Remarks Why Aarogyasri is better for senior citizens 23.4 lakh Smart cards 2.3 crore families Senior citizen may not be left (families) out by family head Started in April 2008 Started in April 2007 More experience & success established BPL families five members BPL families no limit on Very significant from Senior only floater basis covered number of persons floater basis citizens point of view ( 27 states have accepted / Started & fully implemented all started implementation districts covered. TN , Delhi & Kerala are on the way Coverage: Rs 30000 Coverage: 1.5 Lakhs; up to 2.00 Coverage is ideal and decent lakhs in special cases OPD not covered OPD covered Needed Aarogyasri

Total cases (benefited )about 17 lakhs Premium: Central govt 75% State government 25% Registration charges paid by Family Rs 30 per year; Each family is given Biometric ID card Premium paid to Insurer: Varying from Rs 500 to To 850 per family (district is the unit); So far 376 districts are covered out of which 214districts have completed enumeration of BPL family data. Pre existing diseases are covered 8104 hospitals in 376 districts of 26 states Many insurance companies are involved; However in any one district only one insurer is allowed. Cashless reimbursement of expenses; paid directly to hospitals; No follow up related payment ??

430 lakh screened; 37 lakhs cases registered Entirely from State funds ?? No Registration charges; Based of White Ration card, Aarogyasri card is issued Premium paid: about Rs 530 per ?? What could be the likely family; complete data base of 800 premium if APL families are lakh people and 200 lakh BPL included and sharing of premium families with digital photo, socio is accepted in principle? economic data + iris biometrics available Pre-existing diseases are covered Important for Senior citizens 333 Hospitals networked only in AP One insurer for entire state ??

??

?? ??

Cashless reimbursement of expenses; paid directly to hospitals; Cashless Follow up expenses after operation for one full year is also given Very robust IT infrastructure / Website is accessible to all; system which acts as the plenty of info to verify; backbone of success; 24X7X365 RGBS website gives scanty info; instant info / follow up are possible 942 procedures covered thro RSBY does not give data insurer; 612 procedures covered by direct reimbursement of money by Aarogyasri trust to patient Screening camps are integral part Screening & prevention most of Aarogyasri important Training of all levels / types of No provision in RSBY personnel

??

Feedback; monitoring; preventionIn RSBY, Everything is left to of abuse; are al integral part of State and district level the system administration; Commitment levels will vary so the results will be. Proper implementation should be in the hands on one organisation as in Aarogyasri

Any comments? Kindly send them to Chairperson. Dr P Vyasamoorthy, 30 Gruhalakshmi Colony Secunderabad 500015 Ph 040-27846631 / 9490804278.My blog: http://vyasa-kaaranam-ketkadey.blogspot.com/

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