Abstract

Introduction: -Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY scheme) is a government funded insurance scheme for BPL/ APL families, implemented in hospitals all over Maharashtra.

Objectives: -This study was a retrospective analysis of implementation of the RGJAY scheme- study of trends and category of beneficiaries, cost-benefit analysis and scope of improvement in scheme.

Methods:- Records of RGJAY patients were retrieved over period from November 2013 to October 2015. Data retrieved was analysed for parameters like trends for number of cases; for cases in different speciality categories and locations over the period of 24 months, trends for number of claims getting paid; average amount paid per case and time required for claim approval, estimation of number of cases which usually required external funding and cases which were otherwise done free of cost.

Results:- Total 6797 claims were analysed. Overall number of cases went on increasing from 188 in Nov 13-Jan 14 to 1168 in Aug 15-Oct 15; but Cardiovascular and thoracic surgery (CVTS) cases were decreased. Percentage of claims getting paid was increased. Average of claim amount paid, deduction in amount paid and time for approval were decreased.

Conclusions:- Additional services were provided to patients in cashless manner. Good amount was generated through cases which otherwise done free before RGJAY. There is a need of application of RGJAY in all civil hospitals, inclusion of more categories, reduction in the number mandatory investigations and enforcement of information dissemination. Feedback from the treating doctors and hospital co-ordinator for RGJAY suggested certain changes that can improve the application of the scheme for providing free care to the BPL and APL patients.

Keywords:- RGJAY, Health Scheme, Socioeconomic Study.