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LIFE SAVING UNIVERSAL HEALTH SCHEME

“The greatest wealth is Health” is a famous quote which is truly applicable to every human being on earth. No one wants to get sick and have any kind of disease. However, the world we are living today is a place where one cannot be healthy without any kind of disease. Daily pollution, unhealthy foods (fast foods), tobacco, alcohol, etc are becoming a part of life we are living today. No one can deny of the fact that we spend half of our earnings on health related issues in one way or other. Not to mention of metro cities but this is happening also in the hilly and tribal states like Arunachal Pradesh. However, the state government of Arunachal Pradesh is doing whatever it can in order to provide maximum health facilities to its people.

THE SCHEME

In an attempt to provide quality and affordable health care services to the people of the state, the government of Arunachal Pradesh launched a unique health scheme last year. The Arunachal Pradesh Chief Minister’s Universal Health Insurance Scheme (APCMUHIS) activated vide Government order No. APCMUHIS-01/2014 dated 16 September 2014 is now in the talk by many. As many people are not aware of the scheme because of lack in awareness, the scheme is still under uncertainty to public and also to some empanelled private hospitals.  

The scheme is unique in nature by providing cashless treatment to the resident families of Arunachal Pradesh and first of its kind among the north eastern states. The main objective of the scheme is to provide free Medical and Surgical treatment (except Outdoor Patients facility) in government and Private hospitals (empanelled hospitals that has signed a MoU with the state government) in cashless manner to the families of Arunachal Pradesh. By cashless manner it means that when a beneficiary approaches an empanelled hospital for treatment, he or she is not required to make any payment instead the payment is made on his behalf by the Insurer (i.e., New India Assurance Co. Ltd.) to the empanelled hospital. In return the State Govt. will pay money to the Insurer by way of annual premium on behalf of the beneficiary.

The financial limit of the scheme is up to ` 2 lakhs per family per year.

Health Insurance Smart Card commonly called as Green Card issued by the Insurer (i.e., New India Assurance Co.) is a pre-requisite to become a beneficiary. It is a biometric generated card consisting of beneficiary’s family member’s photo with finger prints.

The people who bonafidely stay in Arunachal Pradesh including APL, BPL, APST, Non-APST, state government employees and their dependent family member, all age group and all genders including transgender can avail this facility. The scheme excludes families of office of Profit, Central Govt. Employees, Group-B and above categories of contractors. If a new born baby arrives in the family, that baby is also a beneficiary.

THE BENEFICIARIES

The enrolment process is done by Insurer in phase wise manner for various districts with assistance from PRI on basis of data provided by the state government.

The first phase of enrolment of beneficiaries was started on 1 July 2014 and distribution of smartcard has almost completed in all the districts.

According to the data provided by the scheme head office under Director of Health Services, Naharlagun, altogether 2, 25, 128 families of the state have been enrolled so far under the scheme.

The Scheme will cover treatment procedures requiring hospitalization and day care procedures. Persons covered under Rashtriya Swasthya Bima Yojana (RSBY) and Arogya Nidhi shall also be benefitted to overall financial limit of `2 Lakhs only. Cases like Poly trauma not covered by the Motor Vehicle Act and Pre-existing diseases prior to launching of the scheme will also be covered under the scheme. Cost of treatment of withdrawal symptoms of drug abuse will also be covered for candidates voluntarily opting for de-addiction. In addition, Pre-natal expenses due to complications requiring hospitalization prior to delivery will be taken care of under the scheme.
If any patient is referred through health camps/Government hospital for diagnosis which further may not lead to surgical/medical management shall also be covered. That is cost of diagnostic test and medicines will also be covered under the scheme.


However, the scheme also have some exclusion that includesVoluntary Medical Termination of Pregnancy i.e. Abortion except induced by accident or other medical emergency to save the life of the mother. Other exclusion cases includes Sterilization and Fertility related procedures, Hormonal replacement, sex change related cases, Vaccination, Suicide, Psychiatric and Psychosomatic related disorders, Naturopathy, Unani, Sidha and Ayurveda, Tibetan system of treatments and War, Nuclear Invasion.

