How good & effective is Arogya Sri Scheme ?

 Addressing Deficiencies in Arogya Sri Scheme Management

The Arogya Sri scheme in Andhra Pradesh has been instrumental in providing essential healthcare services to Below Poverty Line (BPL) families. However, its implementation has faced numerous challenges that have hindered its effectiveness.

 AP state has  roughly 1.4cr  ration cards according to the department of consumer affairs, food and civil supplies. This, coupled with an increase in income limit of Rs 5 lakh, has brought almost 96 per cent of the people under the ambit of Aarogyasri, with 1.4 cr separate Aarogyasri cards issued currently. 

One major issue is the irregular payment of claims to empaneled hospitals, leading to financial strain and delays in patient care. Additionally, the annual adjustment of treatment package prices has not been consistent, leaving hospitals facing rising costs.

Furthermore, the process of obtaining and renewing empanelment involves excessive bureaucracy. Hospitals are required to navigate a complex web of permissions from various departments, placing an undue burden on their administrative resources. A streamlined single-window system would alleviate this issue.

The rigidity of insurance package prices fails to accommodate the diverse healthcare needs and financial circumstances of patients. A uniform package price for a specific procedure ignores the varying severity and complexity of cases. Co-existing diseases, unforeseen complications, and individual risk factors can significantly impact the cost of treatment.

 To ensure equitable access to healthcare, insurance packages should embrace flexibility. By tailoring coverage to individual patient needs, insurers can provide comprehensive support without imposing undue financial burdens.

 The claim process must recognize the potential for additional expenses arising from co-existing conditions and complications. Reimbursement should not be hindered by inflexible package pricing but rather honor the actual costs incurred during the course of treatment. This flexibility ensures that patients receive the necessary medical attention without being penalized for factors beyond their control. By embracing a patient-centric approach, insurance companies can foster a healthcare system that is both affordable and responsive to the unique needs of individuals.

some more Challenges in the Arogya Sri Scheme: 

The Arogya Sri Scheme, a healthcare program in AP, has faced several issues that compromise its effectiveness.

Bribery and Unethical Practices:
* Hospitals have been accused of paying bribes in lakhs to obtain empanelment under the scheme.

* Trust employees have colluded with these hospitals, leading to unnecessary admissions and increased financial burden on the government.

* No pre-authorization &Utilization of 1000/- category : not even single hospital is doing above 1000/- package procedures.(OPD &DAY CARE)! Despite the scheme's mandate, no hospital has attempted to provide services under the category of  minimum package procedures Rs.1000/- to the  patients.

Financial Abuses:
* Very few hospitals reportedly collect additional fees from patients, a practice that was not prevalent before.

Lack of Package Adjustments:
* The government has not adjusted the reimbursement packages for hospitals, despite promises to increase them by 3% annually.
* In some cases, hospitals have even faced deductions in payments citing clerical and data entry errors!

*Broken Promises:
* In 2017, the government promised to increase packages by 2.8% per year. However, this was only implemented for one year before the government changed its stance.

These challenges undermine the integrity and effectiveness of the Arogya Sri Scheme. 

Urgent measures are needed to address these issues, including:

* Strict enforcement of anti-bribery laws
* Investigation and prosecution of unethical hospitals and trust employees
* Ensuring that all hospitals provide the required number of free services
* Adjusting reimbursement packages to cover the actual cost of providing care
* Honoring government commitments to increase funding for the scheme.  

To enhance the scheme's efficiency, it is recommended to:

* Ensure timely payment of claims to em-paneled hospitals to maintain their financial viability.
* Establish a regular mechanism for the adjustment of treatment package prices based on inflation and other factors.
* Implement a single-window system for empanelment and renewal to reduce administrative burdens.
* Allow all interested hospitals to participate regardless of bed strength, ensuring access to a wider range of healthcare providers.
* Establish a grievance redressal committee with representation from empaneled hospitals to facilitate prompt resolution of concerns.

By addressing these deficiencies, the Arogya Sri scheme can optimize its management practices and ensure that BPL families continue to receive the quality healthcare they deserve.

Ayushman Bharat Scheme  

The centrally sponsored Ayushman Bharat (PM-JAY Pradhan Mantri- Jan Aarogya Yojana) is being implemented by the National Health Agency and government of Andhra Pradesh by entering into a memorandum of understanding to implement the central scheme. The expenses are shared in the ratio of 60:40 between the Centre and states as is the norm in all schemes.

click this link for  My comments& comments of other stakeholders in :  https://www.downtoearth.org.in/news/health/how-effective-has-andhra-pradesh-s-aarogyasri-scheme-been-81839