Rajiv Gandhi Jeevandayee Arogya Yojana – Rajiv Gandhi Jeevandayee Arogya Yojana

  • Project Category
    : Healthcare
    Sub Category: 
    Health Insurance Initiative
    Reference No: 

    Details of Programme /Project/Initiative:

    Brief Description:
    Government of Maharashtra is implementing the ‘Rajiv Gandhi Jeevandayee Arogya Yojana(RGJAY)’ across the State to assist about 2 crores of Below Poverty Line (BPL) and Above Poverty Line (APL) families from health expenditure unaffordable for the household. The Government has already launched the first phase of the Scheme on 2nd July 2012 in eight districts – Gadchiroli,Amravati, Nanded, Dhule, Raigad, Solapur, Mumbai, Mumbai Suburbs, – on pilot basis covering 49 lakhs families. The aim of the government is to provide quality critical care for low income families and still prevent them for getting impoverished on account of out of pocket spending on health.

    The objective of the Rajiv Gandhi Jeevandayee Arogya Yojana is to improve access of Below Poverty Line (BPL) and Above Poverty Line (APL) families (excluding White Card Holders as defined by Civil Supplies Department) to quality medical care for identified specialty services requiring hospitalization for surgeries and therapies or consultations through an identified network of health care providers.

    Target Group: Below Poverty Line (BPL) and Above Poverty Line (APL) families with an annual income less than 1 lakh

    Geographical Reach within India: 8 Districts in Maharashtra – Gadchiroli,Amravati, Nanded, Dhule, Raigad, Solapur, Mumbai, Mumbai Sub

    Geographical Reach outside India: Nil

    Date From which the Project became Operational: 2-7-2012

    Is the Project still operational?:yes

    Five points that make the Product/Programme/Project/Initiative innovative:

    1. Cashless Critical care of high Quality to the beneficiaries, free diagnostics and investigations .
    2. PPP implementation model of service delivery with Government entering into agreement with insurer.
    3. Real time online workflow system which brings greater transparency and efficiency in the system .
    4. Free health camps by network hospitals to the beneficiaries once a week .
    5. Online application form & workflow for empanelment of hospitals for scrutiny of the hospitals

    Five key achievements of the Product/Programme/Project/Initiative:

    1. Improved transparency and efficiency in the system.
    2. Improved quality and cashless secondary and tertiary health care to the poor.
    3. Better outreach than the paper based Jeevandayee Scheme of Maharashtra.
    4. Preauthorization and claim payment occurring within the defined Turnaround time – Promptness.
    5. Key performance indicators of RGJAY showing good results

    Five key challenges faced while implementing the Product/Programme/Project/Initiative and how they were overcome:

    1. Awareness about the scheme and the mobilization of the beneficiaries to the hospitals .
    2. Patient identification & authentication as the data received from FCS was not digitized.
    3. Detecting & controlling fraudulent and unethical practices by the hospitals .
    4. Inlusion of marginalized sections of the community in the scheme.
    5. Standard Treatment guidelines and protocol to be followed by the hospitals

    Five points that make the Product/Programme/Project/Initiative replicable:

    1. Source code is the property of the State as per the MoU between Government and Insurer .
    2. RGJAY application used to implement charity hospital scheme in the State.
    3. Replicable empanelment module to develop database of hospital profile and expertise .
    4. Seamless data exchange between Society and Health Department or any other departments.
    5. RGJAY application uses call centre facility with toll free number and bulk SMS facility

    Five points to elaborate on the scalability of the Product/Programme/Project/Initiative:

    1. The RGJAY application is a modular application and can be scaled to cover the entire state.
    2. Scalable outsourced model of implementation and service delivery.
    3. The server infrastructure is in cluster mode thus ensuring the scalability of processing capacity.
    4. Redundancy is maintained at each level and load balancing is used at web and application level.
    5. The call centre solution is scalable to address more target population in the rest of the districts.

    Documents publishing URL:  http://www.docstoc.com/docs/159590673/?key=MGIzMjgzYjUt&pass=ZWEyZi00NTAy


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