Family Health Plan Limited

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Information about Family Health Plan Limited

Published on October 2, 2008

Author: aSGuest413


Slide 1: Bharat Swaasth Slide 2: “Think of the poorest person you have ever seen and ask if your next act will be of any use to him” -Mahatma Gandhi Slide 3: Objective “To provide quality healthcare to the most deprived but most deserving segment of the society . Slide 4: 73% of the population in India living in the rural areas. 60% of this work force is in the unorganized sector, predominantly farming. 75% of India’s poor in – Orissa, Bihar, M.P, Maharashtra, U.P, Assam, W.B “ Every Fourth Farmer in the World is an Indian” – NCAER (source) Rural India and Healthcare Source: Slide 5: 60 % agriculture work force 27 % BPL (19.71Cr) 23.6% BPL (6.3 Cr) It is important for any healthcare initiative to bring a quality improvement in the standard of living. 73% 27% India… Rural Vs Urban Indian BPL population 27crore Source: Slide 6: Health Care Scenario of Rural India Poorest 60% receive 30% of the spends while richest 40% receive 70% of the spends. Richest 20% use 6 times the number of bed days in public hospitals than the poorest 20% 71% of rural population seek private facilities 92% of urban population seek private facilities Source: pib. …contd., Slide 7: Limited buying capacity of the individual in the Private hospital Lack of awareness and poor exposure to quality healthcare Health Spending ….. “Second main cause for the Rural Indian’s indebtness” Slide 8: Geographic Access & Financial Access Address these to improve rural healthcare delivery Impediments in rural healthcare ….how to overcome Slide 9: Aragonda Village Health Plan Police Schemes In AP and Karnataka Karnataka Farmer’s scheme Bharat Swaasth Our initiatives towards development of innovative Healthcare Models……. Learning's from these models Have now helped in evolving …… Slide 10: Aragonda Village Health Plan “Affordable health care for all” in Aragonda Village initiated in 2000 Self sustaining model-Each family pays Re.1 per day-covers Medical / Surgical treatment upto Rs.30000/- This model formed basis for evolution of Universal Health Scheme Slide 11: Premium: Rs.365/- ,Rs.548/- & Rs.730/-( coverage for 1,5 & 7 members respectively) Age Limit :3 months to 65 yrs. Hospitalization Benefit Rs. 30,000 / Family /Annum. Compensation for accidental death of earning member: Rs 25,000. Temporary total disablement due to hospitalization of earning member of the family @ Rs 50 /day subject to a maximum of 15 days with a time excess of 3 days. UNIVERSAL HEALTH INSURANCE SCHEME Affordable insurance scheme at Re 1 per day Slide 12: Govt. subsidy : Rs.5Crore ( approx) ( Annual Health Budget 2003-2004 : Rs.2745 Cr) 0.18% of BPL population 0.02% of Annual Healthcare budget Experience of Universal Health scheme ( 2003-04) Budgeted subsidy for UHIS Rs.50 Crore ( 2003-2004) Unutilized fund Rs.45 Crore About 5 lakh lives covered under the scheme (as against 27 crore BPL population) Slide 13: Rs.200/- per person per annum Rs.300/- for family of 5 units Rs.400/- for a family of 7 units Average subsidy per BPL life : Rs.100/- The thrust of Union Government for UHS has redoubled Union Budget announcement of Subsidy for BPL for 2004-2005 towards the UHIS Slide 14: Short comings of UHIS ……… Coverage inadequate to cover any tertiary illness. Numerous sub limits makes it difficult for hospitals to provide cashless Lack of control for monitoring the displacement from work, will lead to higher claims pay outs and financial viability issues. Limited scope of benefits Lack of awareness in market: Individuals, Provider, Insurer Capping on utilization not understood by the end user Lack of Promotional initiatives from Insurer- Low premium, Triple benefit Slide 15: Police Scheme Self Funded healthcare Scheme for Andhra Pradesh State Police force covering 3.45 lakh employees and their dependant family member. Employee contribution of Rs.50 per month and the rest comes from State Govt. Coverage for defined Secondary and Tertiary ailments. Cashless treatment at all network hospitals Andhra Pradesh Police Scheme Karnataka Police Scheme Self funded healthcare Scheme for the Karnataka Police Force covering 2.45lakh, Employees and their dependents Employee contribution of Rs 40 per month rest comes from State govt. Comprehensive Medical & Surgical coverage Cashless Treatment at all network hospitals Slide 16: Community Based Health Insurance for Self Help groups Group Mediclaim for the members of Self help groups Low premium : Rs.120/- per person per annum Hospitalization cover for Rs.10,000/- Sub-limits on utilization Announced by Central Government ….2004-2005 Slide 17: New Healthcare revolution in Karnataka….. Landmark initiative by Congress Govt. in Karnataka for the farming community of India covering 17 Lakh farmers registered with Karnataka State Co-operative Societies for Surgical treatment. Karnataka State Co-operative Farmers Scheme Slide 18: The Scheme was launched on 1st June ‘2003 by Hon’ble Chief Minister of Karnataka , Shri S.M. Krishna. Individual contribution of Rs.90/- per year Coverage for all Surgical treatments for Rs.2 lakh per year Cashless treatment at network hospitals Free OP consultation at network Hospitals ( Physician) 90 quality care Network of providers across the state Hospitals offer standard subsidized tariffs. Karnataka Farmers Scheme Slide 19: Successful completion of One year of Implementation Total No. of members : 17 lakh Total No. of beneficiaries: 11,386 Total Fund Utilized ( one year): Rs.11.26Cr Total No. of Free Out-patient treatments ( one year): over 35,000 cases. Karnataka Farmers Scheme Slide 20: Union Government’s initiatives compared with Karnataka model Karnataka model – cheaper and better and is currently being studied by World Bank Slide 21: Healthcare Spectrum Preventive care In-patient care Out-patient care Medical