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Aarogyasri Health Care Trust

There was a felt need in the State to provide financial protection to families
living below poverty line for the treatment of serious ailments such as cancer, kidney
failure, heart diseases etc. Available network of government hospitals do not have
the requisite pool of specialist doctors to meet the state wide requirement for such
treatment. Consequently poor patients have to go to private hospitals and incur huge
costs. This has led to their destitution and heavy indebtedness. n many cases,
patients die in harness unable to access medical treatment which is beyond their
means. Mounting medical expenses is identified as one of the causes leading to
pauperization of the farming community.

Aarogyasri Health Care Trust was therefore set up to implement a Community
Health nsurance Scheme named Aarogyasri (Aarogyasri-I to begin within three
districts of Mahboobnagar, Ananthapur, Srikakulam from 01-04-07. While formulating
the scheme, experience gained in other States of similar schemes viz. Yashaswini of
Karnataka, Karuna of Tamilnadu, Universal Health nsurance Scheme of Govt. of
ndia was carefully studied. The scheme has since been extended to the entire State
with some modifications in a phased manner. Trust also established a network of
hospitals, fixed the diagnostic and treatment protocol to keep the cost of
administering the scheme low. Government and private hospitals fulfilling minimum
qualifications in terms of availability of inpatient medical beds, laboratory,
equipments, operation theatres etc. and a track record in the treatment of specified
diseases are enlisted for providing treatment under the scheme. Premium under the
scheme is fully borne by the Government.
RoIe of ICT

The Primary channel through

which Rajiv Aarogyasri Scheme
is utilized by the Target groups is
through its CT Website
(http://www.aarogyasri.org. The
Website Portal is a workflow
oriented integrated system which
takes care of the target groups
right from the registrations of a
patient to the discharge, claim
settlement and then

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administering of follow up medicine to the patients.

Each phase through which a
patient goes through, be it n
patient registration/Out Patient
registration/Surgery
Updates/Discharge Updates/Claim
Settlements etc., everything is
taken care by the CT itself. Every
user who facilitates the Patient is
provided with a Login d and
Password using which he/she
should login to the system and
operate on the patient pertinent
details. The Users who facilitate
the patients would have to use the
CT and provide their appropriate
inputs and use the responses
obtained from the CT to help the
patient get a successful treatment and happy discharge. Furthermore the CT allows
for online payments to the Service providers, aids in Auto generation of Tax filing
information, Empanelment of Hospitals, Grievance handling etc.

eneraI Information on the scheme.

1. Details of patients reporting and referrals from the PHC/CHC/Government
Hospitals/ District hospitals on daily basis
2. e-Health Camps system and daily reporting of health camps
3. Details of patients reporting and getting referred from the health camps
4. e-Empanelment system.
5. Emergency approval system
6. Call centre application.
7. Patient registration by Aarogyamithra in Network Hospitals
8. Details of in-patients and out patients in the network hospitals
9. On-bed reporting system.
10. Costing of the Tests done in the network hospitals
11. e-preauthorization.
12. Surgery details.
13. Discharge details.
14. Real-time reporting, active data warehousing and analysis system.
15. Claim settlement
16. Electronic clearance of bills with payment gateway

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17. Follow-up of patient after surgery

18. Distribution of Follow-up medicines.
19. Aarogyasri Messaging Services.
20. Enhancement workflow
21. Grievance and Feedback workflow
22. Bug Tracking system
23. e-Office management
24. Accounting system
25. TDS workflow.
26. Death reporting system.
27. Online Donation System
28. Service ntelligence Tools
On the whole, the CT forms the core of the Scheme which makes sure that the
scheme is run in a smooth way and flags any irregularities to the appropriate
authorities at appropriate points in time.
'ision, Objectives and oaIs:
a. 'ision : 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. n 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 AS 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 nsurer 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. oaI : 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

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the total patients who require surgical treatment 10% require surgical interventions
listed in the scheme. n addition, there is enormous pre-existing load in the state for
which estimation is not available.

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$aIient features of the scheme are:

1. The scheme provides to each family financial protection up to Rs. 2.00 lakhs in a
year for medical treatment. All BPL ration card holders (white card are eligible
for benefit. n Andhra Pradesh 85% of the families numbering 1.92 crores with a
population of more than 7 crores are white card holders. Diseases covered
include Heart, Lungs, Liver, Pancreas, Cancer, Neuro Surgery, Renal, Pediatrics
Surgery, Plastic surgery Burns and Poly-trauma cases (330 major procedures.

2. The entire operation is cashless for the patient from date of reporting to hospital
till discharge. Free diagnostic and treatment facility is provided for all patients,
irrespective of surgery. Hospitals have to conduct at least one free medical
camp in a week, there by taking advanced evaluation to the doorstep of patient.

