Support System For Mass Health Schemes

Government of India rolled out RSBY on April 1, 2008 and following the same several State Governments set up independent commissions to help achieve universal health coverage.

These are huge schemes covering both BPL as well APL categories. State Government schemes mostly offer select tertiary care packages.

There is a need for systematic implementation support to review the performance and ensure that these schemes have been able to achieve the objectives of better health service utilization, lower out-of-pocket (OOP) expenditure and better health status.

What is to be done?

  • The protocols covered under the scheme, to be reviewed w.r.t. pre and post documentation mandated & pricing
  • Empanelment of hospitals (provider as per SLA)
  • Audit of compliance of empanelment and claims processes
  • Audit of healthcare delivery by providers
  • Audit of grievance handling
  • Analytics
    • basis provider utilization
    • basis packages utilization
  • Medical audit of every case of death under the scheme