The scheme also provides Facility to the head of the family. If a head of family get admits in hospital for treatment, he will be paid
`100/-per day upto a maximum of 7 days; and `50,000/- will be paid to the beneficiary if death of Head of family takes place in the Hospital while taking treatment, but not for natural death. And one way transportation expenditure from residence to hospital will be reimbursed at Arunachal State Transport Bus rate and 2nd Class Sleeper Rail fare in case of outside the state.

THE PROCESS

For availing the scheme, the beneficiaries have to approach Help Desk located at every empanelled Hospital along with their smart card and can also take the help of Call Center by calling the toll free number 18002090201.

For ease of hospitalization, in case of emergency the beneficiary can directly approach the help desk of the network hospital and hospitalization procedure/medical treatment can be started subsequent to proper identification of beneficiary. It will be the duty of network hospital along with the help desk manager to inform the insurer regarding hospitalization within 3 days of the admission. In case of planned hospitalization, beneficiaries will consult doctors at Community Health Centres (CHCs) or District Hospitals(DHs), get referral slip signed and authorized in a standard format for hospitalization/medical treatment and proceed to help desk of the networked hospital for hospitalization with the referral slip. For emergency medical treatment without referral outside the state, the benefit is extended to only APST.
The validity of the APCMUHIS is said to be end by coming September and according to some official sources, it is up to the state government for its extension.

 

TAKES FROM STATE HEALTH AUTHORITIES:

According to Dr K. Nishing, Director of Health Services, Naharlagun who is also the executive director of the scheme said that “this is one of the best scheme in the history of Arunachal Pradesh targeting all walks of people especially for those poor people of the state and I am very happy for the successful implementation.”

On being asked about the delay (under the scheme the repayment has to be done within 7days) in repayment to the empanelled hospital, the director said “we want it done within 7 days but due to some unavoidable circumstances we could not. First of the all, the big reason is because of its newness. Internet problem is another hindrance. Further, we have to courier all the documents to the Insurer which is located in Mumbai and after proper verification only they release the money,” he added.

Regarding fund of the project, the director informed that a premium for one year has already been deposited in the concerned bank and appeal the people to avail maximum benefits from the scheme.

Dr. R.D. Khrime, Chief Medical Superintendent, Arunachal State Hospital, Naharlagun expressed the same view as Dr. Nishing by saying “it is a very good initiative taken by the state government and as an implementing hospital we are doing all effort to provide maximum benefits to the beneficiaries.”

Some of the important points that people have to aware for availing the benefits of the scheme at Arunachal State Hospital Naharlagun is that, it is available for only those admitted patients who have enrolled themselves under the scheme. The insurance do not cover OPD (Outpatient Department) services and cabin is also not available under the scheme. There is no system of reimbursement system of expenditure from hospital under this scheme however this varies from hospital to hospital.

“As the scheme is very new therefore some people are not aware of all the benefit and features but we are doing all effort to make it successful,” told Dr. Khrime. “The only big problem we are having is the delay in repayment by the Insurer as sometime it takes month or two that led us in backlog for huge amount, other than that the scheme is great,” he added further.

Under the scheme, the hospital has already treated more than 1500 beneficiaries and the numbers are increasing, informed Dr. Khrime.

Beneficiaries can avail the scheme in all State Government Hospitals including Arunachal State Hospital, Naharlagun, Pasighat General Hospital, Zonal General Hospitals, District Hospitals, CHCs and PHCs.

