Phase 1 a success, health insurance for poor to now cover entire state

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Express news service : Jan 21 2013, 04:05 IST
50 lakh families in 8 districts availed the Rajiv Gandhi Jeevandayee Arogya Yojana since July 2012, says Health Minister Suresh Shetty

A total of 50 lakh families in eight districts have availed benefits of the Rajiv Gandhi Jeevandayi health insurance scheme implemented by the state from July last year.

“A total of 22,100 surgeries worth Rs 59 crore have been conducted and the actual amount paid by the insurance company to the hospitals is Rs 38 crore,” Health Minister Suresh Shetty told The Indian Express.

He said efforts were now under way to extend the scheme to all parts of the state in the second phase.

The limited coverage of diseases and the income limit to avail the usual insurance schemes being restrictive were among the reasons for introducing the scheme for below poverty line and above poverty line families. The scheme implemented last year in collaboration with the National Insurance Company covers heart diseases, renal transplant, brain and spinal cord diseases as well as cancer.

The scheme has been introduced to provide cashless medical facilities to families coming under BPL and APL categories. Valid yellow and orange card holders will be included in the scheme under which patients can get admitted, operated upon and discharged without paying any money.

The entire premium per year per family is paid by the government and the sum insured is Rs 1.5 lakh per family.

“We will conduct health camps by the 147 empanelled hospitals to bring the beneficiaries into the system,” Shetty said.

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RGJAY

Thomas Kuruvilla | 21-Jan-2013Reply | Forward
This health scheme has been criticised by many health activists for several reasons. The main criticism is that the health insurance is procedure driven in that hospitals will only be reimbursed if procedures or operations are conducted. A large number of empanelled hospitals are from the private sector and these hospitals sometimes misuse the scheme to get reimbursed by the Govt. for procedures/operations which are not always essential & which can be treated with equal efficiency by using medicines. A case in point is ischemic heart disease (IHD). It is well accepted that many patients suffering from IHD can be treated equally well by optimal medical treatment but private hospitals use invasive procedures to treat these patients so as to get reimbursed by the Govt. Another criticism is that there are many private hospitals which use this scheme to lure patients. One of these hospitals is Seven Hills hospital, Mumbai.

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