Dr.

NTR Vaidya Seva

Quality Medicare For All
Various Health Schemes under Dr. NTR Vaidyaseva Trust
No.of
Date of No.of No.of Followup
# Scheme Implementati Families Population Procedures Procedur
on (Heads) Covered es
Covered
Dr. Nandamuri Taraka Ramarao Vaidyaseva 150.95 501.64
1 01.04.2007 1044 138
(Dr. NTRVS) (lakhs) (lakhs)
8.34 18.75
2 Employees Health Scheme (EHS) 05.12.2013 1885 170
(lakhs) (lakhs)
3 Working Journalists Health Scheme (WJHS) 21.03.2015 5,120 20,952 1885 170
4 Amaravathi Residents Health Scheme (CRDA) 09.01.2017 37,182 1,30,137 1044 138
Aarogyaraksha
5 07.04.2017 39,188 85,586 1044 138
( enrolment is in Process)
Dr. NTRVS for
6 June, 2017 4,500 1044 138
Orphans and Destitutes and Oldage Homes
7 104 Seva Kendram October, 2012
National Health Protection Scheme To be implemented in
8
(under MOH & FW) 2017-18 financial year
 Origin- Hospitalization Expenses in
Erstwhile Andhra Pradesh

Below Poverty Line

Current
Sell assets Income 6.10% Other 6.10%
12.60%

Saving Borrow
12.00%
63.10%

✓ Catastrophic Illness Costs: Leading cause of rural indebtedness.

✓ Large proportion of people especially below poverty line borrow money or sell assets to
pay for hospitalization.
 Origin-Evolution of Dr.NTR Vaidya Seva

EVOLUTION EXPANSION

VS-I VS-II Total

2004:CMRF
Covered
Fin Year
Procedures (Therapies in (Therapies (Therapies
AUG 2004: Child Lakhs) in Lakhs) in Lakhs)
Cardiac Surgeries 2007-08 210 0.15 0.00 0.15
2008-09 942 0.86 0.51 1.37
APR 2007:
AAROGYASRI I 2009-10 942 1.05 0.91 1.96
2010-11 938 1.36 1.05 2.41
JUL 2008: 2011-12 938 1.17 1.36 2.53
AAROGYASRI II 2012-13 938 0.13 2.51 2.64
2013-14 938 1.16 1.76 2.93
JUL 2008: CMCO 2014-15 938 2.12 1.05 3.17
2015-16 1044 2.57 1.21 3.78
OCT 2009: JOURNALIST 2016-17 1044 2.96 1.38 4.34
SCHEME
Total 13.54 11.75 25.28
 Population Coverage

➢ 150.95 Lakhs Families of the state.

➢ Eligibility Card: White Ration Card Issued by Department of Civil
Supplies, Govt. Of Andhra Pradesh.

Financial Coverage
➢BPL family covered means the group of individuals as indicated in a ‘White
Ration Card’.
➢Sum insured per family-Rs.2,50,000/- per year.
➢Benefit on floater basis can be availed by individual or family.
Benefit Coverage
 Structure-Board of Trustees

1 Hon'ble Chief Minister of the State of Andhra Pradesh. Chairman

2 Hon'ble Minister for Medical and Health., Govt of Andhra Pradesh Vice - Chairman

3 Principal Secretary to Govt., HM& FW Dept., Govt. of Andhra Pradesh. Trustee

4 Principal Secretary to Govt., Finance Dept., Govt. of Andhra Pradesh. Trustee

5 Principal Secretary to Govt., RD Department, Govt. of Andhra Pradesh. Trustee

6 Commissioner of Family welfare, Govt. of Andhra Pradesh. Trustee

7 Director of Health, Govt. of Andhra Pradesh. Trustee

8 Director of Medical Education I/C, Govt. of Andhra Pradesh. Trustee

9 Commissioner I/C, A.P Vaidya Vidhana Parishad, Govt. of Andhra Pradesh. Trustee

10 Chief Executive Officer, Dr.NTR Vaidya Seva Health Care Trust. Trustee, Convenor
 Process Flow-Chart
Inpatient
Direct CMCO
Elective Cases Emergency Cases
PHC 104
Telephonic intimation

Preauthorization Request
Health Network
108
Camps Hospital
Preauthorization by Panel Doctor

