RSBY regional review meeting eastern region Ranchi 28th June 2011

Rashtriya Swasthya Bima Yojna in the State of Chhattisgarh

28th June 2011 RSBY RRM Ranchi 1

State Nodal Agency-Chhattisgarh

Department of Health and Family Welfare – Nodal Department A Separate Nodal Agency under State Health Society has been

constituted.

Nodal Agency comprise of Director Health Services as Ex- officio CEO Additional CEO -functional or Executive CEO Consultant- Hospital, Enrollment, M&E and Computer programmer Accounts Manager and other support Staff. District RSBY Consultant ( in position 16/18 districts) Chief Medical and Health Officers are DKM and a separate Nodal

officer has been nominated for each district. The Hospital Administrator at District Hospital and Block programme

Manager under NRHM will coordinate Hospital activities Health Workers ( male and Female ) have been designated as FKO in

Rural areas whereas AWW work as FKO in Urban areas


Audit– External auditors have been appointed.– Audit for 2009-10 completed. AG CG carried Survey Audit – Audit for 2010-11 under process.

State Server– Being procured and will be set up at NIC Raipur. – Personnel recruited and in position– Presently enrolled data is stored on External hard disks.


Observations on RSBY website

• The web site needs to be updated there are 18 districts.• The figures needs to be updated on regular basis. Date of

update should be mentioned.• List of delisted hospitals to be displayed prominently.• Links to other RSBY sites needs to be included.• Sitemap • The SW downloads versions inside the state login and on main

page differs.


Preparatory Work for Renewal Districts

Status of Availability of Renewal Software with the Insurance Company (if already selected)

S No. Name of the

District

Name of the Insurance

Company last phase

Date of End of Policy in previous

Year

Name of the Insurance

Company in renewal

Enrollment Start date

Renewal Policy Start Date

Change in Data in second year?

1 2 3 4 5 6 7 81 Rajnandgaon OIC Ltd. 31-Aug-10 OIC Ltd. 30-Aug-10 1-Sep-10 Yes

2 Durg OIC Ltd. 30-Jul-10 OIC Ltd. 27-Aug-10 1-Sep-10 Yes

3 Bilaspur OIC Ltd. 30-Jul-10 OIC Ltd. 30-Aug-10 1-Sep-10 Yes

4 Sarguja OIC Ltd. 31-Aug-10 OIC Ltd. 26-Aug-10 1-Sep-10 Yes

5 Raipur OIC Ltd. 30-Sep-10 OIC Ltd. 28-Sep-10 1-Oct-10 Yes

6 Bastar OIC Ltd. 30-Nov-10 OIC Ltd. 15-Nov-10 1-Dec-10 Yes

7 Narayanpur Included in Baster OIC Ltd. 6-Jan-11 1-Feb-11 -

8 Kanker Tata-AIG Ltd. 28-Feb-11 OIC Ltd. 17-Feb-11 1-Mar-11 Yes

9 Dhamtari Tata-AIG Ltd. 31-Jan-11 OIC Ltd. 3-Jan-11 1-Feb-11 Yes

10 Raigarh Tata-AIG Ltd. 28-Feb-11 OIC Ltd. 28-Feb-11 1-Mar-11 Yes

11 Korba Tata-AIG Ltd. 31-Jan-11 OIC Ltd. 31-Jan-11 1-Feb-11 No

12 Janjgir Tata-AIG Ltd. 31-Jan-11 OIC Ltd. 31-Jan-11 1-Feb-11 Yes

13 Jaspur Tata-AIG Ltd. 30-Apr-11 OIC Ltd. 1st April 11 1-Apr-11 Yes14 Dantewada Tata-AIG Ltd. 31st July 11 OIC Ltd. 1st July 11 31st Oct 11 Yes15 Bijapur Included in Dantewada OIC Ltd. 24-May-11 1-Jun-11 Yes

