Financing health care of persons living below poverty line, especially for the treatment of serious ailments such as cancer, kidney failure, heart diseases, is one of the key determinants that affects the poverty levels in Andhra Pradesh. Available network of government hospitals neither have the requisite infrastructure, manpower, resources and
management autonomy nor the ability to satisfy the patients, in order to meet the tertiary care needs of the poor. As a result, many such poor approach private hospitals and incur catastrophic expenditures leading to sale of assets, indebtedness and impoverishment. In many cases, patients die in harness unable to access medical treatment which is beyond their means. Medical expenses is identified as one of the causes driving the farming community into poverty. Chief Ministers’ Relief Fund (CMRF) provides reimbursement of expenses for treatment of ailments. Though, a large number of poor patients request for assistance from CMRF, this was not helpful in meeting their total expenditure on treatment. Health insurance could be a way of removing the financial barriers and improving access of poor to quality medical care; of providing financial protection against high medical expenses; and negotiating with the providers for better quality care. Government of Andhra Pradesh, therefore, designed this scheme for implementation on a pilot basis in three most backward districts of the State viz., Anantapur, Mahaboobnagar and Srikakulam. While
designing the scheme, experience gained in other States implementing similar schemes viz. Yashaswini of Karnataka, Karuna of Tamilnadu, and Universal Health Insurance Scheme of Govt. of India was carefully studied.
A budget of Rs.50 Crores was allocated during 2007-08 to implement this scheme. Aarogyasri Health Care Trust was set up in February 2007 to act as a state level nodal agency for the implementation of theScheme. Rajiv Aarogyasri Community Health Insurance Scheme was launched in the three districts from 01-04-07, and later extended to all
other districts of the State in five phases covering the entire poor population. Coverage was given for 163 treatments including those for heart, cancer, Neuro-surgery, Renal procedures, Burns and Poly-trauma cases, etc. under the banner Aarogyasri-I. Since coverage of treatments was limited, a large number of patients continued to seek assistance from CMRF for treatment of other ailments. The Trust therefore constituted 31 teams of specialist doctors from government and private hospitals, analyzed all diseases afflicting the poor and listed more than 1500 medical and surgical procedures. The selection was based on twin criteria of the procedure being life saving in nature, and secondly shortage of specialist doctors performing the procedure in government hospitals. A list of 533(389 surgical and 144 medical) such procedures was identified for inclusion under the scheme. These procedures were
covered under the banner Aarogyasri-II and launched in the State on 17th July 2008 in order to enable all BPL families avail cashless treatment for more procedures. 79 new procedures in the specialities of Obstetrics, Eye, ENT, Cardiology, and Trauma and Critical care were further added in the Scheme with effect from 14th November, 2008,
thus bringing the total procedures covered under the Scheme to 942.
All poor families of the state of Andhra Pradesh, as defined by Civil Supplies Department of Government of Andhra Pradesh as BPL families, shall be eligible under this scheme.
Eligibility card: The eligible families are provided with Below Poverty Line ration cards or Rajiv Aarogyasri Health Cards, herein after called eligibility cards. Eligibility card for this scheme means:
(a) White ration card;
(b) Antyodaya Anna Yojana (AAY) card;
(c) Annapurna card;
(d) Rajiv Aarogyasri Health card
(e) TAP card
(f) RAP Card
The eligibility of beneficiary under the scheme shall be verified using Aarogyasri IT application or through any other means as decided by the Trust.