Preauthorization by Trust Doctor

Aarogya Mithra Registration
Surgery/Treatment
Cashless Diagnostics
Cashless Post op Diagnostics
Outpatient Inpatient
Discharge
Prescription and Medical Advice
Follow up Claim
Social Audit &
Initiated by
Feedback
Hospital
Home
 Operations Online Workflow

Patient Service at NWH Back Office Processing At Trust

Vaidya
Mithras
Registration
Trust
Preliminary Examination Preauthorization
Doctors

Diagnosis

Admission
Hospitals
Treatment
Discharge Claim Settlement

Follow up
Beneficiaries

Trust IT Application

Patient Eligibility Doctors Case Hospital Financial Call

MIS
Records Cards Records Records History Data Centre
 Departments
Empanelment, Disciplinary Action
And Medical Audit .
Field Operations Department-
NWH Teams and PHC Teams at
District.
Operations-Consisting of
Preauthorizations and Claims.
Planning and Coordination.
Administration Department-HR,
Training, Vigilance, Legal,
Procurement.
Project Monitoring Unit-IT Team,
Hardware and Networking Team&
MIS Team.
Field Operations Support
Services-At Head Office.
104 Call Centre: To Provide
Support through Help line.
Grievance Redressal.
 Health Camps

For Bringing Awareness amongst the rural masses about the disease they are suffering
from and providing free medical advice and Medicines to the Rural People.

51.96 Lakhs People have been screened at their door step by specialist doctors of
network hospitals at 24,369 Health Camps.

2,08,596 Patients referred from Health Camps to Network Hospitals.

422 Net work Hospitals are Conducting 203 Camps in a Month across the state of Andhra
Pradesh. Emphasis is been given in Tribal and Backward areas.
 Scheme-Highlights

Network Hospitals increased from 17 to 422.

686 Surgeries/Treatments daily at a cost of Rs.1.9 Crores/day.

11,924 beds in Government/Corporate Hospitals under Dr.NTR Vaidya

Seva occupation.

4,038 calls attended by 104 call centre daily.

1,803 Vaidya Mithras in Network hospitals/PHCs for Patient facilitation.

25,28,188 Therapies Preauthorized Since 2007.

 Empanelment-Status in Andhra Pradesh

Active Hospitals in Andhra Pradesh From 01-04-2007 to 31.03.2017

Number of Total Number of Dr.NTR Vaidya

Hospital Type
Hospitals Beds Seva Beds

Corporate 273 29,029 7,257

Government 149 18,665 4,666

Total 47,694 11,924

 District Progress From 01-04-2007 to 31.03.2017

Preauthorized
Health Patients Patients Therapies
District In Patients Out Patients Amount
Camps Screened Referred Preauthorized
(In Crs)
East Godavari 2,109 5,21,030 16,415 3,32,399 5,02,276 3,10,849 831.26
Guntur 1,596 3,69,628 16,732 3,02,862 6,22,607 2,78,223 835.53
Krishna 1,650 3,45,926 15,856 2,73,257 4,44,027 2,57,659 738.45
West Godavari 2,045 4,34,941 14,855 2,42,470 5,88,550 2,30,395 631.89
Nellore 1,649 3,77,731 13,117 2,21,975 4,56,293 2,03,603 536.99
Vishakhapatnam 1,948 4,05,484 18,276 2,08,242 2,39,570 1,94,681 509.74
Prakasam 1,715 3,57,819 13,363 1,89,778 3,87,414 1,76,393 504.36
Chittoor 2,050 4,94,524 22,791 1,84,768 4,09,931 1,69,459 460.31
Kurnool 2,254 4,18,927 14,126 1,75,099 1,35,322 1,61,722 461.59
Srikakulam 1,987 3,46,961 14,967 1,46,740 1,58,582 1,39,707 363.92
YSR Kadapa 1,639 3,59,291 14,970 1,54,981 2,25,014 1,41,261 405.57
Anantapur 2,014 4,05,954 20,349 1,44,731 1,44,763 1,35,755 384.99
Vizianagaram 1,713 3,57,332 12,779 1,36,512 1,53,665 1,28,481 334.63
Total 24,369 51,95,548 2,08,596 27,13,814 44,68,014 25,28,188 6999.23
 Category wise Therapies Preauthorized
From 01-04-2007 to 31.03.2017
Category Therapies Preauthorized Preauthorized Amount(In Crs)