16 Mahasamund Tata-AIG Ltd. 28-Feb-11 OIC Ltd. 3-Jan-11 1-Feb-11 Yes

17 Kawardha Tata-AIG Ltd. 28-Feb-11 OIC Ltd. 8-Feb-11 1-Mar-11 No

18 Korea Tata-AIG Ltd. 28-Feb-11 OIC Ltd. 28-Feb-11 1-Mar-11 Yes


District-wise Enrolment of BeneficiariesName of the

District Round

Name of Insurance Company

No. of BPL families

Average family size in BPL Data

Enrolment Start date

Total Enrolment

till date

Enrolment End date

Enrollment No. as downloaded from

FKO Cards

Percentage of BPL Families

getting enrolled

Average family size of

enrolled family

1 2 3 4 5 6 7 8 9 10

RajnandgoanRound 1 OIC Ltd. 109051 6-Jun-09 40980 12-Jul-09 40980 37.6 2.7

Round 2 OIC Ltd. 125975 30-Aug-10 79083 31-Jan-11 79083 62.8 3.6

DurgRound 1 OIC Ltd. 256960 14-Jun-09 130408 30-Jan-10 130408 50.8 2.8


BilaspurRound 1 OIC Ltd. 233371 17-Jul-09 82331 30-Jan-10 82331 35.3 2.9


SargujaRound 1 OIC Ltd. 115677 15-Jul-09 61544 30-Dec-09 61544 53.2 2.8


RaipurRound 1 OIC Ltd. 363266 1-Sep-09 178713 30-May-10 178713 49.2 3.3

Round 2 OIC Ltd. 376643 28-Sep-10 231876 28-Feb-11 231876 61.6 3.5

BastarRound 1 OIC Ltd. 90705 10-Jul-09 41146 16-Jun-10 41146 45.4 3.1

Round 2 OIC Ltd. 141746 15-Nov-10 114758 28-Feb-11 114758 81 3.3

NarayanpurRound 1 - - - - - - - -

Round 2 OIC Ltd. 14889 6-Jan-11 8020 30-Apr-11 8020 53.9 3.2

KankerRound 1

Tata-AIG Ltd.

59741 1-Dec-09 25516 31-May-10 25516 42.7 3.2

Round 2 OIC Ltd. 63866 17-Feb-11 50735 31-May-11 50735 79.4 3.4

DhamtariRound 1

Tata-AIG Ltd.

57513 26-Oct-09 36835 30-Apr-10 36835 64 2.7

Round 2 OIC Ltd. 57513 3-Jan-11 45502 30-Apr-11 45502 79.4 3.428th June 2011 RSBY RRM Ranchi 6

District-wise Enrolment of BeneficiariesName of the

District Round

Name of Insurance Company

No. of BPL families

Average family size

in BPL Data

Enrolment Start date

Total Enrolment

till date

Enrolment End date

Enrollment No. as downloaded

from FKO Cards

Percentage of BPL Families

getting enrolled

Average family size of

enrolled family

1 2 3 4 5 6 7 8 9 10

RaigarhRound 1 Tata-AIG Ltd. 198128 16-Dec-09 113048 19-Apr-10 113048 57.1 2.8


KorbaRound 1 Tata-AIG Ltd. 114660 5-Nov-09 69511 30-Apr-10 69511 60.6 2.9


JangjirRound 1 Tata-AIG Ltd. 129030 6-Dec-09 68482 30-Apr-10 68482 53.1 3.2


JaspurRound 1 Tata-AIG Ltd. 69960 1-Jan-11 52552 30-Jun-10 52552 75.1 3.2

Round 2 OIC Ltd. 70347 1-Apr-11 38733 31-Jul-11 38733 55.1 3.1

DantewadaRound 1 Tata-AIG Ltd. 91421 1-Jan-10 9631 30-Jun-10 9631 10.5 2.8

Round 2 OIC Ltd. 68351 - - - - - -

BijapurRound 1 - - - - - - - -

Round 2 OIC Ltd. 27634 24-May-11 5485 31-Aug-11 5485 19.8

MahasamundRound 1 Tata-AIG Ltd. 118665 16-Dec-09 76362 30-Apr-10 76362 64.4 3.2


KawardhaRound 1 Tata-AIG Ltd. 83640 29-Nov-09 43552 31-May-10 43552 52.1 3.4


KoreaRound 1 Tata-AIG Ltd. 50557 22-Dec-09 28720 30-Jun-10 28720 56.8 1.5



• What were the main reasons for non-enrollment of beneficiaries?– Poor logistics and commitment of enrollment team.– Capacity of the enrollment team.– Target oriented approach of TPA/ Smart card vendor ( Business Guarantee).

