Rajiv Aarogyasri Community Health Insurance Scheme.

AAROGYASRI HEALTH CARE TRUST Govt. of Andhra Pradesh

Background: Hospitalization Expenses in AP

Source: The Institute Of Health Systems, HACA Bhavan, Hyderabad, AP 500004

Escalating health care costs: leading to rural indebtedness Large proportion of people, especially below poverty line borrow money or sell assets to pay for hospitalization

Rajiv Aarogyasri
A PUBLIC PRIVATE PARTNERSHIP
( NOT A CONVENTIONAL INSURANCE SCHEME )

AAROGYASRI TRUST INSURANCE COMPANY NETWORK HOSPITALS DISTRICT ADMINISTRATION

REGULATOR RISK COVERAGE SERVICE PROVIDER MOBILISATION

FED. OF SELF HELP GROUPS HEALTH WORKERS (AAROGYA MITHRAS) SOFTWARE COMPANY TECHNOLOGY SOLUTIONS
3

Main Features
Universal Coverage All BPL Families 2.03 crores Cashless treatment Up to Rs 2 lakhs in a year Health Workers 3394 Aarogyamithras Health camps 8058 camps so far. Simple Procedure Health card/White Card Cost Borne by the Government Diseases Identified Packages For end-to-end treatment Choice of Hospital Left to patients Monitored On-line : 24 hour basis Implementation : Aarogyasri - I through Insurance Co. Aarogyasri II directly by Trust

The scheme would provide coverage for 942 surgeries/therapies for identified diseases in following systems General Surgery ENT Opthamology Gynacology&Obstetrics Orthopaedics Surgical Gastroenterology Cardio Thorasic surgery Pediatric Sugery Genito Urinary surgery Neuro surgery Surgical Oncology Medical oncology Radio Oncology Plastic Surgery Polytrauma Prostheses Critical care General Medicine Infectious Diseases Paediatric Intensive Care Neonatal Intensive care Paediatric General Cardiology Nephrology Neurology Pulmonology Dermatalogy Rheumatology Endocrinology Gastroenterology Cochlear Implantation

Disease Coverage

AarogyaMithras

NW Doctors

Insurance Doctors

Trust Doctors

Trust
CEO

Banks

Citizens

AAROGYASRI IMPLEMENTATION
Trust Administration /Insurance Company
PHCS/ CHCS AREA HOSPITAL DIST HOSPITALS DIRECT HEALTH CAMPS ACCIDENT SITES CM CAMP OFFICE Preliminary Verification

Preauthori zation

Monitoring

Claim Processing

Patient

Claims

Payments

Treated Patient

Diagnosis

Admission

Treatment

Billing Follow Up

Network Hospital

Health Camps Bed Patient Patients Medicines BPL Data Inventory Data Capacity Records Feedback Workflow designed by Trust and Technology Solution Inventory By TCS Ltd Provided

Financial Data

Infrastructure and Manpower

Aarogyamithras at PHC/CHC/Area Hospital Aarogyamithras at Network Hospitals Operations team (Preauth, Claims, Health Camps, Grievance etc.) Doctors (Preauth, Claims, Inspections etc.) Field officers Call Centre Executives Work Stations/Systems ( Computer, Servers) Bandwidth Usage
Application Server ,Web server ,Data Base Server ,File Server ,Back up server for Application server and Web server ,Back up server for data base server, Application server cluster ,Web server cluster

1840 1554 422 120 196 120 219 37 mbps 1 each 38

TCS Professionals

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.

23-03Category wise surgeries/Therapies ( 23-03-09)

Category
ONCOLOGY CARDIAC AND CARDIOTHORACIC SURGERY NEUROSURGERY GENITO URINARY SURGERIES POLY TRAUMA GENERAL SURGERY GYNAECOLOGY AND OBSTETRICS SURGERY NEPHROLOGY CARDIOLOGY NEUROLOGY PEDIATRIC SURGERIES ORTHOPEDIC SURGERY AND PROCEDURES

Surgeries/ Therapies 47536 42045 23323 21488 21165 20155 12695 5284 4797 4407 4231 3824

23-03Category wise surgeries/Therapies ( 23-03-09)

Category PEDIATRICS PLASTIC SURGERY ENT SURGERY SURGICAL GASTRO ENTEROLOGY OPTHALMOLOGY SURGERY CRITICAL CARE GASTROENTEROLOGY PULMONOLOGY GENERAL MEDICINE COCHLEAR IMPLANT SURGERY RHEUMATOLOGY ENDOCRINOLOGY DERMATOLOGY INFECTIOUS DISEASES TOTAL

Surgeries/ Therapies 3706 3540 2306 1558 1453 1226 1175 603 268 256 179 109 36 2 2,27,376

23-03Hospital - surgeries/Therapies ( 23-03-09)

Corporate Hospitals Govt. Hospitals Total Surgeries/Therapies 192382 34985 2,27,367 % 84.16 15.39 100.00 Amount (Rs Crores) 627.87 104.26 732.13 % 85.76 14.24 100.00

23-03Gender - surgeries/Therapies ( 23-03-09)

Women and childen Men Total Surgeries/ Therapies 1,27,429 99,938 2,27,367 Surgeries/ Therapies (%) 56.05 43.95 100.00

23-03Age - surgeries/Therapies ( 23-03-09)

Age Group Below 45 Above 45 Total Surgeries/ Therapies 1,49,205 78,162 2,27,367 Surgeries/ Therapies (%) 65.62 34.38 100.00