Oncology 5,70,535 823.03

Poly Trauma 3,60,957 1007.45
Nephrology 3,10,803 419.79
Cardiac And Cardiothoracic Surgery 2,57,538 1716.91
Genito Urinary Surgeries 1,87,776 499.81
General Surgery 1,47,665 409.63
Neurosurgery 1,06,151 468.95
Pediatrics 96,053 276.30
Neurology 76,266 176.41
Orthopedic Surgery And Procedures 73,875 167.23

Cardiology 74,266 229.55

Ent Surgery 59,814 91.69

Ophthalmology Surgery 54,311 84.64

Gynaecology And Obstetrics Surgery 40,144 109.68

 Category wise Therapies Preauthorized
From 01-04-2007 to 31.03.2017

Category Therapies Preauthorized Preauthorized Amount(In Crs)

Pediatric Surgeries 26,573 104.32

Plastic Surgery 17,312 89.12
Pulmonology 19,991 62.77
Gastroenterology 15,459 62.77
Surgical Gastro Enterology 10,138 53.72
Critical Care 10,605 66.94
General Medicine 7,266 20.99
Endocrinology 1,658 4.45
Rheumatology 1,211 2.71
Cochlear Implant Surgery 933 48.46
Dermatology 698 1.79
Prostheses 131 0.02
Infectious Diseases 59 0.13
Total 25,28,188 6999.23
 Financial Year wise No. Of Claims Paid

4,50,000
4,18,876
4,00,000

3,50,000
3,21,918
3,00,000
2,90,188
2,54,141 2,62,469
2,50,000 2,48,054
2,28,523
2,00,000
1,87,040
1,50,000

1,00,000 94,843

50,000
10,307
2007-2008 2008-2009 2009-2010 2010-2011 2011-2012 2012-2013 2013-2014 2014-2015 2015-2016 2016-2017
 Financial Year wise No. Of Claims Paid
Amount (in Crs)
1200.00

1000.00
1,035.07

800.00 800.34
703.50
669.38
600.00 576.90 596.41 573.86
493.43
400.00
294.14
200.00

47.87
0.00
 Socio Demographic –Therapies Preauthorized
From 01-04-2007 to 31.03.2017

Gender wise –Therapies Preauthorized Age wise –Therapies Preauthorized

Therapies Therapies Therapies Therapies
Gender Age group
Preauthorized Preauthorized(%) Preauthorized Preauthorized(%)
Children 2,47,940 9.81
Below 45 13,68,321 54.12
Women 9,88,305 39.09
Men 12,91,943 51.10 Above 45 11,59,867 45.88

Total 25,28,188 100.00 Total 25,28,188 100.00

Caste wise –Therapies Preauthorized

Therapies Therapies Preauthorized Therapies Preauthorized
Caste Therapies Preauthorized(%)
Preauthorized Amount (in Crs) Amount(%)
BC 12,72,288 50.32 3496.58 49.96
OC 6,27,105 24.80 1749.14 24.99
SC 4,05,591 16.04 1105.20 15.79
Minorities 1,48,454 5.87 437.42 6.25
ST 67,718 2.68 188.72 2.70
Others 7,032 0.28 22.18 0.32
Total 25,28,188 100.00 6999.23 100.00
 Hospital Type wise – Therapies Preauthorized
From 01-04-2007 to 31.03.2017

Therapies Therapies
Therapies Therapies
Hospital Type Preauthorized Preauthorized
Preauthorized Preauthorized(%)
Amount (in Crs) Amount (%)
Corporate 18,61,126 73.62 5348.54 76.42

Government 6,67,062 26.38 1650.69 23.58

Total 25,28,188 100.00 6999.23 100.00

0
200000
400000
600000
800000
1000000
1200000
1400000
1600000

14,40,518

8,22,849

5,68,461

4,51,841

4,25,642

4,07,660

1,97,600

1,87,174

1,05,694

87,495
TOTAL CALLS

44,554

34,891

13,624

6,275
48,03,015

3,067

2,698
Toll Free Number(104) Calls
From 01-04-2007 to 31.03.2017

1,241

613

549

359

85

74

44

7
Monitoring of Operations
Grievance-Social Audit
 PPP-Heamodialysis Units at Hospitals

Hospitals District Units

RIMS Hospital Prakasham 21
RIMS Govt. Hospital YSR 17
Govt.General Hospital Kurnool Kurnool 16
RIMS General Hospital Srikakulam 15
D S R District Hospital - Nellore Nellore 14
GGH - Guntur Guntur 14
Govt General Hospital East Godavari 13
Govt General Hospital Krishna 12
➢Established by B-Braun.
King George Hospital Visakhapatnam 12
➢Space, Electricity& Water provided by Hospitals.
District Hospital-Eluru Westgodavari 11
➢Revenue sharing – Rs.1250.
Govt.General Hospital-Anantapur Anantapur 10
➢ Hospital-Rs.170.
SVRR Hospital Chittoor 9
➢ Service Provider-Rs.1080. District Hospital Vizinagaram 7
Grand Total 171

