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    Aarogya Sree

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    nrenukumar
    The document describes the Rajiv Aarogyasri Community Health Insurance Scheme in Andhra Pradesh. The scheme provides universal health insurance coverage for all below poverty line families, providing cashless treatment of up to Rs. 2 lakhs per year for identified diseases. It covers 942 different surgeries and therapies. The scheme is implemented through a partnership between the government, private hospitals, an insurance company, and community groups. Over 2.27 lakh surgeries and therapies have been performed under the scheme so far, primarily in private hospitals.

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    Aarogya Sree

    Uploaded by

    nrenukumar
    318 views11 pages
    The document describes the Rajiv Aarogyasri Community Health Insurance Scheme in Andhra Pradesh. The scheme provides universal health insurance coverage for all below poverty line families, providing cashless treatment of up to Rs. 2 lakhs per year for identified diseases. It covers 942 different surgeries and therapies. The scheme is implemented through a partnership between the government, private hospitals, an insurance company, and community groups. Over 2.27 lakh surgeries and therapies have been performed under the scheme so far, primarily in private hospitals.

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    The document describes the Rajiv Aarogyasri Community Health Insurance Scheme in Andhra Pradesh. The scheme provides universal health insurance coverage for all below poverty line families, providing cashless treatment of up to Rs. 2 lakhs per year for identified diseases. It covers 942 different surgeries and therapies. The scheme is implemented through a partnership between the government, private hospitals, an insurance company, and community groups. Over 2.27 lakh surgeries and therapies have been performed under the scheme so far, primarily in private hospitals.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    318 views11 pages

    Aarogya Sree

    Uploaded by

    nrenukumar
    The document describes the Rajiv Aarogyasri Community Health Insurance Scheme in Andhra Pradesh. The scheme provides universal health insurance coverage for all below poverty line families, providing cashless treatment of up to Rs. 2 lakhs per year for identified diseases. It covers 942 different surgeries and therapies. The scheme is implemented through a partnership between the government, private hospitals, an insurance company, and community groups. Over 2.27 lakh surgeries and therapies have been performed under the scheme so far, primarily in private hospitals.

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    Attribution Non-Commercial (BY-NC)
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    of 11

    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

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