Rajiv Aarogyasri Health Insurance Scheme is being implemented in the state of Andhra Pradesh in India to assist poor families from catastrophic health expenditure. The scheme is a unique PPP model in the field of Health Insurance, Tailor made to the health needs of poor patients and providing end-to-end cashless services for identified diseases through a network of service providers from Government and private sector. The scheme introduced on 01.04.2007 in three backward districts of Mahaboobnagar, Anantapur and Srikakulam on pilot basis was subsequently extended to the entire state in phased manner to cover 20.4 million BPL families encompassing 70 million population spread across 23 districts of the state from 17.07.2008. The scheme started with coverage to 163 identified diseases in 6 systems was gradually extended to 330 diseases in 13 systems under Aarogyasri-I. The coverage under the scheme was extended to 942 procedures in 31 systems with addition of 612 procedures through Aarogyasri-I. The scheme was formulated in consultation with specialists in the field of Medicine, Health and Insurance to address the needs of catastrophic health expenditure among the BPL families of the state and at the same time not to sideline the existing infrastructure in government hospitals. However the scheme is designed in such a way that the benefit in the primary care is addressed through free screening and outpatient consultation both in the health camps and in the network hospitals as part of scheme implementation. Vision, objectives and goals:
Rajiv Aarogyasri is the flagship scheme of all health initiatives of the State Government with a mission to provide quality healthcare to the poor. The aim of the Government is to achieve “Health for All” in Aarogyandhra Pradesh (Healthy Andhra Pradesh state). In order to facilitate the effective implementation of the scheme, the State Government has set up the Aarogyasri Health Care Trust under the chairmanship of the Chief Minister. The Trust is administered by a Chief Executive Officer who is an IAS Officer. The trust, in consultation with the specialists in the field of insurance and medical professionals, runs the scheme. b. Objective :
To improve access of BPL families to quality medical care for treatment of identified diseases involving hospitalization, surgeries and therapies through identified network of health care providers through a hybrid model consisting of tailor-made policy (serviced by Insurer) and self funded reimbursement mechanism (serviced by Trust) to assist BPL families for their catastrophic health needs without compromising the importance of existing Health Care Delivery system of the Government. However the scheme is designed in such a way that the benefit in the primary care is addressed through free screening and outpatient consultation both in the health camps and in the network hospitals as part of scheme implementation and areas of catastrophic health expenditure is met by the insurance scheme. The scheme combined with existing public health infrastructure together meets the total health needs of people thus providing universal coverage. c. Goal :
Since the scheme is unique and unparalleled in the country, and having introduced for the first time in the state, there is no available data to indicate the disease load and morbidity in the state. However, based on some non-specific data from the tertiary care government hospitals and incidence rate of certain diseases it is construed that around 10% of population suffer from ill health at any point of time. Out of this 60% require medical treatment and 40% require surgical treatment. Out of the total patients who require surgical treatment 10% require surgical interventions listed in the scheme. In addition, there is enormous pre-existing load in the state for which estimation is not available. • Trust is aiming at providing universal coverage in the long run through...