– Migration of the beneficiary/Death of the beneficiary.

• Is data of missing families in the BPL list being collected in prescribed format at enrollment station?

No.


Enrolment of Beneficiaries

Incentive system for FKOs Incentives 3 Rs per card to FKOYes , areas reaching 70 % coverage

IEC and BCC activities are being done by the Insurer for enrolment?

• Milking and informal meetings , IPC .• Jingles in local languages• Block workshops /Informal meetings .• Distribution of slips

Steps taken to correct gender and age

Being done after verification

Any innovation in enrolment process?

Yes. The teams are encouraged to stay at base villages. Admin providing support.

Main issues and learning from Enrolment process

Proper communication , local support and good logistics management .Capacity of the enrollment team.


Empanelment of Hospitals

Name of the DistrictNo. of BPL

families

Private Public

How many private hospitals already have

operational transaction system

How many Private provider have

received at least one RSBY patient

How many public hospitals already have operational

transaction system

How many public provider have

received at least one RSBY patient

Rajnandgaon 125975 5 5 20 12Durg 281660 20 24 22 12Bilaspur 238328 32 18 32 10Sarguja 232801 6 5 34 14Raipur 376643 91 62 26 3Bastar 141746 3 4 17 4Narayanpur 14889 0 0 2 1Kanker 63866 0 2 6 3Dhamtari 57276 6 5 5 4Raigarh 233153 8 5 6 3Korba 114660 5 4 4 2Janjgir 128193 9 3 8 1Jaspur 70347 2 2 9 2Dantewada 68351 0 0 7 0Bijapur 27634 0 0 4 0Mahasamund 118983 4 4 5 0Kawardha 83640 3 5 4 1Korea 61769 0 0 6 3

Total 2439914 194 148 217 7528th June 2011 RSBY RRM Ranchi 10

Em p an elm en t o f H o sp itals

• District Workshops for hospitals organized at all the Places• District administration actively involved in the empanelment process- A

three member committee constituted for recommending and delisting of hospitals

• Except few districts, Private hospitals are available across the state.• Presently No special IEC or BCC activities are done by Insurer• Innovation in empanelment process?

– Yes EOI for empanelment issued by Nodal agency– Display board at Empanelled hospital with Govt Logo and DHS – Govt communication regarding empanelment of all government

accredited hospitals in the scheme.• Main issues and learning from Empanelment process.

– The District Administration should take lead.– Insurance companies should reciprocate – The MOU should be shared with nodal agency


Have Insurance Companies done mapping of Empanelled Hospitals on the district map for each district? Show this mapping on the slide.

No, SNA is doing it .


Data Analysis

• Show some data analysis based on– Conversion ratio– Hospitalization ratio Average and Gender wise– Average Family size– Burnout Ratio– RSBY Summary 22nd June 2011.xlsx– Disease pattern


Total cases Surgical 0

10

20

30

40

50

60

5149

40

30

3610

2.8

8.2

GeneralSugicalGeneral OrthopedicGynaeNormal deliveryHysterectomyC SectionOthers


Any Issue with the Fund flow at different levels• Flow from State Government- No• Flow from Central Government- Delayed receipts.• Flow from IA to TPA- No.• Flow from TPA to Hospitals- ?