e-India Awards 2010
e-India Awards 2009
CSI-Nihilent Award' 09
Manthan South Asia Award' 09
Forum for Health-Geneva' 09
Skoch Challenger Award 2008
FICCI Health Care Excellence
Award-2014
CSI-Nihilent Award' 2014
Recognition
Jury Award –‘‘Health Insurance Initiative of the Year’’
Citizen Choice Award – “Health Insurance of the Year”
'E-Governance Initiative in G2G category for 'E-Office‘ – Citizen Choice
Award
"Government Policy Initiative of the Year'
through Public Opinion
Jury Award for 'Civil Society / Development Agency of the Year'
Award of Excellence - Project of the Year
2008 - 2009 Project Category G2G
Service Delivery Leveraging IT
For Service Delivery
Government Initiative for the Healthcare Industry
e-Governance – Sustainability Award.
Recognition
 Employees Health Scheme

Objective:
Employees Health Scheme is formulated to provide cashless treatment to the employees,
pensioners of the State Government and their dependent family members, which will ipso
facto replace the existing medical reimbursement system under the 'Andhra Pradesh
Integrated medical Attendance Rules, 1972 (APIMA Rules, 1972)', with additional benefits
such as post-operative care and out patient treatment of Chronic diseases, which do not
require hospitalization
 Stakeholders in the Scheme

➢ Beneficiaries:
• Serving State Government employees, Retired employees and family pensioners & their
dependent family members.

➢ Implementing Agency:
• Dr.NTR Vaidya Seva Trust.

➢ Monitoring of the Scheme:

• Steering committee under the chairmanship of Chief Secretary to Government will
review/monitor the implementation of the scheme from time to time.

➢ Service Providers(Treatment).
• 620 Network Hospitals.
➢ Technology Solutions.
• Software Company(TCS).
 Andhra Pradesh State EHS Statistics
From 05-12-2013 to 31.03.2017
Indicator Employee Pensioner Total

enroled Employees/ Pensioners 3,49,630 2,33,646 5,83,276

Dependents 8,77,636 1,68,129 10,45,765

Total Cards Generated 11,49,599 3,89,076 15,38,675
Registrations 3,03,308 2,78,431 5,81,739
No. of InPatients Registered 1,09,827 1,10,510 2,20,337
No. of OutPatients Registered 1,56,146 1,35,794 2,91,940
No. of Therapies Preauthorized 2,02,838 1,31,990 3,34,828
Preauthorized Approved Amount (In Crs) 180.41 224.34 404.75
No. of Surgery Done 1,61,147 1,05,977 2,67,124
Surgery Done Amount (In Crs.) 137.53 179.83 317.37
No. of Claims Paid 8,77,636 1,68,129 10,45,765

Claim Paid Amount (In Crs) 11,49,599 3,89,076 15,38,675

 Salient features of Employees Health
Scheme

➢Eligible beneficiaries:- All regular State Government employees, provincialized work

charged employees, provincialised employees of local bodies, All service pensioners, RE-
employed Service Pensioners, Family pensioners & their dependent family members.

➢Eligibility criteria:- Individual Health Card for each and every family member of the
employee / pensioner including the employee.

➢Financial coverage:- Rs.2.00 lakhs per episode of illness with no limit on the number of
episodes.

➢Premium contribution:- 60% from Government and 40% by the employee / pensioner.

➢Procedures Covered:- 1885 identified procedures. 25 Chronic OP Procedures are also

covered. Necessary follow-up treatments of 170 surgical or medical ailments.

➢Service Provider:- 501 Hospitals empanelled under EHS.

➢ Ward entitlement:- Private and Semi-private ward as per the eligibility.

 Financing Arrangement

➢ 60% of total amount will be borne by Government and 40% by the employee /

pensioner contribution.

