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Bhamashah Scheme Enabling People Better Patient Care: Ashish Modi

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Ashish ModiThe Rajasthan Government has reduced out of pocket medical expenses through the Bhamashah Scheme which has been enabling poor and vulnerable people to avail best medical facilities. Since the inception of BSBY, we have booked packages worth more than Rs 1,800 crores, says Ashish Modi, Joint CEO, RSHAA (Rajasthan State Health Assurance Agency), in conversation with Sudheer Goutham of Elets News Network (ENN).

Q You are running BSBY (Bhamashah Swasthya Bima Yojana) last few years. Kindly elaborate the scheme.

The Rajasthan Government had started this scheme on 13th December, 2015 and since then, the State has been running it successfully. The first phase of BSBY continued for two years till 12th December 2017. After that, many disease packages were revised based on our experience of implementation of BSBY and based on the changing needs of the people. The second phase of implementation of BSBY started from 13th December 2017 and it shall continue till 12th December 2019.

In the current phase of BSBY, we are having 1401 different diseases packages which cover 21 different specialties. As on today, We have 1418 empanelled hospitals. Out of these, we have 899 private empanelled hospitals across rajasthan and 519 government hospitals, right from the medical college to the CHC (Community health centre) level. Since the inception of BSBY, we have booked packages worth more than Rs 1,800 crores in the State of Rajasthan. Out of 1401 packages, 778 are secondary and 623 falls into the category of tertiary packages. Currently, we have packages for critical illnesses as well like kidney transplant, cardiac surgery, cancer treatment etc

Q How this scheme is benefitting newborns and pregnant women?

There are many gynecological procedures related packages for pregnant women and neonatal care packages for the newborn children in the scheme. There is a comprehensive package for antenatal checkup and for delivery caesarean section. We have been successfully dealing with the complications in cases of complicated pregnancy like caesarean section, preeclampsia and asphyxia within the newborn babies with the help of our extensive network of government as well as private empanelled hospitals across the length and breadth of Rajasthan.

One of the most important package for pregnant women is comprehensive ANC (Ante Natal Checkup) package, which comprises four ANCs during the entire course of pregnancy.

Q What are your future plans and strategy to further strengthen the insurance plan to benefit people at large?

The journey has been very enriching since the inception of the programme in 2015. These three years have been a learning experience and provided us with an enriched data set which will help us in improvising further. We have re-designed our packages on the basis of workability of disease packages in these years . We had found that more than 300 packages needed re-working.

Hence, we deleted, modified or replaced them with better options. At the same time we realised that some packages need to be added in the list.

Q What kind of challenges you have been facing to implement the scheme across the State?

Challenges are the part of any journey. We too have been facing a lot of challenges on the go. However, we have always been open to learning from our mistakes which we come to know by interacting with patients and identifying the grey areas which are likely to be misused/misinterpreted.

BSBY is being implemented through Bhamashah card which rides on a well-designed IT platform to enable biometric identification of the beneficiaries. The Bhamashah card helps us in maintaining a wallet for the family which makes the IT platform robust and simpler.

Further, the photograph of the beneficiary is taken at the time of admission as well as discharge, which helps us to know the exact date and time of admission/discharge along with the longitude and latitude of the place. It ensures beneficiary’s presence both at the time of admission and discharge in the hospital.

We have introduced some technological innovations in the BSBY software recently. Earlier, the patients used to wait for a long time at the discharge counter because all the papers had to be scanned and uploaded. It usually used to take 10-15 minutes. Now, we have devised a new mobile application through which patients’ photographs can be taken and uploaded in the software instantly and remaining documents can be uploaded later. Thus, the waiting time for discharge is practically less than a minute!

In addition, we have also provision according to which if a claim is rejected by an insurance company, one can make an appeal to the office of JCEO, RSHAA (Rajasthan State Health Assurance Agency).

Earlier these appeals were made through email and Google forms. Now we have incorporated that in the software to make the process simple and streamlined. Thus, using software, filing appeal of rejected cases has become a lot easier for the hospitals. It has also increased our capacity to hear appeals manifold.

The entire decision-writing process has also been made online. Decisions shall automatically be dispatched through e-mail.

We have made IT intervention to tackle cases where patient cannot be identified biometrically. It happens sometimes because of old age, or someone doesn’t have an Aadhar card or a Bhamashah card.

In that case, the treating doctor himself verifies the patient. As per the provision, before a doctor identifies patient through his signature, the patient has to try at least three times on a biometric machine to identify himself. If he fails, then only treating doctor can go for a MOIC (Medical officer in charge) verification.

Q Do you have any monitoring system to keep a tab on the scheme?

We have a monitoring system i.e in-house calling centre, which calls BSBY beneficiaries to check their satisfaction level. As this is a complete cashless scheme, we also try to ensure that beneficiaries are not required to pay anything at the hospitals. At the same time, we regularly do field audit to promote good practices among the empanelled hospitals and beneficiaries.

Q Do you like to add something for your eHealth magazine readers?

I would like to reiterate that people should focus more on preventive healthcare instead of curative care. Unless we focus on preventive healthcare, it would be really difficult to manage ever increasing number of citizens who are falling ill. We need to particularly focus on managing lifestyle diseases which can be reduced significantly if we follow a healthy routine.

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