How effective has Andhra Pradesh’s Aarogyasri Scheme been

Context

Andhra Pradesh’s Aarogyasri scheme.

About

About Aarogyasri scheme:

The Aarogyasri scheme is a unique health scheme implemented by the State Government of Andhra Pradesh (AP).
The Aarogyasri scheme was started in
This scheme provides financial assistance to the Below Poverty Line (BPL) families for meeting their catastrophic health needs.
To achieve universal health coverage for the BPL families in terms of access to adequate health care and financial protection, the government of AP is implementing the state-sponsored Aarogyasri Health Insurance Scheme.
The Aarogyasri scheme aims to provide good quality health care services in the state and assist poor families with expensive health expenditure.
It is a Public-Private Partnership (PPP) model in the field of Health Insurance custom made to the health needs of poor patients.
This scheme provides end-to-end cashless services for the specified diseases under secondary and tertiary care through a network of service providers from the government and private sector.
The Aarogyasri scheme is designed to benefit out-patient consultation and primary care through free screening in the health camps and the network hospitals that are a part of this scheme implementation.
This scheme is unique in its applicability since no other state or government agency has provided universal health coverage to the poor.
The Information, Education and Communication (IEC) activity during the health camps, counselling, screening and treatment of common ailments in the health camps and out-patient services in the network hospitals is supplementing the government health care system in the primary and preventive care.

Objective of Aarogyasri:

To provide equity of access and free quality hospital care to the BPL families by purchasing quality medical services through a self-funded reimbursement mechanism from the identified network of health care providers.
To give financial security against catastrophic health expenditure.
To strengthen the government hospitals through demand-side financing.
To provide universal coverage of health for both rural and urban poor of Andhra Pradesh.

Shortcomings:
Aarogyasri has been lauded for some of the benefits it provides such as for tertiary and secondary care. But it also has a number of shortcomings.

Primary care:
- Primary care has to be available within a kilometre from the patients’ homes.
- For this, sub-centres and wellness centres should have MBBS doctors with basic infrastructure. This is not well addressed by the insurance model.
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.
- Though AP has fared better compared to others in allocation to healthcare, it has failed its doctors.
- The UGC pay scales were due to them from 2016.
Hospital woes
- A cross-section of empanelled hospitals made it clear that the dues to hospitals from the government were piling up.