➢ The monthly contribution will be Rs.90/- by the Employee/Pensioner and Rs.135/- by

Government (for Slab A consisting of employees with Pay Grades from I to IV, and

Slab B consisting of employees with Pay Grades from V to XVII) and Rs.120/-by the

Employee/Pensioner and Rs.180/- by Government (for Slab C consisting of

employees with Pay Grades from XVIII to XXXII).

➢ If both of the spouses are Government employees or Service Pensioners, contribution

by any one of the spouses is sufficient.

 Vital Statistics(From 05-12-2013 to 31.03.2017)

Registrations

Total Registrations In Patients Out Patients

5,81,739 2,20,337 2,91,940

Preauthorizations
Total Government Private
Andhra Pradesh 3,34,828 3,30,265 4,563

Preauthorized Amount(In Crs)

Total Government Private
Andhra Pradesh 380.52 11.40 369.12

Claim Paid Amount(In Crs)

Total Government Private
Andhra Pradesh 404.75 392.67 12.08
 Guidelines on Chronic OP Treatment

 25 Chronic diseases requiring OP treatment which includes consultation with specialists,

investigations and supply of drugs identified.

 OP treatment for chronic diseases will be in notified Government Hospitals.

 Separate timings for OP treatment and investigations will be provided.

 Proposals along with budget requirement sent to the Government for issuing guidelines –
orders are awaited.

 Urgent need for Strengthening of lab Services in DME Hospitals & District Hospitals.
Patient District wise Therapies Approved
From 05-12-2013 to 31.03.2017
TP Amount
S.NO District TP
(In crs)
1 Nellore 52214 48.609
2 East Godavari 43720 47.324
3 Kurnool 42638 40.376
4 Krishna 29293 35.759
5 Chittoor 28258 21.639
6 YSR Kadapa 26678 33.047
7 Guntur 24838 43.91
8 West Godavari 23441 30.913
9 Prakasam 17202 29.922
10 Anantapur 13747 20.769
11 Srikakulam 11775 14.997
12 Visakhapatnam 10238 19.197
13 Vizianagaram 8181 16.068
14 Hyderabad 2605 2.217
Total 3,34,828 404.75
 Category wise Therapies Approved
From 05-12-2013 to 31.03.2017
TP Amount
S.NO Category TP
(In crs)

1 DENTAL SURGERY 225649 80.499

2 OPHTHALMOLOGY SURGERY 51423 107.622
3 NEPHROLOGY 8762 13.334
4 ORTHOPEDIC SURGERY AND PROCEDURES 7329 61.990
5 MEDICAL ONCOLOGY 6842 7.145
6 CARDIAC AND CARDIOTHORACIC SURGERY 6352 48.075
7 GENERAL SURGERY 5350 14.006
8 POLY TRAUMA 4892 15.569
9 GYNAECOLOGY AND OBSTETRICS SURGERY 4675 9.867
10 GENITO URINARY SURGERIES 3827 11.569
11 CARDIOLOGY 2290 6.990
12 RADIATION ONCOLOGY 1716 7.280
13 SURGICAL ONCOLOGY 1026 4.286
14 ENT SURGERY 1006 1.651
 Category wise Therapies Approved
From 05-12-2013 to 31.03.2017
TP Amount
S.NO Category TP
(In crs)

