| 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 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.