Submission of Audited Financial Statements to the Government of India- Done


Utilization of Services and ClaimsName of the

District RoundBPL

Population enrolled

Date of Start of Policy

Number of claims till

now

Amnt of Claims

% Cases in Public

Hospitals

% of cases where women

have taken benefits

Average Claim Size

Average Burnout

Ratio

RajnandgaonRound 1 40980 1-Aug-09 428 11.44 59.35 NA 2673 24.5

Round 2 79083 1-Sep-10 2414 69.92 84.30 48.59 2896 47.91

DurgRound 1 130408 1-Sep-09 7748 266.20 19.84 NA 3436 67.2

Round 2 156860 1-Sep-10 13167 452.71 23.51 51.69 3438 98.83

BilaspurRound 1 82331 1-Sep-09 1965 88.80 18.88 NA 4519 81.9

Round 2 139658 1-Sep-10 3725 205.45 28.05 47.11 5515 62.84

SargujaRound 1 61544 1-Sep-09 1206 33.63 68.33 NA 2788 30.4

Round 2 153249 1-Sep-10 8447 304.34 56.26 48.29 3603 75.93

RaipurRound 1 178713 1-Oct-09 4693 269.42 7.82 NA 5741 62.3

Round 2 231876 1-Oct-10 8159 582.37 16.39 51.86 7138 89.30

BastarRound 1 41146 1-Nov-09 1163 37.24 7.57 NA 3202 60.2

Round 2 114758 1-Dec-10 328 12.54 37.80 52.44 3823 28.21

NarayanpurRound 1 - - NA

Round 2 8020 1-Feb-11 10 0.23 100.00 70.00 2300 26.16

KankerRound 1 25516 1-Jan-10 506 19.29 44.47 NA 3813 33.8

Round 2 50735 1-Mar-11 143 3.59 76.22 57.34 2510 27.23

DhamtariRound 1 36835 1-Dec-09 1991 102.60 20.74 NA 5153 72.8

Round 2 45502 1-Feb-11 2156 110.72 21.29 54.87 5135 87.31


Utilization of Services and ClaimsName of the

District RoundBPL

Population enrolled

Date of Start of Policy

Number of claims till now

Amt of Claims

% Cases in Public

Hospitals

% of cases where

women have taken

benefits

Average Claim Size

Average Burnout

Ratio

1 2 3 4 5 6 7 8 9

RaigarhRound 1 113048 1-Jan-10 3578 179.59 69.98 NA 5019 49.8

Round 2 119235 1-Mar-11 401 24.38 26.68 43.89 6080 30.63

KorbaRound 1 69511 1-Dec-09 1278 62.50 43.58 NA 4890 36.5

Round 2 69598 1-Feb-11 179 9.05 29.61 55.87 5056 28.74

JangjirRound 1 68482 1-Jan-10 1475 82.84 23.93 NA 5616 42.5

Round 2 74033 1-Feb-11 181 10.31 14.92 50.28 5696 28.97

JashpurRound 1 52552 1-Mar-10 2476 67.59 52.46 NA 2730 44.0

Round 2 38733 1-Apr-11 34 1.08 23.53 52.94 3176 26.14

DantewadaRound 1 9631 1-Mar-10 44 2.10 13.64 NA 4773 23.4

Round 2 - - - - - - - -

BijapurRound 1 - - - - - - - -

Round 2 5485 1-Jun-11 - - - - - -

MahasamundRound 1 76362 1-Jan-10 1346 62.44 13.52 NA 4639 35.0

Round 2 73094 1-Feb-11 238 8.11 17.23 45.38 3408 28.25

KawardhaRound 1 43552 1-Jan-10 783 56.11 18.52 NA 7166 44.0

Round 2 59997 1-Mar-11 576 43.25 5.21 35.94 7509 43.76

KoreaRound 1 28720 1-Feb-10 421 9.28 96.44 NA 2204 25.4

Round 2 40263 1-Mar-11 288 9.31 100.00 46.18 3233 31.3128th June 2011 RSBY RRM Ranchi 17

Utilization of Services and ClaimsName of the District

Total Claims in current round

Claim paid within 21 days

Claim paid after 21 days

Number of Claims rejected

Reasons for rejection

Rajnandgon 2414 1258 838 32

Durg 13167 6545 4364 548

Bilaspur 3725 1323 882 120

Sarguja 8447 3600 2400 263

Raipur 8159 3474 2316 178

Bastar 328 134 90 8

Narayanpur 10 0 0 0

928 others and 238 duplicate

Kanker 143 33 22 0

Dhamtari 2156 838 558 70

Raigarh 401 62 42 3

Korba 179 68 45 12

Janjgir 181 102.6 68 2

Jaspur 34 0 0 0

Dantewada 0 0 0 0

Bijapur 0 0 0 0

Mahasamund 238 8 5 0

Kawardha 576 31 21 0

Korea 288 13 8 0

Total 40446 17489 11660 127228th June 2011 RSBY RRM Ranchi 18

Utilization of Services and claims

Inter-Insurance Company Claim

Problems still pending for last 12 months.