15 NEUROLOGY 864 2.183

16 NEUROSURGERY 809 4.144
17 PULMONOLOGY 541 1.863
18 GASTROENTEROLOGY 284 1.237
19 PEDIATRICS 235 0.643
20 CRITICAL CARE 232 1.871
21 GENERAL MEDICINE 222 0.621
22 PEDIATRIC SURGERIES 187 0.542
23 SURGICAL GASTRO ENTEROLOGY 141 0.789
24 PLASTIC SURGERY 125 0.657
25 ENDOCRINOLOGY 23 0.045
26 DERMATOLOGY 10 0.025
27 RHEUMATOLOGY 10 0.032
28 COCHLEAR IMPLANT SURGERY 4 0.210
29 PROSTHESES 2 0.000
Total 3,34,828 404.75
 Working Journalist Health Scheme
Salient Features of Working Journalist Health Scheme:-
➢ Eligible beneficiaries:- Journalists recognised by the I&PR along their dependent
family members.
➢ Eligibility criteria:- Individual Health Card for each and every family member of the
journalist including the Journalist.
➢ Financial coverage:- Rs.2.00 lakhs per episode of illness with no limit on the
number of episodes.
➢ Premium contribution:- 50% from Government and 50% by the employee /
pensioner.
➢ Procedures Covered:- 1885 identified procedures. 25 Chronic OP Procedures are
also covered
➢ Follow-up treatment:- The scheme will provide inpatient treatment for the listed
therapies under all specialties in the empanelled hospitals. Necessary follow-up
treatments of 170 surgical or medical ailments.
➢ Service Provider:- 501 Hospitals empanelled under EHS.
➢ Ward entitlement:- Semi-private ward
 Working Journalist Health Scheme Statistics
from 21.03.2015 to 30.04.2017
Indicator Count/ Amounts
Therapies Preauthorized 2341
Preauthorized amount Rs. 2,22,05,147
Surgery Done 2192
Surgery Done amount Rs. 2,16,17,687
Claims Paid 1369
Claim Paid Amount 94,24,023
 Comparison of RSBY and Dr. N.T.R.Vaidya Seva
S.No. Feature
1 Year of Launch of the scheme
2 Identification of the BPL family Rural BPL – Rs. 75,000/- per year
2 Population coverage
3 Financial coverage
5 Disease coverage
6 Benefit coverage
7 Premium
8 Portability concept
Dr.N.T.R.V.S. is aimed at
9 tertiary care cover
Common procedures for both
10 the schemes
Difference in cost for the
11 common procedures
Procedures that are not covered
12 under Dr N.T.R.V.S
Dr.NTR Vaidyaseva RSBY
01.04.2007 01.04.2008
The beneficiary in any Below Poverty Line (BPL) family,
whose information is included in the district BPL list
prepared by the State government BPL family For enroled
White ration card / BPL card issued by the State Govt. beneficiaries, smart card will be issued.
Urban BPL – Rs. 1 Lakh per year Urban BPL – Rs. 5000/- per month for a family of 5 i.e., Rs. 60,000/- per year
Rural BPL – Rs. 4080/- per month for a family of 5 i.e., Rs. 48960/- per year
40 . 04 lakh BPL families enroled in 23 districts of state
130.98 lakh BPL families. (Tendulkar Committee).
Up to Rs.2.5 lakhs per family on floater basis per year Up to Rs.30,000/- per annum on family of 5 floater basis
1044 procedures 1090procedures
Secondary and tertiary care including
i. OP evaluation with consultation and lab investigations In-patient treatment and 1day pre- hospitalization and 5
ii. In-patient treatment days post hospitalization cover
iii. Food and transportation charges for the patient.
Iv. Follow-up treatment for one year for selected (84 SURGICAL
+ 54 MEDICAL)138 procedures.
V. Elements of primary health care including screening in health
camps.(ITDA only)
Contribution by Government of India: 75% of the estimated
annual premium of
Rs.750, subject to a maximum of Rs. 565 per family per
The Premium of Rs. 440/- per family and the total expenditure annum. The cost of
premium is borne by the State Govt. smart card will be borne by the Central Government.
Contribution by respective State Governments: 25% of the
annual premium, as
well as any additional premium.
As RSBY is implemented across the country, the NWH is
covered only in the hospitals empanelled by Dr. N.T.R.V.S.T more in number allowing portability across states
While the scheme started with the coverage of tertiary care procedures, it has evolved over years to cover many secondary
care procedures also
460 procedures are common procedures ( detailed list enclosed)
There is huge difference in cost even in the procedures that are common. Dr. N.T.R.V.S provides higher package rates and is
more close to the current days cost for that procedure ensuring quality care is not compromised for the patient
Certain medical and dental packages, follow up packages .
 S.No. Feature Dr.NTR Vaidyaseva RSBY

13 Coverage Dependents - Mother, Father, Children(all included), wife and Husband Only 5 members of Family Husband, Wife and 3 Children only

Rs. 30/- for registration and

14 Registration fee Free Rs. 60/- for issue of smart cards.

15 Agency for registration By Civil Supplies Department District Key Manager appointed by State Nodal Agency.
NTRVS provides treatment for high end and low frequency
16 Focus diseases RSBY covers secondary care of high frequency.

