“Mukhyamantri Amrutam (MA) Yojana”
Project Director, State Nodal Cell, "Mukhyamantri Amrutam (MA)" Yojana

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
Before the launch of ‘Mukhyamantri Amrutam (MA) Yojana’, families living Below Poverty Line (BPL) and Lower Middle Class (family having an annual income $1,791.45 or below per annum) were pushed into the vicious debt poverty cycle because of excessive out-of-pocket expenditures arising during catastrophic health events more over these categories of people was also subjected to poor living standards, inadequate nutrition, overcrowding, their nature of job and lack of health awareness, make them frequent occurrence of diseases and when need of treatment arises, they often ignore it either due to lack of resources, fearing wages loss, or wait till the last moment when it becomes too late.

B. Strategic Approach

 2. What was the solution?
The solution found was to… • Provide health assurance to all such categories of people. So, that they can access cashless quality tertiary medical and surgical care treatments through network hospitals. • Where the beneficiary can select hospital of his/her choice from a network of empanelled hospitals during any catastrophic life threatening diseases up to $ 2,985.74 per annum on a family floater basis. • Early diagnosis & early prevention of life threatening diseases.

 3. How did the initiative solve the problem and improve people’s lives?
A detailed study was carried out on various health insurance and assurance scheme implementation by other state and central Government. • The target beneficiaries were all BPL (Below Poverty Line) families (approximately 41.49 Lakh families) & families having an annual income of $1,791.45 or below per annum (approximately 62.55 Lakh families). • In order to avoid duplicacy list of procedure which were life threatening and require tertiary care of treatment which shortlisted. After discussing it in various expert panels a final list was prepared. • Falling under 7 (seven) critical diseases namely: (1) Cardiovascular diseases (2) Renal (Kidney) diseases (3) Neurological diseases (4) Burns (5) Poly-Trauma (6) Cancer (Malignancies) (7) Neo-natal (newborn) diseases. Objectives • For early diagnosis and early prevention of catastrophic diseases health camps were mandatory for the empanelled hospitals to conduct in their surrounding villages. • Targeted families can get services at their nearest place. • To have maximum hospital participation e-tendering processing adopted. • The scheme was made totally cashless, so that beneficiary protected from high, unexpected cost for health. • For timely claim settlement & claim processing an agency with this expertise was hired. So that patients cannot get suffered due to delay in payment to the hospital.

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
In order to identify the scheme beneficiaries easily at the scheme empanelled hospitals a unique QR (Quick Response) coded “MA” card was decided to give to each eligible family under the Scheme and for the ease of beneficiaries it was decided to carry out the enrolments throughout the year. This card facilitated both the hospital in beneficiary’s identification and the scheme beneficiaries in availing the scheme benefits without any difficulty and timely at the hospital and because of this ease today more than 138 hospitals are empanelled under the scheme. To ensure quality of services at the hospitals it was decided to give 10 % extra over and above the package rates as Quality incentives to the Hospitals who were accredited either by NABH / JCI/ ACHS (Australia) or by any other accreditation body approved by International Society for Quality in Healthcare (ISQua) and because of this unique step today the scheme has more than 12 NABH accredited hospitals under the scheme which initially during the scheme launch were hardly two in number. For smooth & transparent financial transaction of claims, it was decided to release payment to all the hospitals directly through RTGS without any mediator. To keep beneficiaries updated about their available card balance and claim transactions at 3 instances: after pre-authorization, after treatment and after discharge are sent to the beneficiaries. To guide patients at any instance on phone 24x7 call center 18002331021 has been established under the scheme. Innovative Practices • Innovative Supply Chain, Distribution, Retailing structures: The services are delivered to the beneficiaries by means of a QR coded card. For effective distribution of these cards, an in-house Technical Support Agency has been appointed. This agency assured timely issuance and distribution of thus cards to the targeted beneficiaries. • An opportunity to all beneficiaries was given to the beneficiaries indirectly empowering the family in taking health care related decisions in the family and also evaluating the performance of both private Vs government network hospitals

