Aarogyasri

Aarogyasri or ntr Vaidya seva is a program of the Government of Andhra Pradesh. It covers those below the poverty line. The government issues an Aarogyasri card and the beneficiary can use it at government and private hospitals to obtain services free of cost.^[1]^[2]^[3]

History

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.Nandamuri Taraka Rama Rao Vaidya Seva Health Insurance Scheme (Dr NTR Vaidya Seva 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 Programme

Dr NTR Vaidya Seva Health Insurance Scheme is the flagship scheme of all health initiatives of the State Government with a mission to provide quality healthcare for the poor. The aim of the Government is to achieve "Health for All". In order to facilitate the effective implementation of the scheme, the State Government set up the Aarogyasri Health Care Trust under the chairmanship of the Chief Minister. The trust is administered by a Chief Executive Officer, an IAS Officer. The trust runs the scheme, in consultation with specialists in the field of healthcare.

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.2.50 lakh per family per annum on floater basis. There shall be no co-payment under this scheme. Benefit Coverage (Depth of Universal Health coverage)

Enrollment

The beneficiaries of the scheme, the members of Below Poverty Line (BPL) families, as enumerated and photographed in BPL Ration Card and available in Civil Supplies Department database.

Extent of Cover

The benefit to the family is on a floater basis i.e. the total reimbursement of Rs.1.50 lakhs can be availed individually or collectively by members of the family. An additional sum of Rs 50,000 is provided as a buffer to take care of expenses if it exceeds the original sum i.e. Rs 1.50 lakhs per family. Excepting cost for cochlear implant surgery with auditory-verbal therapy is reimbursed by the trust up to a maximum of Rs.6.50 lakhs per case.

All transactions are cashless for covered procedures. A BPL beneficiary can go to any hospital either public or private and come out without making any payment to the hospital for the procedures covered under the scheme. The same is the case for diagnostics, if eventually the patient does not end up in undergoing the surgery or therapy.

Hospitals are mandated to conduct free health camp, thereby taking advanced evaluation at the doorstep of patient.

Point of Contact

All the Primary Health Centers (PHCs) which are the first contact point, area/district hospitals and network hospitals, are provided with help desks manned by AAROGYA MITHRAs to facilitate the illiterate patients. The Aarogyamithras were selected by the Zilla Samakhyas and Mandal Samakhyas under Indira Kranti Patham (Self Help Groups).

Excluded Treatments

The diseases specifically excluded from the list are high end diseases such as hip and knee replacement, bone morrow, cardiac and liver transplantations, gamma-knife procedures in neuro surgery, assisted devices for cardiac failures etc; and diseases covered by national programmes viz., TB, HIV/AIDS, leprosy, infectious diseases,malaria, filaria, gastroenteritis, jaundice etc.

To the extended RAS covers the treatments, it would no longer be permissible for the BPL holders to apply for relief for medical purposes under Chief Minister Relief Fund (CMRF).

Controversies

There is widespread misuse of the programme by hospitals.

External links

References

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