17 Quality of Treatment Not bothered on treatment outcome Very robust system

18 OPD services No OPD services No OPD services

19 Claim Settlement process No Claim settlement process Very robust online claims workflow

20 Claims appeal committee No Claims Appeal Committee Yes

21 Performance No Key Performance Indicators Has Key Performance Indicators for all stake holders

No Medical audit of preauthorization, Sanction

22 Medical Audit No monitoring Has a separate Medical audit department

23 Empanelment No specialty Empanelment form Online additional specialty option available

Separate Board of Trustees will review the program
24 Refund/Annual financial review No refund/annual financial review of program annually
The above portability issue may not be considered where in majority of the poor of the state are getting treated within the state as they also look
for the support of the family members for medical attendance in and post hospitalization
 Dovetailing RSBY and NTRVS as per Tendulkar Committee

 Tendulkar Committee proposed that the 56 lakhs people fall

under BPL in the combined state of Andhra Pradesh.
 As per the State bifurcation act, 58 % of the above said 56 lakhs
i.e., 32.4 lakhs will be BPL for bifurcated Andhra Pradesh.
 The total utilization of Dr NTR Vaidya Seva for the financial year
2015-16 is 3.78 lakh procedures for an amount of Rs. 1065.85
Crs.
 There are 460 Common procedures between NTRVS and RSBY.
 The utilization of 460 common procedures among the 3.78 lakh
procedures is 1.23 lakh for an amount of Rs. 353.53 Crs as per
NTRVS NTRVS package rates and Rs. 166.55 Crs as per RSBY
package rates for the financial year 2015-16.
 The premium calculated for each BPL family is Rs. 750/-(GOI – Rs.
565/- and GOAP – Rs. 185)
 1.23 lakh no. of BPL people utilized those 460 matched
procedures. Hence, Trust should get an amount of Rs. 124.91 Crs
as 75% share from Government of India for the financial year
2015-16.
 Out of 460 procedures, 5 can be done in PHCs and CHCs, 27
can be done in Area Hospitals, 127 can be done in District
Hospitals and 301 can be done Government General
Hospitals accordingly they can be mapped and IT enabled.
 The claim can directly be paid to those hospitals from the 75%
share which we get from the Government of India as per the
existing NTRVS norms.
 Comparison of RSBY and NTRVS

 No compulsion for the states to introduce RSBY

 The beneficiaries has to pay Rs. 30/- for registration fee and the
Central/State government pay the premium to the insurer in the
ratio of 75(Central):25(State)
 Limited to 5 members of the family only (Husband, wife and 3
children).
 As per 2011 census 27.54 % of the population is BPL.
 NTRVS provides treatment for high end and low frequency
diseases where as RSBY covers secondary care of high frequency.
 Dovetailing would accrue additional benefits and help the
government to achieve value for money and Universal Health care.
 Out of pocket Expenditure to make payment upfront and wait till
reimbursement for the secondary care will be reduced.
 Aarogya Raksha

 Hon’ble Chief Minister Shri N.Chandra babu Naidu has launched “Aarogya Raksha” Scheme for quality treatment of
the people of Andhra Pradesh those who are not covered under the health schemes namely “Dr.NTR Vaidyaseva”,
“Employees Health Scheme” and “Working Journalists Health Scheme”.
 Family as a unit should enrol under the Aarogya Raksha Scheme with a minimum premium of Rs. 1200/- per
month. APL families can enrol through the www.ntrvaidyaseva.ap.gov.in or nearest “Mee Seva” centres for enrolment.
Final date for enrolment is 06.04.2017.
 The health insurance coverage is Rs.2 lakh per person per year which is non-transferable among the family members.
 Unlike other Insurance Schemes there is no extra premium for the aged people and people with preexisting
diseases like B.P, Sugar or any Chronic Diseases.
 All the enroled members can avail treatment for 1044 procedures in 400 plus hospitals empaneled under the Dr.
NTR Vaidya Seva Trust.
 The Health Card holder can get Doctor’s consultation, diagnostic tests freely. During the treatment the card holder
can avail cashless treatment along with food and follow-up medicines for 11 days after discharge.
 Follow-up medicines are available for 138 identified diseases for one year after discharge.
 Total 85,586 family member were enroled with a premium of Rs. 10,26,99,600 as on 06.04.2018.
 District wise Arogya Raksha enrolment Status as on 06.04.2017
enrolment through NTRVS portal or App enrolment through Mee Seva Centers Total enrolments
No. of family Premium No. of No. of family Premium No. of No. of family Premium
S.No District Name No. of Families Members Amount Families Members Amount Families Members Amount