3. Cashless arrangement with network hospitals is one of the key elements of the
scheme, whereby beneficiary once registered in network hospital does not have
to pay at all for the entire process of treatment. This has become possible by
evolving package rate, which in addition to actual cost of treatment includes cost
of conducting heath camps, screening of patients, diagnostics, testing and
treatment, food, transport and follow-up.

4. An insurance company undertakes the health insurance and provides risk cover,
on payment of premium. Selection of insurance company is done through a
process of competitive bidding (technical & financial and quote of lowest
premium.
5. Scheme provides coverage for meeting expenses of hospitalization and surgical
procedures of beneficiary members up to Rs.1.50 lakhs per family per year
subject to limits, in any of the network hospitals. The benefit on family is on
floater basis i.e., the total reimbursement of Rs.1.50 lakhs can be availed of
individually or collectively by members of the family.

6. A separate fund is maintained as Buffer / Corporate floater to take care of
expenses; if it exceeds the original sum i.e., Rs.1.50 lakhs per ndividual / family.
n such cases, an amount upto Rs.50, 000 per individual / family is additionally
provided.

7. Participating hospitals are required to be empanelled with selected insurance
company, based on pre-fixed criteria of availability of infrastructure, equipment
and qualified personnel. Choice of hospital for treatment from among
empanelled hospitals is given to the patient. Patient facilitation is done through a
dedicated team of Aarogyamithras (Health workers. 24 x 7 Call Centre (Toll
Free Number 1800-425-77-88 and a Help Desk at each network hospital.
Treatment is to be provided in hospitals as per pre-fixed medical protocols.

8. All Primary Health Centres (PHCs, which are the first contact point, are provided
with Aarogyamithra (Health Worker selected by women self-help groups to help
illiterate patients.

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9. Scheme is implemented online through an T portal for efficiency, transparency

and accountability. An T company is engaged to develop and maintain software,
hardware and all data and medical records pertaining to the scheme.

Aarogyasri scheme is unique in its applicability, since no other State/
government agency has provided universal health coverage to the poor for major
ailments. The choice of hospital for treatment is with the patient. The entire process
from the time of conduct of health camps to the screening, testing, 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 fully meets the medical requirements of BPL
population. Government hospitals treating Aarogyasri patients are entitled to receive
same payment as the private and corporate hospitals. Government hospitals and
institutions have obtained approvals worth Rs.526.68 Crores till date under the scheme.
65 percent of the revenue goes to hospital development society and remaining 35
percent to the team of treating doctors and Para medics as incentive. This system is
motivating more and more government hospitals to participate in the scheme and utilize
the revenue earned to improve facilities to provide quality medical care and thus bring
reforms in tertiary medical care. Several States and foreign dignitaries have visited the
Scheme and appreciated the efforts. The scheme is providing much needed help to
poor families for treatment of serious ailments, thereby saving them from debt trap. t is
also bringing advanced surgical treatment within their reach and helping many an
invalid young and elderly patients to resume their livelihood.

!rogress of the $cheme (as on 29.03.2011):

Since inception of the scheme (Aarogyasri- from 1
st
April, 2007 and Aarogyasri-
from 17
th
July 2008 25,330 Medical camps were held by the network hospitals in rural
areas and 43.11 Lakh patients were screened in these health camps. So far 24.03 lakh
patients were treated as out- patients and 11.01 lakh patients treated as in-patients in
334 network hospitals under the scheme. 9.63 lakh patients underwent surgery /
therapy and the preauthorized approved amount is Rs 2732.63 Crores.

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abu Ahamed is a member of the ndian Administrative Service

(AS and presently working as Chief Executive Officer of
Aarogyasri Health Care Trust, an independent Trust established by
the Government of Andhra Pradesh, ndia to formulate, design and
implement an insurance scheme for 70 million people below
poverty line of the state. Under his leadership this unique health
insurance scheme 'Aarogyasri Community Health nsurance
Scheme', was launched as a pilot scheme on 1st April 2007 and
was extended to all 23 districts covering 70 million people within 15 months, thus
transforming the health care scenario in the state. He has established an online
process flow for tracking patients from the point of screening in the villages, reporting
to hospitals, treatment, discharge, follow-up and fund management thus making the
scheme work on a paperless platform with accountability.

!R$ONAL $&ARY:

- Date of irth : 14 JuIy 1975
- NationaIity : Indian
- aritaI $tatus : arried


!ROF$$IONAL $&ARY:


2000 2002 Manager, National Bank for Agriculture & Rural Development,
Bhopal, Madhya Pradesh
2002 2003 ndian Revenue Service
2003 2005 Asst. Commissioner (Customs & Central Excise
Assistant Collector, Guntur, Andhra Pradesh
ndian Administrative Service
2005 2007 Sub Collector, Madanapally, Chittoor, AP
2007 February
till date
CEO, Aarogyasri Health Care Trust, Hyderabad, AP