Surgical Aragonda Model UHIS Police Scheme Traditional Insurance model Karnataka Farmer model All the existing Models cater to the In-patient requirement only Vaccination Check-ups Heath camps For Minor ailments For Major ailments Slide 22: Number of lives to be covered Extent of coverage Extent of Financial coverage Prevailing Health care cost ( Rate) Level of healthcare facility Socio-economic status of the target population Geographical area to be covered Existing financial assistance Govt. subsidy / contribution Factors influencing the Contribution / Cost Slide 23: Need of the hour…. Innovative product with Public Private Partnership Bharat Swaasth Swasth Bharat .......Sabal Bharat Slide 24: Proposed Product features Health Insurance coverage for In-patient treatment only. Out Patient treatment is out of the scope of the proposed product assuming the Govt. healthcare delivery machinery would cater to the Out patient and Preventive component of healthcare needs of the community at large. Bharat Swaasth Slide 25: Healthcare Spectrum Preventive care In-patient care Out-patient care Medical Surgical Both the above Models would feature Free Physician consultation Proposed Model-II Proposed Model-I Slide 26: Suggested Plan Bharat Swaasth Model- I Surgical treatment Relevant Medical treatment Govt. hospitals capable of handling medical treatment Surgical treatments are expensive Second commonest cause for rural indebtness Lack of surgeons in Rural Hospitals Hence Health Insurance cover for…… Slide 27: Suggested Plan Bharat Swaasth Model- I Cover for 1600 defined Surgical procedure requiring hospitalization Medical emergencies Cancer treatment – Medical & Surgical both Slide 28: Suggested Plan Bharat Swaasth Model- II Health Insurance Cover for…… Comprehensive Medical & surgical cover for Family of 5 members for annual benefit of Rs. 30,000/- Extensive cover of Rs. 2 lakh for surgical treatment for main member of the family Slide 29: Suggested Plan Bharat Swaasth Model- II Slide 30: Financial Implication Bharat Swaasth Union Govt. can extend its subsidy to BPL population and the other segments desirous of coverage should arrange for the fund :  Co-operative Societies Banks/ NABARD Co-operative Banks Suggested medium 30% rural Indians avail Banking services ( 41.6 million families) Almost 100 % villages are covered under co-operative fold 67% of rural household are members of Co-operative institutions 7% of the Farmers have Kisan credit card Over 35,000 branches of 560 banks located in 563 districts in 30 states Source:NABARD.microfinance.2004 Bharat Swaasth Slide 32: Provider of healthcare services Govt. Hospitals Private Hospitals Nursing Homes Network of hospitals across the country to facilitate delivery of treatment to the rural poor at their door step…… Public Private partnership Bharat Swaasth FHPL has contracted over 2100 quality hospitals that have passed strict accreditation norms for providing CASHLESS treatment to its members. Slide 33: Phase wise implementation II nd Phase: Expand the Cover to all BPL families / Farmers of the four more States I st Phase: Pilot Project : Adopt two crore BPL families / Farmer population of two States III rd Phase: Year 3 Expand the cover to all India BPL Families /Farmers Bharat Swaasth Leading to …………health revolution in rural India Slide 34: Wider age band for coverage Comprehensive surgical coverage and treatment for all medical emergencies Access to quality treatment, Geographically well dispersed network of providers Free OP Consultation and discounted investigations Cashless treatment at the identified hospital 24 hrs Member Helpline Cost containment through negotiated tariff & Medical audit Revenue generation and better utilization for Govt. hospitals/PHC’s. Trouble free administration with FHPL’s services. Benefits Bharat Swaasth Slide 35: Spin off Benefits Bharat Swaasth Better rural health – better productivity and …over a period of time more people will cross over the BPL Rural health initiative will lead to investments in rural areas in healthcare leading to better employment opportunities Rural healthcare investment will lead to lower healthcare costs General improvement in the standard of living Slide 36: Healthcare has several components as elucidated…. All the various facets such as: Primary Care Preventive Care and Secondary/Tertiary treatments need to be addressed individually as Well as collectively so that there is a synergy. Bharat Swaasth…. Filling the gap in rural healthcare Slide 37: Bharat Swaasth While the Govt has always made plans for improving the Govt Healthcare Facilities and initiated several preventive and promotive programs including Vaccination,Maternity,AIDS prevention and so on, the 2nd biggest cause for Rural Indebtedness…. Health is not addressed adequately without a cover for costly tertiary care surgeries and Bharat Swaasth attempts to fill in this very Void. Bharat Swaasth is just one part of the multi pronged approach that needs to be initiated by the Govt. to address all the levels of healthcare needs of Rural India. Slide 38: About Family Health Plan Limited “ Pioneers” in the concept of Managed care in the country with National Presence . Operational since a decade, FHPL has evolved as one of the largest IRDA licensed “Third Party Administrator ” (TPA). Nationwide presence - Operating from 22 locations across the country. Extensive coverage through network of Hospitals ( 2086 ) Slide 39: Operations backed by State-of-the-art technology with dedicated VPN ( 512 KBPS). Helpline - 24 hrs Nation wide Toll Free Online connectivity - Real time data processing Highly professional and committed staff Only TPA in the country with experience in conceptualizing , designing and implementing Self Funded schemes for PSU’s. Servicing over 4.5 million lives across the country. About Family Health Plan Limited Slide 40: Jai Hind Bharat Swaasth

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