Ideas

Assam’s New Health Insurance Scheme Can Be A Model For Other States To Follow

Himanta Biswa Sarma
Snapshot
  • The brainchild of state health minister Himanta Biswa Sarma, Assam’s Atal Amrit Abhiyan health insurance scheme is distinct in many ways, and worth emulating.

Assam will roll out a comprehensive health insurance scheme on Wednesday (18 April) that could serve as a model for other states to emulate. Named Atal Amrit Abhiyan (AAA) after former prime minister Atal Behari Vajpayee, the novel scheme will be inaugurated by Vice President M Venkaiah Naidu in Guwahati. The scheme will provide coverage for a staggering 92 per cent of the state’s population.

The scheme is the brainchild of state health minister Himanta Biswa Sarma who says he drew inspiration from Prime Minister Narendra Modi. Atal Amrit Abhiyan (AAA) will cover the cost of treatment, including surgery, of six disease groups and conditions: cardiovascular, cancer, kidney, neurology, neonatal and burns. Beneficiaries can avail free treatment up to Rs 2 lakh per person a year for a total of 438 procedures (including surgery) under the six specialties at 23 empanelled super-speciality hospitals, both government and private, in Assam and 13 superspeciality and renowned private hospices in Kolkata, Bengaluru, Delhi and Chennai. Sarma said that more hospitals within and outside the state would be empanelled soon.

Apart from all adult members of all BPL (below poverty line) families in the state, APL (above poverty line) families whose annual family income is up to Rs 5 lakh will be covered by the scheme. Enrolment kiosks have been set up in all district headquarters and 1.5 crore beneficiaries have already been enrolled. After providing citizenship documents, applicants will have their biometrics recorded and embedded in a smart card that will be given to them and will have to be produced to avail of benefits under the scheme. Children up to 18 years of age belonging to eligible families will not be issued separate cards, but their names and biometric information will be tagged in the AAA card of the head of the family.

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The novelty of Assam’s health insurance scheme lies in its user-friendliness. A 24x7 AAA call centre has been set up to guide beneficiaries. Besides, help desks have been set up in all empanelled hospitals and these will be manned by arogya mitras round the clock. “These arogya mitras will do the necessary hand-holding and shall ensure that the patients or their accompanying attendants do not face any problems. They will be the interface between the patients and the empanelled hospitals,” said Sarma. He added that a lot of attention will be given to ensure that patients covered by the scheme have a seamless treatment experience in the empanelled hospitals. A round-the-clock feedback and grievance redressal mechanism has also been set up and senior officers of the health department as well as senior doctors of government hospitals in the state will monitor the scheme very regularly. Sarma said he would also personally monitor and review the functioning of the scheme at regular intervals.

Beneficiaries who want to avail treatment in the empanelled hospitals outside the state can call the AAA call centre, which will make all necessary arrangements, including travel to the hospital outside the state. Beneficiaries will be entitled to round-trip airfare of a maximum of Rs 30,000 for treatment outside the state and a daily allowance of Rs 1,000 a day for a maximum of 10 days. Within Assam, a patient and an attendant will get a travel allowance of Rs 300 per visit to an empanelled hospital subject to a maximum of Rs 3,000 a year.

Another unique feature of AAA is that unlike some other states’ health insurance schemes, all diagnostic tests done 24 hours prior to the admission of a beneficiary patient will be covered by it. “All one needs to avail cashless treatment in any of the empanelled hospitals is the AAA smart card which will have the beneficiaries’ data stored in them,” said Sarma, adding that Rs 400 crore has already been allocated for the implementation of the scheme in the current fiscal. Funds, he added, will be no constraint. While the AAA scheme has been fine tuned in consultation with government doctors and private healthcare providers over the past few months, Sarma says that further fine-tuning can be carried out whenever necessary. “Our prime concern is to make it completely user friendly and fully responsive to the needs of patients and their families,” he said.

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