Dr.YSR Aarogyasri health insurance scheme

Introduction

Towards achievement of universal health coverage for BPL families whether defined in terms of financial protection or access to and effective use of health care, Government of Andhra Pradesh is implementing state sponsored Dr.YSR Aarogyasri Health Insurance Scheme. This scheme certainly counts to be one of the pioneers in terms of achieving equity and providing accountable and evidence-based good-quality health-care services in the state to assist poor families from catastrophic health expenditure. The aim of the Government is to provide Universal Health Coverage to BPL families. The scheme is a unique PPP model in the field of Health Insurance, tailor made to the health needs of poor patients and provides end-to-end cashless services for identified diseases under secondary and tertiary care through a network of service providers from Government and private sector.

The scheme has established a demand-side mechanism that mobilizes and channels additional public financing to health, introduced an explicit benefits package, pioneered cashless care and fostered public private partnerships.

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. The IEC activity during the health camps, screening, counselling and treatment of common ailments in the health camps and out-patient services in network hospitals is supplementing the government health care system in preventive and primary care.

In order to facilitate the effective implementation of the scheme, the State Government set up the Dr.YSR Aarogyasri Health Care Trust, under the chairmanship of the Honorable 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 healthcare, runs the scheme.

Dr.YSR Aarogyasri Health Insurance scheme is unique in its applicability since no other State/ government agency has provided universal health coverage to the poor. The choice of hospital for treatment is with the patient. The entire process from the time of conduct of health camps to the screening, diagnosing , treatment, follow- up and claim payment is made transparent through online web based processing to prevent any misuse and fraud. The scheme is complimentary to facilities available in government hospitals and put together provides Universal Health Coverage to BPL population including Prevention, Primary care and In-Patient care. All the Primary Health Centres (PHCs) which are the first contact point, Area/District Hospitals and Network Hospitals, are provided with Help Desks manned by VAIDYA MITHRA’s to facilitate the illiterate patients.

Objective

  • To provide free quality hospital care and equity of access to BPL families by purchase of quality medical services from identified network of health care providers through a self-funded reimbursement mechanism (serviced by Trust).
  • To provide financial security against the catastrophic health expenditures.
  • To strengthen the Government Hospitals through demand side financing.
  • To provide universal coverage of health for both urban and rural poor of the State of Andhra Pradesh.

Geometry Of Health Insurance Coverage

  • Population coverage (Breadth of Universal Health coverage) The beneficiaries of the scheme are the members of Below Poverty Line (BPL) families as enumerated and photographed in White Ration Card linked with Adhar card and available in Civil Supplies Department database.
  • Financial coverage (Height of Universal Health coverage) The scheme shall provide coverage for the services to the beneficiaries up to Rs.5 lakh per family per annum on floater basis. There shall be no co-payment under this scheme.
  • Benefit Coverage (Depth of Universal Health coverage)
  • Out-PatientThe 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.
  • In-PatientThe scheme shall provide coverage for the 3257 “Listed Therapies” for identified diseases in the 31 categories ‘€“ Are listed in website: www.ysraarogyasri.ap.gov.in

 

Package includes the following services:

  • End-to-end cashless service offered through a NWH from the time of reporting of a patient till ten days post discharge medication, including complications if any up to thirty (30) days post-discharge, for those patients who undergo a “listed therapy(ies).
  • Free OP evaluation of patients for listed therapies who may not undergo treatment for “listed therapies.
  • All the pre-existing cases under listed therapies are covered under the scheme.
  • Food and Transportation.

The scheme provides coverage for the procedures under following categories:

  • CARDIAC & CARDIOTHORACIC SURGERY
  • CARDIOLOGY
  • COCHLEAR IMPLANT SURGERY
  • CRITICAL CARE
  • DERMATOLOGY
  • EDOCRINOLOGY
  • ENT SURGERY
  • EPIDEMIC DISEASE
  • GASTROENTEROLOGY
  • GENERAL MEDICINE
  • GENERAL SURGERY
  • GENITO URINARY SURGERIES
  • GYNAECOLOGY AND OBSTETRICS SURGERY
  • INFECTIOUS DISEASE
  • MEDICAL ONCOLOGY
  • NEPHROLOGY
  • NEUROLOGY
  • NEUROSURGERY<
  • OPTHALMOLOGY SURGERY
  • ORGAN TRANSPLANTATION SURGERY
  • ORTHOPEDIC SURGERY AND PROCEDURES
  • PEDIATRIC SURGERIES
  • PEDIATRICS
  • PLASTIC SURGERY
  • POLY TRAUMA
  • PSYCHIATRY
  • PULMONOLOGY
  • RADIATION ONCOLOGY
  • SURGICAL GASTRO ENTEROLOGY
  • RHEUMATOLOGY
  • SURGICAL ONCOLOGY

 

Important Stakeholders In The Scheme Are

The beneficiaries The Scheme is intended to benefit 129.44 lakh families in all 26 districts of the state.

 

  • Dr.YSR Aarogyasri Health Care Trust – Implementing agency In order to implement the scheme in a dynamic and hassle free manner Government of AP established an Independent Trust “Dr. YSR Aarogyasri Health Care Trust”. The scheme is implemented directly by the Trust by entering into contract agreement with network hospitals

 

  • Network Hospitals – Service Providers A health care provider shall be a hospital or nursing home in Andhra Pradesh/Telangana established for indoor medical care and treatment of disease and injuries and should be registered under Andhra Pradesh Private Allopathic Medical Establishments (Registration & Regulation) Act and Pre-Conception and Pre-Natal Diagnostic Techniques Act (Wherever Applicable).

 

  • District Administration – Mobilization District level monitoring committees are setup with district collector as the chairman of the committee. This committee not only reviews the implementation of the scheme through regular review meetings but also help mobilize patients by encouraging them to attend health camps, conducting awareness campaigns through peoples representatives, Self Help Groups and other field functionaries.

 

  • Software Company – Technology Solutions A dedicated real-time online workflow system was designed by the Trust in order to bring dynamism and decentralization of work like Online processing of the cases starting from registration of case at first referral center, health camps etc., registration at network hospital, pre-authorization, treatment and other services at the hospital, discharge and post treatment follow-up, claim settlement, payment gateway, accounting system, TDS deductions, e-office solutions etc. The maintenance of the workflow is done round the clock..

For more information 

https://www.ysraarogyasri.ap.gov.in/asri