GOVERNMENT OF ANDHRA PRADESH 

ABSTRACT

 

Health Insurance – Constitution of Task Force for study, design and submission of report on a Comprehensive Social Health Insurance Programme for Andhra Pradesh – Orders – Issued.

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HEALTH MEDICAL AND FAMILY WELFARE (K1) DEPARTMENT

 

G.O.Ms.No.510                                                                                                  Dated 05-10-2005

                                                                                                                 Read the following:

 

ORDER:

 

Despite the excellent primary and secondary health infrastructure, in the public and private sector in Andhra Pradesh, health outcomes are not commensurate with the investment made. While timely access to quality and affordable health care, reduction in maternal mortality, infant and under 5 mortality, universal coverage under the T.B. Control program, eradication of leprosy or containment of malaria and other infectious diseases continue to be problematic, the disease burden in 2015 on account of non communicable diseases is also estimated to reach unsustainable levels. Illness continues to be a major cause of rural indebtedness. A study by NIMHANS showed that chronic ill health was the second reason for the large number of suicides in rural areas of Andhra Pradesh during the years 2001-2003. Financial risk protection against catastrophic illness is thus a core concern for reducing poverty and preventing social conflicts.

 

2.       The Health care services in Andhra Pradesh are financed in two ways – out of pocket by households and through the state budget out of taxes. User fees which used to fund one third of the non salary expenditures have since been abolished.  Insurance as a form of financing is restricted to a small segment of upper middle class households under voluntary, private, commercial insurance programs. Due to rapid increases in the prices of inputs and technology, shifts in perception and disease profiles towards illnesses that are more expensive to treat, a critical concern is the need to sustain the present system of health care and ensure access to quality care.

 

3.       In view of the increasing importance of providing risk protection against illness, several departments are planning schemes and models for their own target groups. This has the danger of segmenting the target population, create scope for policy contradictions and also duplicate effort. Besides, in merging risk pools, the potential for getting a balanced mix of high and low risks enabling a more affordable premium. This will also ensure a more comprehensive approach to the development of a social health insurance system for the State.

 

4.       At a meeting held by the Hon’ble Chief Minister on 23-9-2005 on health sector issues, it was decided that a Task Force consisting of all related Departments be constituted immediately for formulation of Health Insurance programmes to the target groups and be implemented with effect from 1-01-2006 on a pilot basis.

 

5.       Government after careful consideration of the matter hereby constitute Task Force with the following members to design and submit a comprehensive social health insurance programme for the State:-

i) Composition of the Task Force:

1.     Sri Ramakanth Reddy, Principal Secretary to Govt., Finance Deptt.     Chairman

2.     Ms. Sujatha Rao, E.O. Prl Secy. to Govt., HM&FW                           –Member -Convener

3.     Sri K.Raju, Prl Secy. to Govt., Rural Dev. Deptt.                                 Member

4.     Principal Secretary to Govt., Health, Medical & FW Deptt.                  Member

5.     Secretary to Govt., (Health) incharge of Secondary Hospitals               Member

6.     Secretary to Govt. MA&UD Department                                             Member

7.     One Representative of the Director General of Police                           Member

8.     The Secretary to Govt., Agriculture                                                     Member

9.     The Secretary to Govt., Labour                                                           Member

10. The Secretary to Govt., (Services) General Admn. Dept.,                     Member

11. The Secretary to Govt., Animal Husbandry & Fisheries Deptt.-            Member

12. The Secretary to Govt., Textiles                                                          Member

13. One Representative of the I.R.D.A.                                                     Member

14. Two Representatives of the Bankers                                                    Member

15. Two Representatives from President of the Govt. Employee

Association, Nominated by G.A. (Ser-Wel) Deptt.,                              Member

16.  President and Genl. Secy. of the Govt. Doctors

Association, Hyderabad                                                                      Member

17. Special invitees: –

i).  The Director of Medical Education, A.P., Hyderabad,                   

ii). The Director of Health, A.P., Hyderabad                             

iii). The Commissioner, A.P. Vaidya Vidhana Parishad, Hyderabad.    

iv). The Commissioner of Family Welfare, A.P., Hyderabad.     

 

ii) Terms of Reference of the Task Force:

·        To make policy recommendations for facilitating Social Health Insurance in the State;

·        Specifying the districts where the pilots in the first phase need to be taken up;

·        Design models specifying the target group, the benefit package and entitlements, the institutional structure for collection of premiums and settlement of claims and disputes, the delivery of services, the treatment standards and costs of services, reporting formats and contract forms, monitoring and supervisory systems etc.;

·        Examine the training needs for implementation of the proposed design in the pilot districts;

·        Facilitate initiation of the pilot and recommend means of institutionalizing the monitoring and support to the pilots.

iii) Specific tasks:

·        Mapping of Health Financing in the State - Government expenditures pattern on health, financing of Government hospitals, staff health reimbursements, and schemes subscribed to by different Departments;

·        Mapping of Health provision/facilities in the related pilot districts - Government Hospitals, ESIs, CGHS, Railways, and Police etc.;  

·        Negotiations with Insurance agencies and Third Party Agencies, and providers for developing relevant products and mechanism for cashless services;

·        Define strategy, steps for the operationalization of the selected models;

·        Facilitate the implementation of the Health Insurance pilots w.e.f.1-01-2006.

·        Any other item as permitted by the Chair.

 

6.       The Task Force will interact with stakeholders, providers, insurance agencies, Third Party Agencies, consumer organizations, to bring in various perspectives in to the recommendations; It will also interact with experts, development partners, donors, as the need may be. It will collate necessary information and data in order to design models and strategy.

 

7.       Detailed operational systems will be formulated in consultations with key members of the task force. Financing of Task Force operations, implementation of pilots have to be decided upon before commencing its activities.

Outputs:

1) Design schemes/models for health Insurance for the targeted population, with justifications for viability, budget, detailed operational procedures.

2)     Design pilot projects on Health Insurance and facilitate their initiation in the selected districts.

3) Recommend means for institutionalizing the pilot implementation, monitoring and support

4)     Design an institutional process for developing strategy for the state, with lessons learnt from the pilots for upscaling to the entire state during 2007-2009

Time Frame:

8.       The Task Force shall design the scheme and submit its report and operational plan to Govt. by 1-1-2006 positively.

 

9.       This order issues with the concurrence of Finance Department -vide their No.2784/PFS/2005, dated 28-9-2005.

 

(BY ORDER AND IN THE NAME OF THE GOVERNOR OF ANDHRAPRADESH)

 

T.K. DEWAN

CHIEF SECRETARY TO GOVERNMENT

To

The Chairman of the Task Force.

All Members of the Task Force.

All Departments under the Administrative Control of HM&FW

General Administration (Service–Wel) Department.

Copy to:

The Secretary to GOI, Min. of Health & FW, Nirman Bhavan, New Delhi.

The Commissioner, I & P.R., A.C. Guards, Hyderabad.

HM&FW (OP-1/OP-II/D/F) Department.

The Spl. Secy. to C.M.

The P.S. to Minister  (Finance & Health)

The P.S. to C.S.

The P.S. to Prl. Secy., Finance Department.

P.S. to Prl. Secy/ E.O. Prl. Secy./ Secy./E.O. Secy. to Govt. HM&FW Deptt.

 

// FORWARDED :: BY  ORDER //

 

SECTION OFFICER