The rural population as well as the low-income families in the urban areas of the state of Telangana did not have access to advanced medical infrastructure earlier. They, hence, endured the health conditions they were suffering from for a long time. Many individuals who had cancer, or any kidney-related, heart-related, or brain-related health conditions were forced to remain untreated due to the lack of healthcare facilities in the region.
The government was constantly trying to strengthen the health sector of the state at that time. However, there were not enough medical professionals or adequate equipment to treat patients. Therefore, there was a gap between the number of sufferers of ill health and the capacity of the government to cater to the needs of the people. Due to this reason, the low-income groups could not afford medical services in private hospitals and would incur huge debts or end up losing their lives because of the non-treatment of the disease they were suffering from.
The state government of Telangana then introduced a health insurance scheme named Aarogyasri Community Health Insurance Scheme that provides health insurance coverage to Below Poverty Level (BPL) families. The scheme, that aims to cover the underprivileged from critical illnesses, is implemented by the Aarogya Healthcare Trust. The Chief Minister of the state chairs the trust. The trust, along with many experts from the fields of healthcare and health insurance, created a scheme for the benefit of the rural masses.
Aarogyasri Community Health Insurance Scheme:
The Aarogyasri health insurance scheme was created with the idea to provide financial aid to BPL families requiring hospitalisation, therapies, or surgeries in hospitals.
Features of the Aarogyasri Health Insurance Scheme:
The features of the government-funded health insurance scheme are:
- Beneficiaries who require hospitalisation and surgery are covered for a sum assured limit up to Rs.2 lakh per year per family. A total of Rs.1.5 lakh can be reimbursed as part of the treatment for a single family member or all family members together. An additional Rs.50,000 is provided if the Rs.1.5 lakh is exceeded.
The scheme offers coverage for a range of procedures. All in all, 949 procedures are covered under the scheme. A few of the health issues and treatments that are covered under the scheme are:
- Heart, liver, lung, kidney, pancreas-related health conditions
- Post-burn contracture surgery
- Cancer – Radiotherapy, chemotherapy, surgery
- Cochlear Implant Surgery plus Auditory Verbal Therapy (Coverage up to Rs.6.5 lakh is available)
Pre-existing conditions of the above-mentioned health issues are also covered.
- All transactions made under the scheme are cashless. An individual need not go through the hassle of paying the bill and then requesting for a reimbursement of the spent amount.
- In case the beneficiary undergoes diagnostic tests but does not end up going through a surgery or any major treatment, coverage will still be provided to him/her.
- Primary healthcare facilities, network hospitals, and district hospitals have help desks with an Aarogya Mitra. The Aarogya Mitra will help the beneficiaries in the hospitalisation and claim process.
Exclusions of the Aarogyasri Health Insurance Scheme:
A few procedures mentioned below are excluded from the health insurance scheme:
- Knee and hip replacement
- Gamma knife procedures required for neurosurgeries
- Liver, bone marrow, and cardiac transplantations
- Assisted devices for heart failures
- Infectious diseases
Health Camp services:
The goal of the state of government is to create awareness among the rural population about the state health insurance scheme. Also, the state wishes to spread awareness about the different diseases existent around. Further, it is important for people to be aware of the free medicines as well as medical advice available to them under the scheme.
As part of the IEC activities, network hospitals of the scheme are required to conduct free health camps in order to take evaluation and treatments to the doorstep of the beneficiaries.
Some of the activities conducted by the health camps are:
- Addressing the public on a microphone in public areas
- Making advertisements on the radio
- Playing audio-visual media
- Distribution of pamphlets
- Writing news articles and advertisements in daily newspapers
- Putting up posters and banners
- Conducting village meetings
- Exhibits in general health, early detection of diseases, prevention of communicable and chronic diseases
Beneficiaries of the scheme are mobilised through the health camps conducted under the scheme. The Aarogya Health Care Trust will also conduct mega health camps at the revenue division level to make sure maximum number of people are aware of the scheme.