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
• The Health & Family Welfare Department of Gujarat implementing the scheme. 100 % funding of the scheme is done by the state Government. The scheme covered around 62 lakh families, which is around 70 % population of the state. • For planning, monitoring supervision at the state level a State Nodal Cell (SNC) has been established. At the Regional level Regional Coordinator (RC) and at district level District Coordinator (DC) has been appointed under the scheme. • The scheme cover all the Below Poverty Line (BPL) families & Lower income group families having an annual income $1791.45 or below per annum. Covering a total 70% of state population till date 28/01/2017 total 4,57,241 beneficiary get benefit under this scheme.
 6. How was the strategy implemented and what resources were mobilized?
A detailed planning of the scheme was approved by the state government. • The number of beneficiaries families were identified and strategy how to enrollment them was materialized. Around $298.57 million budget was provided under the scheme in first year. • After the state approved and budget provision, necessary guidelines pertaining to number of procedure diseased to be covered, sum assured, fraud control etc, were formulated. • For hospital empanelment & package pricing tendering was done. • During the first year (2012) a total 32 hospital (including public & private) were empanelled. • Side by side through open tendering process an Implementation Support Agency (ISA) for helping the State Government in claim processing, hospital empanelment, Information, Education & Communication (IEC), deployment of Arogyamitra, District Coordinators etc, • A support agency was selected chronologically the sequence of scheme implementation can be summarized as follows: Process layout of the Entire ‘MA’ Yojana: End-to-end services are provided to the beneficiaries of the Scheme. The process flow can be summarized as follows: Step – 1: Beneficiary approaches Network Hospital with QR-Coded card. Step – 2: Details of the beneficiary are transferred to the ‘MA’ & ‘MA Vatsalya’ server via a dedicated online portal. Step- 3: Preauthorization for the required medical procedure is obtained through the portal from the Implementation Support Agency (an agency hired for claim processing). Step – 4: Once the preauthorization is received, treatment of the beneficiary commences. During discharge details (patient satisfaction letter, certificate of receiving transportation cost $ 4.48 etc.) are entered online on Mukhyamantri Amrutam (MA) portal (www.magujarat.com) and sent to Implementation Support Agency (ISA) for payment process. Step – 4: The ISA scrutinizes the claims and forwards the claims to the State Nodal Cell, which after due verification approves the claims. Step – 5: Payment of the approved claims to the hospitals is made directly through RTGS by the State Nodal Cell (a cell created under H&FW department). No intermediary agency is involved in the process. Strategy for Claim process Mechanism: Step: 1 Network Hospital • Beneficiary approaches Network Hospitals with QR-Coded card • Details of the beneficiary are transferred to the 'MA Vatsalya' server via a dedicated online portal Step: 2 ISA • Preauthorization for the required medical procedure is obtained through the portal from the Implementation Support Agency. • Any additional preauthorization is also obtained via the same portal. • The ISA scrutinizes the claims and forwards the claims to the State Nodal Cell Step: 3 SNC • Approval of Claims after due verification • Payment of the approved claims to the hospitals is made directly through RTGS by the State Government  Citizen centric services: • SMS alerts are sent to beneficiaries at 3 instances: after pre-authorization, after treatment and after discharge. Beneficiaries can also enquire about the status of claim amount remaining in their MA card for their treatment in the current year. • To guide patients at any instance on phone a 24x7 call center 18002331021 has been established under the scheme. • Detail of the scheme is provided on the web portal www.magujarat.com. Major key activities under the scheme: Following are the main activities under the scheme: • Enrolment of eligible beneficiaries. • Empanelment of hospitals • Information, Education & Communication (IEC) activities under the scheme. • Claims & hospital audit. Chronology of scheme implementation: • 18th April, 2012 - The Government Resolution (GR) of ‘Mukhyamantri Amrutam Yojana’ was passed. • 4th September, 2012- ‘Mukhyamantri Amrutam Yojana’ was launched. • 2012-13 – Budget of $ 298.58 million provisioned. • 2013- 72 more procedures are added in the Scheme. (Initially total 472 procedures are there in the scheme.) Now total 544 procedures included under the scheme. • 13th August, 2014 - The Government Resolution (GR) of ‘Mukhyamantri Amrutam Vatsalya Yojana’ was passed. • 15th August, 2014- The scheme was further extended as ‘Mukhyamantri Amrutam Vatsalya Yojana’ for all females & their children (Below the age of 21 years) belonging to the families having an annual income $1791.45 or below $1791.45 per annum. • April, 2015 – The limit of 21 years for male was removed under ‘Mukhyamantri Amrutam Vatsalya Yojana”. All males were included under ‘Mukhyamantri Amrutam Vatsalya Yojana’ for lower income group families. • 7th July, 2015 – The Income certificate’s validity is increased up to 3 years. • 2016 – The scheme was further extends to all unorganized workers of the state with the name “U-win Scheme”. • 2017-18 – The $ 746.88 million Rupees budget is provisioned for the Scheme to the state government. Funding of the “Mukhyamantri Amrutam Yojana”  The Government of Gujarat is contributing fund for the scheme.

