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Sardar Patel Aarogya Mandal, Gujarat
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Subject Area="Health financing." Objective="Mobilising community participation."
Details for Reform Option "Sardar Patel Aarogya Mandal, Gujarat"
Summary

Background: This community-based health insurance scheme is run by a charitable trust the Sardar Patel Arogya Mandal on behalf of the AMUL dairy company. It is not a formal insurance scheme but a way of ensuring that members of the dairy cooperative have the means to pay their health bills. Action: The scheme is open to all members of AMUL’s dairy cooperative. It charges a premium of 1.5 paisa deducted from each litre of milk deposited plus one rupee per family per year. Members must deposit a minimum of 300 litres of milk per year and are not allowed to sell to AMUL’s competitors. It covers inpatient and outpatient care and free hospitalisation at selected referral hospitals. Members must go for treatment at the Tribhuvandas Foundation (TF) (a trust also set up by Amul’s founder chairman to provide health services to its members) or any of its sub-centres for referral to hospital. It has signed a Memorandum of Understanding (MoU) with 9 hospitals (all trust hospitals) and patients are admitted by showing a membership card containing the names of all family members. Bills are then sent directly to the Sardar Patel Arogya Mandal office on a monthly basis so the patients are not out-of-pocket at any stage. There is a cap of INR 7 to 10,000 on average on reimbursement but at the discretion of the management, reimbursements of up to INR 1 lakh can be made. Services excluded include angiography, angioplasty, bypass surgery, all cancers, major orthopaedic operations (joint replacement) kidney transplant, AIDS and TB. Results: The scheme has 83,000 family members.

Cost In 2004, the scheme collected INR 27 lakhs through premiums but the total cost of hospitalisation exceeded INR 1.25 crore. The cost was borne by AMUL.
Place Kheda and Anand districts, Gujarat. Since 2001.
Time Frame Two years.
Advantages

Improved use of medical facilities: Insured members are more likely to seek care when they are ill. Direct billing: Hospital bills go directly to the Sardar Patel Arogya Mandal office so the patient is not out-of-pocket.

Challanges

Excludes the poorest: The scheme excludes those who cannot deposit a minimum 300 litres of milk per year. Prepayment concept: Members have to accept that to be part of a health insurance scheme, they must pay for a service that they might not use.

Prerequisites

Funding. Staff for collecting funds and processing claims.

Who needs to be consulted

The Community. The organisation backing the scheme (in this case AMUL).

Risks

Sustainability

This scheme is not currently self-sustaining. It is heavily subsidised by AMUL (see costs box).

Chances of Replication

This scheme has not been replicated elsewhere. It is specific to rural, cattle-rearing areas.

Comments

None.

Contact

Submitted By

Clare Kitchen, Research Consultant, ECTA, New Delhi, November 2005.

Status Active
Reference Files
EPW (Akash).pdf Akash Acharya, M Kent Ranson: Health care Financing for the Poor: Community-based Health Insurance Schemes in Gujarat. Economic and Political Weekly, September 17 2005.
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