NTR Vaidyaseva

a) Introduction :

Towards achievement of universal health coverage for BPL families whether defined in terms of financial protection or access to and effective use of health care, Government of Andhra Pradesh is implementing state sponsored Dr. Nandamuri Taraka Rama Rao Vaidya Seva Scheme. This scheme certainly counts to be one of the pioneers in terms of achieving equity and providing accountable and evidence-based good-quality health-care services in the state to assist poor families from catastrophic health expenditure. The aim of the Government is to provide Universal Health Coverage to BPL families. The scheme is a unique PPP model in the field of Health Insurance, tailor made to the health needs of poor patients and provides end-to-end cashless services for identified diseases under secondary and tertiary care through a network of service providers from Government and private sector.

The scheme has established a demand-side mechanism that mobilizes and channels additional public financing to health, introduced an explicit benefits package, pioneered cashless care and fostered public private partnerships.

The scheme is designed in such a way that the benefit in the primary care is addressed through free screening and outpatient consultation both in the health camps and in the network hospitals as part of scheme implementation. The IEC activity during the health camps, screening, counselling and treatment of common ailments in the health camps and out-patient services in network hospitals is supplementing the government health care system in preventive and primary care.
In order to facilitate the effective implementation of the scheme, the State Government set up the Dr. Nandamuri Taraka Rama Rao Vaidya Seva Trust, under the chairmanship of the Honorable Chief Minister. The Trust is administered by a Chief Executive Officer who is an IAS Officer. The trust, in consultation with the specialists in the field of insurance and healthcare, runs the scheme.

Dr. Nandamuri Taraka Rama Rao Vaidya Seva Trust Health Insurance scheme is unique in its applicability since no other State/ government agency has provided universal health coverage to the poor. The choice of hospital for treatment is with the patient. The entire process from the time of conduct of health camps to the screening, diagnosing , treatment, follow- up and claim payment is made transparent through online web based processing to prevent any misuse and fraud. The scheme is complimentary to facilities available in government hospitals and put together provides Universal Health Coverage to BPL population including Prevention, Primary care and In-Patient care. All the Primary Health Centres (PHCs) which are the first contact point, Area/District Hospitals and Network Hospitals, are provided with Help Desks manned by VAIDYA MITHRA’s to facilitate the illiterate patients.

b) Objective

• To provide free quality hospital care and equity of access to BPL families by purchase of quality medical services from identified network of health care providers through a self-funded reimbursement mechanism (serviced by Trust).
• To provide financial security against the catastrophic health expenditures.
• To strengthen the Government Hospitals through demand side financing.
• To provide universal coverage of health for both urban and rural poor of the State of Andhra Pradesh.

Geometry Of Health Insurance Coverage

• Population coverage (Breadth of Universal Health coverage) The beneficiaries of the scheme are the members of Below Poverty Line (BPL) families as enumerated and photographed in White Ration Card linked with Adhar card and available in Civil Supplies Department database.
• Financial coverage (Height of Universal Health coverage) The scheme shall provide coverage for the services to the beneficiaries up to Rs.5 lakh per family per annum on floater basis. There shall be no co-payment under this scheme.
• Benefit Coverage (Depth of Universal Health coverage)
o Out-Patient The scheme is designed in such a way that the benefit in the primary care is addressed through free screening and outpatient consultation both in the health camps and in the network hospitals as part of scheme implementation.
o In-Patient The scheme shall provide coverage for the 3257 “Listed Therapies” for identified diseases in the 31 categories Are listed in website: www.drntrvaidyaseva.ap.gov.in.