 

TAKES FROM PRIVATE HOSPITAL OF THE STATE:

“So far we had treated more than 100 patients under this scheme however we are running it on reimbursement basis in order to meet up our hospital requirements but as soon as we got repayment we call up the beneficiaries and give them their money back”, informed Dr. Kesang W Thongdok, Medical Superintendent of Heema Hospital, Itanagar. Though, the hospital provides free treatment to those people who are very poor and in some emergency cases but being a private hospital, its running cost is high; the problem we are having now is the delay in repayment because of some communication gap between hospital and the Insurer, shared Dr. Thongdok. “The state should carry forward this unique scheme and keep enrolling the people especially those poor and needy one,” he added while applauding for the scheme.

M.D. Burhan, General Manager, Samaritan Hormin Hospital, Naharlagun informed that the hospital is giving free treatment for surgery and hospitalization without reimbursement system. “We are charging for medicines as some of the packages by the government do not meet up our hospital expenses. And for cabins, we are giving discount for those beneficiaries under the scheme. So far the hospital has given free treatment to more than 200 beneficiaries,” informed Burhan.

The reviewed copy of empanelled hospital excludes RK Mission Itanagar and Niba Hospital Naharlagun which were listed earlier under the scheme.

Other private hospital that started the implementation of the scheme in the state includes Assa Diagnostic & Nursing Home, Pasighat in East Siang District, BTM Hospital Naharlagun and Tago Memorial Hospital Nirjuli in Papum Pare.

 

TAKES FROM THE BENEFICIARIES:

Bajiv Perme whose mother was treated under the scheme at Assa Diagnostic & Nursing Home, Pasighat while appreciating the scheme said that “it could have cost me around 20,000 but because of the scheme I could now use those in healthy diet for my mother.” However, Perme is worried about the future status of the scheme.

One Tino Lozi from Banderdewa who is undertaking a treatment in Samaritan Hormin Hospital was in total confusion with the scheme. “We don’t exactly know the facilities we are going to get under the scheme. So far they did not charge me for my treatment and I have been admitted free of cost. However we are bearing the medicinal expenses by our own,” Lozi share with a confused face.

“With the help of this smart card I saved more than half of the total expenses of 30,000 on my daughter’s treatment. They provide us treatment and hospital bed for free and that’s a great help to poor people like us,” shared Gichik Yajuk mother of Gichik Yape who is having treatment under the scheme at Hormin Hospital.

Other than some technical problems, the health scheme seems to be appreciated by all.

“I am coming from BJ Nursing Home, Tezpur where my wife is getting treatment. As my finger prints are not matching I am here to do some necessary correction in the card,” Shared Pem Norbu from Rupa, West Kameng who travelled far away from Tezpur to Itanagar just for some minor corrections.

 

STATUS OF EMPANELLED HOSPITALS

There are around 54 empanelled hospitals in the country under the Arunachal Pradesh Chief Minister’s Universal Health Insurance Scheme as per the record provided by the Directorate of Health Service. Though, some are doing perfectly well benefitting the people of the state but the performance of some hospitals under the list was found uncertain as when LES team contacted them regarding the said scheme, their response was ‘Not started’ yet. The group of Apollo Hospital – DRDO, Apollo Hospital – Hyderguda, Apollo Hospital – Jubilee Hills, all in Hyderabad, Platinum Hospital Mumbai, Prasad Hospital Bangalore, Sevenhills Healthcare Pvt. Ltd. Mumbai, R.G. Stone Urology & Laproscopy Hospital Mumbai etc. responded with ‘Not Started’ stature.

As the state till now does not have a hospital that can match with the sickbay establishments outside the state, hence, many a time, patients were referred outside for various medical treatments. Now, the faith of the promising health scheme depends very much on those big hospitals with all the facilities available which are empanelled under the scheme. The negative response from such hospitals on the scheme’s implementation can be a major setback for the people of Arunachal as well as for the scheme itself.   

Also, ‘No response’ till date from the Scheme insurer (New India Assurance Co.) overall in-charge, Melwyn D’souza about certain queries is not very appreciative. However, the Team LES hopes that the said insurer is active enough to respond to the empanelled hospitals or the Government of Arunachal Pradesh for any sort of queries, doubts and reimbursement problems etc. for the smooth functioning of the noble scheme. 

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