1 Anantapur 801 1,652 19,82,400 255 531 6,37,200 1,056 2,183 26,19,600

2 Chittoor 723 1,673 20,07,600 481 904 10,83,600 1,204 2,577 30,91,200

3 EastGodavari 3,148 6,453 77,41,200 1,515 2,860 34,29,600 4,663 9,313 1,11,70,800

4 Guntur 5,276 11,188 1,34,24,400 2,842 6,126 73,51,200 8,118 17,314 2,07,75,600

5 Krishna 5,088 12,230 1,46,74,800 2,850 6,164 73,95,600 7,938 18,394 2,20,70,400

6 Kurnool 401 1,030 12,40,800 199 439 5,26,800 600 1,469 17,67,600

7 Prakasam 1,370 3,149 37,78,800 880 1,780 21,36,000 2,250 4,929 59,14,800
SriPottiSriramuluNell
8 ore 889 2,097 25,17,600 1,139 2,300 27,64,800 2,028 4,397 52,82,400

9 Srikakulam 241 572 6,86,400 144 321 3,85,200 385 893 10,71,600

10 Visakhapatnam 3,161 8,194 98,34,000 718 1,572 18,86,400 3,879 9,766 1,17,20,400

11 Vizianagaram 535 1,256 15,07,200 115 251 3,01,200 650 1,507 18,08,400

12 WestGodavari 3,132 6,316 75,79,200 2,262 4,439 53,23,200 5,394 10,755 1,29,02,400

13 YSRCuddapah 750 1,530 18,33,600 273 559 6,70,800 1,023 2,089 25,04,400

-- Total 25,515 57,340 6,88,08,000 13,673 28,246 3,38,91,600 39,188 85,586 10,26,99,600
 Arogya Raksha District wise utilization as on 30.04.2017

Hospitals Out Preauths Preauths Preauth Approved Surgeries

DISTRICT Performed Registrations Patients In Patients Raised Approved Amount Done Discharges
Anantapur 3 26 17 9 9 9 114400 6 4
Chittoor 8 75 44 31 31 27 640830 17 16
East Godavari 6 54 38 16 16 14 302080 13 11
Guntur 13 250 223 27 23 20 640943 12 11
Krishna 14 130 95 35 34 23 867746 15 13
Kurnool 1 8 5 3 3 2 68780 2 2
Nellore 10 135 93 42 41 41 1059482 21 15
Prakasam 3 84 70 14 14 13 426020 5 4
Srikakulam 2 8 4 4 4 3 37500 1
Vishakhapatnam 4 28 23 5 4 2 16050 1 1
Vizianagaram 3 21 12 9 9 8 180280 3 2
West Godavari 4 100 61 39 39 36 729006 20 18
YSR Kadapa 8 66 42 24 23 20 513298 11 9
Grand Total 79 985 727 258 250 218 5596415 127 106
Issues with the ASHA (NWHs)
 To enhance the package prices under Dr NTR vaidya Seva @ CPI of previous financial year as decided in the Health Minister meeting
held on 13.12.2016.
 ASHA NWHs not accepting the reduction of NABH quality incentive percentage for Employees Health Scheme from 25% to 2% as per
GO.MS.NO 12, HM&FW, dt: 23.02.2017.
 Requesting to increase the NABH quality incentive for Employees Health Scheme.
 Requesting the EHS Private ward package rates for Aarogya Raksha beneficiaries also.
 NWHs are against the clinical audit through external Clinical audit agencies .
Unable to start the Open-sky enrolment in Aarogya Raksha:
 Hon’ble CM approved the Open Sky enrolment in Aarogya Raksha on payment of premium by the willing APL and BPL beneficiaries. This
would lead to the enrolment of all those who other wise approaches the CMRO by having a dedicated counter at CMRO.
 The main condition of enrolment under Aarogya Raksha is “Family as Unit should enrol under the scheme”. Hence, the enrolment option
under Aarogya Raksha is designed in such a way that “ by entering the aadhar number of a family member, the entire family details will be
retrieved based on the Praja Sadikara Survey Database. Premium will be calculated based on the family members available in that
particular family.
 In this regard, Trust has addressed letters to IT secretary and CEO- ePragathi on 23.04.2017 with a request to accord permission to
access the people hub and UUID data to start the open sky enrolment under Aarogya Raksha as approved by Hon’ble CM.
 Still awaiting for permission in this regard.
THANK YOU