Windfall for insurance companies: Just one per cent of beneficiaries utilise high end medical services under Rajiv Arogyasri scheme

By Syed Akbar
Hyderabad: The major benefits of Arogyasri notwithstanding, a
majority of patients from BPL families spend about Rs 3600 each
towards diagnostic tests, transport and other hospital incidentals.

Though there is a provision for pre-diagnostic tests, patients in many
cases spent money on the facility. Though the beneficiaries were
satisfied by the medical treatment, they were not happy with the way
health camps are conducted and information disseminated by officials
on the scheme. About 111 beneficiaries per 100,000 BPL population had
utilised the scheme. However, beneficiaries from the scheduled castes
(SCs) and scheduled tribes (STs) were significantly lower than their
proportions in the population, in a majority of the districts. The
beneficiaries did not find useful the health camps conducted by
hospitals to pick up patients in rural areas

The Indian Institute of Public Health, Hyderabad and Bhubaneswar
units, which conducted a rapid assessment of Rajiv Arogyasri Scheme,
have found that cardiac,
cancer and neurological interventions made up 65 per cent of all
treatments. Of the 350 and odd participating hospitals, 30 hospitals
located in six cities had undertaken more than 50 per cent of all
interventions. Incidentally, a majority of these hospitals are in and
around Hyderabad forcing patients to visit the State capital for
treatment.

“If the facilities at primary health centres are improved, many health
complications can be avoided. For instance, if diabetes is diagnosed
at early stage and patients given proper medicine at the PHC level,
complications like kidney problems can be prevented. This will reduce
the over all expenditure on higher medical care under the scheme,”
said Dr Shridhar Kadam, assistant professor at IIPH, Bhubaneswar.

He told this correspondent that patients living in far off places had
to spend on transport and other incidentals and these could be avoided
if the scheme is fine-tuned and logistics strengthened. The IIPH teams
observed that with increasing distance to major cities, the
utilisation rate declined.

The teams analysed 89,699 treatments undertaken for 71,549
beneficiaries and conducted surveys in six randomly selected
districts. The study was sponsored by the State government. Another
study is currently underway to update the data obtained from the last
survey.

Nearly 60 per cent beneficiaries incurred a median out-of-pocket
expenditure of Rs 3600 with transport, medicine and pre-diagnostic
investigations being the major reasons. Thirteen per cent of
beneficiaries had no follow-up visit and 28 per cent had only one
follow up visit.

The evaluation has revealed that there is scope for the scheme to
improve strategic purchasing, quality of care, integration, continuous
audit and in-built evaluation, he said.
The IIPH has suggested developing more coherent, cohesive and
integrated health system with convergence of preventive, promotive and
curative services taking into account the wider determinants of health.