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
Following were the stakeholders involved in the design of the “Mukhyamantri Amrutam” Yojana: • Public health expert, Sociologist, Panchayati Raj Institute (PRI) members • Health Financing Experts (Accountants, Account officer, Deputy secretary etc) • Private and Government Hospitals (Apollo Hospitals, General Hospitals Civil, GMERS Hospital, GCS Hospital etc...) • IT Experts • Specialist Doctors • Implemented Support Agency • ICT (Information & Communication Technology) Following are the stakeholders involved in the implementation of the “Mukhyamantri Amrutam” Yojana: • IT experts Team ( (n) Code Solutions) • Implemented support Agency (MD India Networx Limited) • State Nodal Cell (Commissioner of Health, Additional Director, Program Officer, Chief Medical Officer, Operational manager, Hospital coordinator, MIS coordinator, Quality Coordinator, IEC Coordinator etc...)

 8. What were the most successful outputs and why was the initiative effective?
The most successful outputs achieved by the Scheme are:  Women Empowerment : Before the implementation of the scheme, in a family women’s early diagnosis of their medical complains are avoided to save the wages or precious commodities. But after launching of the scheme, in the families women’s are also ready for the early diagnosis & early treatment of their health problems. Under the scheme, for women’s & girls, Breast Cancer & Cervical Cancer screening is given free of cost. In such cases, early treatment is provided to prevent the critical conditions.  Power to choose Hospital Services: After implementation of the scheme, beneficiaries could choose their nearest public as well as private sector hospitals for their tertiary level treatment. Due to this long distance traveling is reduced.  Reduction in Out -of-pocket Expenditure : After the launch of this scheme, till date (28/01/2017) around 4,57,241 beneficiaries have been benefitted and an out-of-pocket expenditure of around $93.67 million of the BPL & Lower Income Group people of Gujarat has been saved.  Increased life expectancy : Since most of the vulnerable beneficiaries benefitted under the scheme got easy access to the hospital, early diagnosis, early treatment and early prevention, an early cure increase life expectancy.  Reduction in tragic outcomes: Ignoring the treatment may lead to unnecessary suffering and death bounding the beneficiaries to sell their property or taking debts which may end a family’s hope of ever escaping poverty. These tragic outcomes are avoided through the scheme.

