GROUP 6 Dr.

Deepika Mehra Kumkum Bala Kumud Kiran Morup Namgail Ravi Kumar Kunwar

In may 2009, there was a discussion between Pinakin Bhatt, chairman of Shree Krishna Arogya Trust with Pragnesh Gor, General Manager of Krupa Arogya Suraksha (KAS), a health insurance scheme. KAS scheme provided health services to the BOP population through Shree Krishna Hospital located at Karamshad, Anand. Even with some donor contributions, trust was barely able to meet the cost of services provided to the subscribers of the scheme. Bhatt was worried about the long term viability of the scheme. He asked Gor to take on the challenge of designing a plan to make the scheme sustainable without donations.

India spent only 6% of GDP on health, of which govt. accounted for nearly one third. During 1980s general insurance companies introduced health insurance schemes throughout India. But the scheme was costly, which was not affordable for the low income people. Due to rising health care costs, coupled with burgeoning population, private sector came into play in 1999. IRDA was established to supervise the expansion of insurance industry.

There were 14 private players, 5 public sector companies and 3 specialized companies offering insurance services. The industry was growing at a CAGR of 37% between 2002-2008. Despite such policies, barely 5% of population was covered under various schemes. Community based health insurance scheme was established that extended health coverage to the lower segment of society.

Public health services in Anand and Kheda has three tiered structure:
Civil hospital at district headquarters

Community health centers at large towns

Primary health centers at large villages

There were 207 and 332 sub-centers in Anand and Kheda dist, which was the first contact point between PHCs and village community.

These hospitals were short of specialist. Apart from public health services there were several trust hospitals in the area like Emery and Jakaria hospitals in Anand, Santaram and MahaGujarat hospitals at Nadiad. There were several specialty and super specialty hospitals for orthopedics, ophthalmology, cardiology etc. These hospitals were largely patronized by affluent members of society. Govt. hospitals provided health services for free or reduced cost.

As per a study by ministry of health and family welfare, GOI:

68% felt that public health service was not up to sufficient

standard. While 47% didnt go to these hospitals due to lack of proximity. The participants preferred private hospitals even though they were costlier.

One of the largest and best equipped hospitals in Gujarat, opened in 1981 with 136 beds. In 1990, new hospital with capacity of 550 beds was constructed from the donations of NRI community. Facilities available at the hospital were:

Trauma care centre, research center Four ICUs, various operating theatres Laboratories, CT scanning

It was in process of obtaining accreditation from NABH (National Accreditation Board for Hospitals and Health care Providers). It promoted the KAS scheme through its association with the Shree Krishna Arogya Trust.

2003 KAS SCHEME CREATED

To extend modern health facilities to BOP population

SKH will better utilize its infrastructure and facilities

Enrollment was available through annual membership or life time membership. Subscription through food grains was allowed. Eligibility criteria- age between 91 days to 75 years. Maximum available coverage was INR 100000.

Enrollment in the scheme tripled from 14000 in 2005 to 49000 in 2009 Coverage of Rs.5000 was most popular which accounted for more than 90% of schemes members Lifetime membership was not as popular as annual membership 62% of the members were farmers, 30% were school and college students and 8% were workers and employees of industries 45% of the farmers and labourers, 22.5% of the employees availed out patient services 58.9% of the farmers and labourers, 8.9% of employees availed in patient services

Scrapping out of one time premium per person Reducing the expenses on promotions as target population can be reached by direct marketing efforts of Krupa staff To encourage the participation through grains farmers can be formed in groups by the sarpanch and then the garins can be collected by trust staff directly from village Differentiated premium rates can be used for industrial employees To increase membership in 21 -40 km radius more promotional activity is required Increasing awareness among the people about precautionary health measures

THANK YOU