Citizens' Issues
Widespread leakages in Maharashtra government’s mediclaim scheme
Nearly half of the people who have benefitted from the Rajiv Gandhi Jeevandayee Arogya Yojana are not eligible. Government hospitals are looting the poor by asking them. Private hospitals are charging for services that are already covered under the Scheme. Questions are also being raised about inefficiencies of insurer or TPAs. All this at taxpayers’ cost!
 
The Maharashtra government’s Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY), launched in July 2012, provide health insurance cover up to Rs1.5 lakh for families earning less than Rs1 lakh per year. The Scheme is meant for people below poverty line (BPL) families (yellow cardholders) and above poverty line (APL) (orange cardholders). A study conducted by the Tata Institute of Social Science (TISS) points to an unusually high level of leakages in the system. If so, how is the system still afloat?
 
The loss created from different stakeholders like false beneficiaries, hospitals, insurers, third party administrators (TPAs) is funded by the taxpayers. This shows how another ambitious project for the poor does not actually help the poor. The study clearly indicates that poorer the beneficiaries, greater the level of difficulty for availing benefits. Here are the main conclusions from the study along with Moneylife comments in italics – 
 
  1. Arogyamitra should be at the hospital to help the beneficiaries about the amount approved, inclusions they are entitled to and protocols regarding registering complaints. Arogyamitra seem to be an imaginary character missing in action. Will RGJAY visit hospitals to locate this friendly guy?
  2. The analysis revealed that almost half of the RGJAY beneficiaries are actually from the non-eligible category with family income higher than Rs1 lakh per annum. A massive fraud from consumers? Rich consumers will always find ways to loot the government scheme. What is the exact way by which those having income over rupees one lakh (and hence non-eligible category) were able to make RGJAY pay in such a high number of cases (nearly half)?
  3. Out-of-pocket (OOP) expenses seem to be more than just OOPs moment for the RGJAY. Hospitals made beneficiaries pay for services like diagnostic tests, medications, and consumables, even when it was covered under the Scheme. A notable finding was that the mean OOP spending in private hospitals was more than twice that compared with public hospitals. Seems to be in-line with the expectation that private hospitals are better qualified at looting the consumers.
  4. Reasons for private hospital OOPs - The most predominant reasons cited for paying for services in private hospitals were “procedure was not covered under RGJAY,” (30%) followed by “lack of knowledge” (18%). The other reasons were paying for food, “noncooperation from hospital staff,” and “lack of time to complete the necessary paperwork.” So, the nice staff at private hospitals may suddenly seem non-cooperative once you ask for benefits under RGJAY scheme.
  5. Reasons for public hospital OOPs - Those who cited “lack of information” as the reason for paying for services in public hospitals was the highest (33%), followed by “unavailability of time to complete all the necessary paperwork” to avail of the services (19%). So, for staff of public hospitals not having information or time to complete the paperwork seems to be the plausible reasons and this is not something out of the world.
  6. Unable to reach the poor – Difficulty in reaching the poor is also as expected. According to the data provided by the Food and Civil Supplies Department, of the total eligible families in Mumbai, 99.22% are orange ration cardholders (annual income between Rs15,000 and Rs1 lakh), 0.28% (annual income less than Rs15,000) are yellow ration card holders. Such a wide gap? Yellow ration cardholders in Mumbai should buckle up to avail of RGJAY services.
  7. Insurers and TPAs are minting? For the year 2014-2015, according to the RGJAYS, premium was paid for 21.9 million households. In other words, 85% of the population is currently covered by the scheme. While insurers earned good premium and TPAs a slice of it, there are reports of issues with them. Why would there be no leakages with this stakeholder?
 
When Dr Raju Jotkar, assistant director, Rajiv Gandhi Jeevandayee Arogya Yojana, was asked “How much is the incentive given to TPA for keeping the claims ratio down?” he said “No precise idea, but I hear that bonus is given to TPAs which is also substantial.”
 
 
The study found that about a third of the beneficiaries experienced financial catastrophe, if indirect expenditure is taken into consideration. This also implies that for the poor, ill health has further deepened the existing poverty. There is the need for awareness campaigns targeting the eligible households to be carried out. This is to be done not just by media but by including local non-governmental organisations (NGOs) and self-help groups to make people aware of the scheme’s features and benefits.
 