 9. What were the main obstacles encountered and how were they overcome?
• Illiteracy & lack of health awareness of the scheme was also one of the barrier in the earlier phase • The scheme was implement first time in the state. In prior such scheme for tertiary care was not there. So nobody wants to take risk in the initial phase. Due to that lack of hospital participation for empanelment under the scheme. • The scheme covered only for specific catastrophic diseases. • Lack of tertiary care hospital in remote areas. • Lack of confidence in tertiary benefits under the scheme.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
The key benefits resulting from the scheme are • Through the scheme the Below poverty line (BPL) & Lower Income Group (LIGs) families having an annual income $1791.45 or below per annum got quality tertiary care treatment against life-threatening diseases at their nearest. • The cashless treatment made them overcome from bothering about ‘out-of-pocket expenditure’ and made them health conscious. • The beneficiary gets expensive treatments without pay any single Rupees for the treatment during hospitalization. • A cashless hospitalization strengthening the faith on government scheme. • The vulnerable & poor people are now been diagnosed early & treated accordingly. • The scheme has increased lifespan of the vulnerable people of the state. • Under the scheme especially for girls & women gets screened of Breast & cervical cancer, and during health camps prevented them from further damage. • With quality of health services at their nearest has served the poor people of the state. • Ignoring the treatment may lead to unnecessary suffering and death while selling property or taking debts may end a family’s hope of ever escaping poverty. These tragic outcomes have been avoided through this scheme. • In case of death Rs. 6/- per km as transportation allowance is provided under the Scheme. • After the implementation of the scheme it was observed that Chronic Renal Failure (CRF) patients had to undergo dialysis throughout the life. Therefore new special guidelines for standalone dialysis were implemented.

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
Yes. “Mukhyamantri Amrutam Yojana” improves integrity and accountability in public service. • Under the scheme IEC (Information, Education & Communication) has been done. So intensified that everyone should know about the services available under the scheme. So that agents under the scheme can’t be totally avoided. • The Field Verification Authority (FVA) & Taluka Verification Authority (TVA) were only the government authorities. Therefore there was no chance of corruption is left under the enrolments. • The enrolment and card printing was totally hired in house with close supervision of day today activities and enrolment performance. Hence, kept no scope for any other agent for making any commission from it. • For those people who are very poor and were staying in remote areas and were not in touch with the TV and news paper adds. To motivate them for scheme enrollment ASHA’s were educated to council them, to educate them about the scheme benefits and for the same 1.49 $ per enrolment was given by the Government against the enrolment of BPL of her area. • For timely resolution of grievance at state level (SGRC) and at district level District Grievance Redressal Committee (DGRC), were formed so that any issue if beneficiary faces they can easily approach to them and get it resolve directly. Therefore no confusion on how much to give, what to give, whom to give…. • No premium is collected for the enrolment under the scheme.

 12. Were special measures put in place to ensure that the initiative benefits women and girls and improves the situation of the poorest and most vulnerable? (If applicable)
Till date the scheme provides opportunity for all women for screening of breast & cervical cancer. If it positive then they get treatment under Mukhyamantri Amrutam Yojana. So, early detection of cancer can prevent further damage in the body. Under the scheme (till date 28/01/2017) total 464614 claims registered. In that total 171290 claims of females. Out of these 77% claims of females belongs from the age group of 36 year and more which shows that after the age of 36 year increases the risks of diseases. The females have an opportunity for getting treatment under the scheme to the nearest empanelled private or public hospitals.

Contact Information

Institution Name:   Project Director, State Nodal Cell, "Mukhyamantri Amrutam (MA)" Yojana
Institution Type:   Government Department  
Contact Person:   Shri Jagdish Prasad Gupta
Title:   Project Director, State Nodal Cell, "MA" Yojana  
Telephone/ Fax:   Telephone: 079-23253271, Fax: 079-23256430
Institution's / Project's Website:  
E-mail:   mayojanagujarat@gmail.com  
Address:   Commisionerate of Health, Block No.5, Dr. Jivraj Mehta Bhavan, Sector 10, Gandhinagar, Gujarat
Postal Code:   382010
City:   Gandhinagar
State/Province:   Gujarat
Country:  

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