Data transmission Manual and Electronic data sent directly from the Hospital to Central Server of TPA

Feed back Period survey undertaken by SNA and TPA

Fraud, Moral hazards Yes. Case is being investigated. Double billing at some instances which are dealt severely.Touts of hospitals are being reported

Settlement of claims Hospital TPA approved and raises Float to IA IA verifies and releases funds to TPA releases money to the Hospital through Cheque

Electronic funds transfer All funds after 1st of November are being transferred electronically. Presently only 50 % ECS.


Grievance Redressal MechanismWhat is the Grievance redressal mechanisms in the State at District and State level

Coordination committeeCentralized helplineDistrict committee/ DKMA

Any feedback on the current grievance redressal?

Yes

Has any Grievance redressal committee being formed at the State level as suggested in the “Advisory from the Central Government regarding de-empanelment hospitals”?

Already committees are in place at district level


Fraud /Abuse ControlIs there any report of Fraud etc. from the field?Hospital related-Smart card issuance-

Yes

YesYes

Has any mechanism developed by the SNA for the Fraud prevention and control?

Yes ,data analysis Daily sample checks and surprise visits.

Has any mechanism developed by the Insurance Company for the Fraud prevention and control?

No.

What actions have been taken by the SNA in this regard?

Hospital visits, Feedback from Mitanins and feedback during social audits.


De-Empanelment of Hospitals

–

Detail on Hospitals which have been de-empanelled in the scheme (if any)

1. Christian Mission Hospital – Dhamtari2. Champa fertility Nursing Home- Jangjir.3. Swami Narayan Hospital Raipur4. MPM Hospital Baster5. Kanwar Hospital Raipur6. Chandulal Chandrakar Hospital Durg

What was the process followed for de-empanelment?

Complaints –TPA issues SCTPA examines and takes action with the concurrence of SNA/District Committee

What actions were taken after the de-empanelment (e.g. press release)?

Print media and electronic media .Notice from DHS


IEC Activities• Funds have been released to all the districts for holding health camps/ Melas for

increasing utilization of services.• TV spots developed and broadcasted.• Radio jingles developed in local language and dialect and broadcasted• Distribution of printed pamphlets and material.• Regular meeting cum review cum reconciliation workshops being held for

hospitals • RSBY material is included in 14th round Mitanin training programme ( ASHA)• RSBY is part of Fast track training programme for District Health planning under

NRHM.• Review meetings are being organized regularly on a monthly basis for District

Collectors, CMHOs, DPMs and Civil Surgeons besides video conferencing on fixed monthly dates.

• Media workshops.


EvaluationDoes State Government/ Nodal Agency conducts regular review meetings (Periodicity)?

Daily coordination meeting with IA and TPAMonthly meeting with District personnel.

Is there any concurrent evaluation done by using tools provided by MoLE for spot checking of enrollment and hospitalization?

Yes

Has data from enrollment and utilization been analyzed?

Yes


Evaluation Study

• Has any formal study being planned/ conducted by the State Government?

– Quality of providers in RSBY – Facility Survey- ongoing– Pre and Post Hospitalization Survey of beneficiaries

• Study has been undertaken by PHRN report available on PHRN website.

• Evaluation study –RFP will be floated shortly.


Decisions taken/ proposed• Incentives have been provided to Providers of Public

Hospitals• Training of Jeevan Deep Samittees is under process as part

of quality development initiative• CM hospital development has been set up for Gap support

to hospitals in difficult areas• Scheme extended to

– Building and construction worker

– PTG not covered – Families affected by Naxallite violence– Mitanin ( ASHA)– NRHM contractual staff

• Web portal and Centralized help line started • List of packages increased to 1130 .


Suggestions for Improvement

• Capacity building at all levels• Real time data management• Online transaction of claims and settlement.• Trust and Transparency among the team.


Thank You


RSBY regional review meeting eastern region Ranchi 28th June 2011

Health & Medicine

Transcript of RSBY regional review meeting eastern region Ranchi 28th June 2011