The Rajiv Gandhi Jeevandayee Aarogya Yojana (RGJAY) scheme, a unique PPP model health insurance scheme, which had completed a year, could provide cashless treatment to around 70000 BPL and APL families. And the number of people undergoing critical identified surgeries are still increasing. Dr K Venkatesham, IPS, Chief Executive Officer of RGJAYS & member secretary of the society, in an interview with Abhidnya S Matwankar gives an overview of the scheme and shares his views on making the scheme successful in reaching out to the public and also the expansion plans in the state.
After initiating RGJAY scheme last year, to what extent the scheme is successful?
We feel that the scheme was reasonably successful in reaching out to the needy. If we compare the first year impact of the existing similar schemes in Andhra Pradesh and Tamil Nadu, the number of people who had been benefited in Maharashtra is quite high. However, as the scheme was new to the state we were not sure to what extent it will be successful in the state.
The biggest challenge was in sensitising public of the availability of the scheme. Any government scheme will be successful only when its beneficiaries are aware of it. Further apart from the beneficiaries coming under a particular scheme, no one else should be allowed to utilise it.
Another challenge was to bring government hospitals and its institutions on board. Till date we have about 40 plus institutions and their hospitals as a part of the scheme which is a plus point for expanding the reach of the scheme across the state.
The number of people who have been benefited out of this scheme in one year is now close to 70,000 families from the eight districts i.e. Gadchiroli, Amravati, Nanded, Sholapur, Dhule, Raigad, Mumbai and Suburbs.
Currently the scheme is being carried out only in eight districts in phase I. Are there any major steps the state government is initiating to increase the reach of the scheme?
The government intends to expand the scheme to cover the entire state. The state government, through its Public Health Department at Mantralaya is in talks on this with the National Insurance Company for the last few months. Soon the government may expand the scheme in phase II by empanelling around 370 hospitals. We are also aiming to cover the entire state and thus maximising its reach among the masses.
How different is this scheme from the schemes run by charitable hospitals?
Charitable hospitals have their own schemes which are different from RGJAY. Under charity schemes, hospitals get benefit from government in form of free land lease hold, income tax or custom tax benefits. For this they have to register themselves as charity societies and need to provide 10 per cent free of cost to Below Poverty Line (BPL) and 10 per cent at lowest cost to Above Poverty Line (APL) people.
But our scheme is identified for tertiary care procedures. Under this scheme, the state government provides various facilities like free diagnostics, treatment for 972 critical surgeries, health camps, medicines, follow up treatments, etc. where the entire thing is free. So our scheme is recognised as a “Complete Cashless Scheme”.
Can you briefly explain how the system works?
The state govt has found a society i.e. Rajeev Gandhi Jeevandayee Society which is headed by the Chief Minister Prithviraj Chauhan, Health Minister Suresh Shetty and Deputy Chief Minister Ajit Anantrao Pawar and this society is run by a member secretary, CEO. Under the CEO there are officers on deputation or on contract basis. The society has purchased a national insurance policy from the National Insurance Company.
How is the response from the public for the scheme? How many BPL families have been benefited by the scheme, till date?
We have been receiving enthusiastic response from the public and now more and more people are coming forward for enrolling under this scheme since its inception last year. By July 2013, we had around 70000 families under APL and BPL who had been treated under this scheme. We are providing health insurance cover up to Rs. 1.5 lakh for families earning less than Rs. one lakh per year.
We have also sent letters signed by the Chief Minister to each of the beneficiaries who have been treated under the scheme. We had a very good response to this. They have send their suggestions and also difficulties faced by them during the treatment. Up to this time we haven't got any negative response from the beneficiaries. In case we get any negative response, we consider it only as a suggestion for improving the scheme further.
How does the society help a patient to enrol in the scheme?
If a patient have any difficulty in finding a hospital or doesn’t have the knowledge on how to reach the hospital, he can give a call on 155388 at our call centre which runs 24X7 for helping patients. The moment a patient tells about his ailment, our call centre members see whether the patient comes under any of the 972 critical surgeries and ensure that he gets benefit out of it. The society gives the approvals to those who have enrolled for the scheme within 12 hours.
Whenever patient/beneficiary visits an empanelled hospital, Aarogyamitras (facilitator services) help them to get the problem diagnosed. Once a patient is identified and enrolled for one of the 972 surgeries mentioned under the scheme, Aarogyamitras will help him in getting the cashless treatment.
Those who are aware of the scheme has the opportunity to work with us to bring RGJAY scheme to the beneficiaries.
How many Aarogyamitras are currently involved in the scheme? Could you kindly explain their role in the implementation of the scheme?
Aarogyamitras act as facilitators for the patients. Whenever a patient comes to the hospital, he explains the modalities of scheme. Then he liaises with doctor and ensures that the patient gets a cashless treatment.
Till date, we have total 600 plus Aarogyamitras across all the empanelled hospitals.
According to some reports, hospitals are rejecting surgeries under the scheme. How far this is true?
Our scheme is very ambitious. We have came across complaints about some hospitals rejecting genuine patients and some hospitals abusing the procedures just to make money. We are taking strict actions against such hospitals like suspension for some time or totally de-empanelling from the scheme.
We have received complaints about two hospitals from one of the districts. We had suspended them for a while and only after the assurance from them that they will not repeat it again, we have empanelled them again for the scheme.
What is the response to the health camps under the scheme? Is the society planning to conduct more such health camps in future?
Earlier when the scheme was launched, all the empanelled hospitals had to conduct health camps four times in a month in places suggested by the government. Initially they were reluctant to hold the camps as this was very expensive.
Now, on an average we are able to conduct two camps per month at a hospital. These health camps help in taking primary healthcare to the public. Those who are found to be in need of any one of the 972 surgeries during these camps is followed up and taken up or enrolled in this scheme.
Thus these camps help to make common man aware of the scheme. If the public is not aware of the scheme, it is of no use. When hospitals organise camps in remote villages after advertisement campaigns, public will be aware of the scheme and the message will reach the right target audience.