C) SCHEMES/ACTIVITIES/ACTION PLAN

i. Dr.NTR Vaidyaseva Scheme:

• The Scheme was a “flagship scheme” of all health initiatives of the State Government, launched on 01.04.2007.
• Initially it was under insurance mode and from 2011 it was shifted to Trust Model.
• A maximun of Rs.25.00 Lakhs per family per year. No limit on the financial limit for Cancer Patients.
• 3255 procedures and cashless treatment is offered right from registration of the patient to the 10 days post discharge.
• 138 Identified follow-up procedures for one year from the date of discharge.

ii. Employee Health Scheme

• The Scheme was introduced on 05.12.2013 for the benefit of State Government Employees, Pensioners and their dependants on a permium contribution of 50:50 between State Government and Employees / Pensioners.
• 1885 Procedures including Dental Procedures covered in this Scheme.
• Rs.2.00 lakhs per episode of illness with no limitation on number of episodes.
• 170 procedures identified under Follow-up treatments in this scheme.
• Treatment for chronic diseases OPD treatment for 25 identified chronic diseases is provided in Govt. Teaching Hospitals.
• Steering Committee under chairmanship of Chief Secretary to Government, for review of the scheme.
• Management Committee under chairmanship of CEO,Dr.NTR Vaidyaseva Trust.

iii. Working Journalists Health Scheme:

• This Scheme is being implemented by the Trust since 21.03.2015 on the lines of Employee Health Scheme (EHS) for accredited Journalists identified by I&PR Department which is nodal Agency.
  Salient features: same as Employee Health Scheme
  This Scheme is being implemented by the Trust since 21.03.2015 on the lines of Employee Health Scheme (EHS) for accredited Journalists identified by I&PR Department which is nodal Agency.
• Salient features: same as Employee Health Scheme

iv. Aarogya Raksha Scheme:

• The Govt of AndhraPradesh with an objective of providing “Universal Health Coverage” initiated a new health scheme called “Aarogya Raksha” for above poverty Line Families (APL). It is implemented from 07.04.2017.
• Salient features:
  i. The Scheme covers any family as one unit, in other words, all the members of family can become by paying Rs.1200/- per member per year to avail the benefits of the scheme.
  ii. The Scheme Cover same as Dr.NTR Vaidyaseva Scheme.
  iii. The beneficiaries are eligible of Semi – Private ward in Empanelled Hospitals under Aarogya Raksha Scheme.

V. Amrutha Health Scheme:

• Amrutha Health Scheme has been started on lines of Dr.NTR Vaidyaseva scheme to provide cashless services to Orphans and Destitutes, who are living in Orphan and Old age homes recognized by the Govt of A.P.
• Trust has collected Orphans and Destitute District wise data recommended and authenticated by the respective District Collectors for generation of health Cards on name “Amurtha Health Scheme for 2812 Orphans and Destitutes till now.
• Salient features:
  The Scheme Cover same as Dr.NTR Vaidyaseva Scheme.

Vi.Aarogya Aasara

• (Post Operative Sustenance allowance)
  The Vaidyaseva beneficiaries after discharging from the hospitals were unable to work their convalescent period which led to loss odd daily wage and the poor families who were depending on their daily wages were unable to meet their regular expenses like for food and other basic needs . This Scheme launched on 02.12.2019.
• Government has decided to provide Aarogya Aasara to the patients who undergo surgeries under Vaidyaseva scheme for the post-op recovery period @Rs.225/- per day subject to a maximum of Rs.5000/- per month.
• Total number of procedures identified: 836.
• Bank passbooks must be submitted to Vaidyamithras and Aasara amount will deposited on the same date of discharge.

d) Structure of Department in District

e) Empanelled Hospitals Details:

1. Total No. Of Active Network Hospitals in the District : 132
2. Govt. General Hospital, Nellore : 01
3. No. Of District hospitals in the District : 01
4. No. Of Area hospitals in the District : 02
5. No. Of CHCs in the District : 10
6. Total No. Of PHCs in the District : 52
7. Total No. Of Empanelled PHCs in the District : 52
8. No. Of Private NWHs in the District : 35
9. No. Of Dental Hospitals (EHS) in the District : 31

f) Contact:

g) Postal Address:

District Coordinator,
Dr.NTR Vaidyaseva Trust,
Admin Block,
IP Building,Govt General Hospital,
Dargamitta,
SPSR Nellore-524003.

h) Important links:

www.drntrvaidyaseva.ap.gov.in