Rural population of state, majority of whom are farmers, are not having access to advanced medical treatments and are silent sufferers of ill health. This is more true in case of diseases related to heart, kidney, brain, cancer and injuries due to domestic accidents and burns. While the Government is in the process of adequately strengthening the health institutions for basic health care, lack of specialist doctors and equipments for treatment of serious diseases has created a wide gap between the disease load and the capacity of the Government hospitals to serve the poor. These facilities though available in corporate sector are catering mainly to the affordable sections of society and are beyond the reach of poor families living in villages. Because of this gap poor patients are constrained to go to private hospitals for treatment and in the process incur huge debts leading to sale of properties and assets or are, sometimes, left eventually to die.
Aarogyasri I is a unique Community Health Insurance Scheme being implemented in Andhra Pradesh from 1st April, 2007. The scheme provides financial protection to families living below poverty line upto Rs. 2 lakhs in a year for the treatment of serious ailments requiring hospitalization and surgery. 330 procedures are covered under the scheme. The scheme is being implemented through Insurance Company, selected through a competitive bidding process. The objective of the scheme is to improve access of BPL families to quality medical care for treatment of identified diseases involving hospitalization, surgeries and therapies through an identified network of health care providers. The scheme provides coverage for the systems like Heart, Lung, Liver, Pancreas, Renal diseases, Neuro-Surgery, Pediatric Congenital Malformations, Burns, Post -Burn Contracture Surgeries for Functional Improvement, Prostheses (Artificial limbs), Cancer treatment (Surgery, Chemo Therapy, Radio Therapy), Polytrauma (including cases covered under MV Act) and Cochlear Implant Surgery with Auditory-Verbal Therapy for Children below 6 years (costs reimbursed by the Trust on case to case basis ). All the preexisting cases of the above mentioned diseases are covered under the scheme.
The beneficiaries of the scheme are the members of below poverty line (BPL) families as enumerated and photographed on the Rajiv Aarogyasri Health Card/ BPL Ration Card. 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. An additional sum of Rs 50,000 is provided as buffer to take care of expenses if it exceeds the original sum i.e. Rs 1.50 lakhs per Individual/family.Cost for cochlear Implant Surgery with Auditory ?Verbal Therapy is reimbursed by the Trust up to a maximum of Rs.6.50 lakhs for each case.
The transaction is cashless for covered procedures. BPL beneficiary can go to hospital 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 doing the surgery or therapy. Hospitals have to conduct at least one free medical camp in a month, there by taking advanced evaluation to the doorstep of patient. 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 Mandal Samakhyas under Indira Kranti Patham (Self Help Group Movement).
Encouraged by the success of the ongoing scheme, Government have now decided to launch with effect from 17th July, 2008, the Aarogyasri-II scheme to include a large number of additional surgical and medical diseases to enable many more BPL people who are now suffering from acute ailments, to lead a healthy life.
Aarogyasri-II scheme is an extension of the ongoing Health Insurance Scheme. The front end of the ongoing scheme viz., network hospitals, Aarogyamithras, Health Cards etc., will remain the same. Only difference would be that the pre-authorization and claim processing for the new diseases would be done by the Trust directly and funded from the C.M. relief fund.
30 groups of eminent doctors from the Government and corporate hospital sectors have through a series of discussions and in consultation with the managements of corporate hospitals finalized a list of 389 surgical and 144 medical diseases and also evolved package rates for its cashless treatment.
With the launch of Aarogyasri-II, cashless treatment of BPL population for all major diseases will become possible in Government / corporate hospitals. Diseases covered under ongoing Aarogyasri - I and those proposed to be covered under Aarogyasri-II are complimentary to the facilities available in Government hospitals and put together substantially meet the medical requirement of general population. The diseases specifically excluded from the list are:
To the extent the scope of Aarogyasri- I is enlarged by Aarogyasri-II , it would no longer be permissible for the BPL population to approach the Government for providing relief for medical purposes from the CMRF.District wise details of Aarogyasri