It also says that given the fact that precious financial resources are spent for implementing RGJAY, it would be desirable that policy makers take note of the above evidence and do a critical analysis to fully understand the implications of this new financing intervention.
 
Moneylife has asked a few questions to the authors of the eye-opening report and also to RGJAY officials. If and when, we get responses with additional information, we will write an additional article.
 
 
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COMMENTS

Shirish Sadanand Shanbhag

1 year ago

In Mumbai, all types of treatments in BMC Hospitals like KEM, Nair, Sion, Rajavadi, etc. or Maharashtra Govt. Hospitals like JJ, Cama, GT, etc. are available free of charge to all, even before Rajiv Gandhi Arogya Scheme was launched by the Govt.

Fall in public, private investment major concern: Rajan
Reserve Bank of India Governor Raghuram Rajan on Friday said he was concerned that the fall in public and private investment in India would affect the country's economic growth. 
 
"On the growth front, the central concern is with investments. Private investment has fallen back a bit and so has public investment," Rajan said at an event here.
 
However, despite the slowdown in growth and investments, strong foreign direct investment and some traction in infrastructure development could encourage private investments, he added.
 
Prime Minister Narendra Modi said in Britain last week that the world's confidence in India is rising is proved by the fact that foreign direct investment into India has increased by 40 percent.
 
The RBI recently lowered its growth forecast for the country's current fiscal to 7.4 percent, from the 7.6 percent it had projected earlier.
 
In September, the central bank cut the repo rate, at which it lends to commercial banks, by 50 basis points to 6.75 percent.
 
Disclaimer:  Information, facts or opinions expressed in this news article are presented as sourced from IANS and do not reflect views of Moneylife and hence Moneylife is not responsible or liable for the same. As a source and news provider, IANS is responsible for accuracy, completeness, suitability and validity of any information in this article.

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'The Man Who Knew Infinity' brings Ramanujan's legacy back to India
If Richard Attenborough brought home Mahatma Gandhi by making a biopic on the 'Father of the Nation', young director Matt Brown has brought home the legacy of mathematics genius Srinivasa Ramanujan Iyengar back to India with his film "The Man Who Knew Infinity", according to executive producer Swati Bhise.
 
Addressing a press conference in Panaji, the host city for the 46th edition of the International Film Festival of India which opens with Brown's film, Bhise on Thursday said the director was sensitive to a great degree as far as cinematically examining the delicate nuances of the South Indian culture and the influence of two women, Ramanujan's mother and wife, on the country's greatest mathematician.
 
"Sir Richard Attenborough had made 'Gandhi'. But we are very happy that someone like Matt Brown has brought Ramanujan to India and with great sensitivity, he has shown the aspect of how it was in India with the relationship with his wife and his mother," Bhise said.
 
"To understand two strong women, one a mother figure in the South, we know what that is. And his relationship of having to leave as a Brahmin Iyengar boy all the way to Cambridge, what a huge sacrifice that was in the pursuit of knowledge," she said.
 
The film is based on the book "The Man who Knew Infinity: A life of the genius Ramanujan" written by Robert Kanigel.
 
Brown may have lacked the cinematic pedigree of Attenborough, but his diligence and attention to detail was remarkable, Bhise said.
 
"Matt worked very closely with Ken Ono and Manjul Bhargava, two leading mathematicians, who have won the Fields award and the Padmashree respectively.
 
"They worked for a long time, exactly on the formulas and how they were written. How partitions were done. Lot of attention was given to each aspect of the film to bring the realistic quality forward," she said.
 
The fragile dilemmas of Ramanujan, a young vegetarian Iyengar boy, in England during the days of the British Raj and racism of the times have also been realistically captured, Bhise said.
 
"He is yearning for his home, his culture. You know the sambhar and rice and not having to eat vegetarian food. The traditions at Trinity and England at that period and whether it was racism or it was the sensitivity of food," she said.
 
"So I think that it is really important that Ed (producer Edward Pressman) and Matt have made a film which takes Ramanujan from Hollywood back to India and that's something that I think is a privilege for India to say that we celebrate Ramanujan, especially December 22, his birthday, as Mathematics Day," Bhise added.
 
Disclaimer: Information, facts or opinions expressed in this news article are presented as sourced from IANS and do not reflect views of Moneylife and hence Moneylife is not responsible or liable for the same. As a source and news provider, IANS is responsible for accuracy, completeness, suitability and validity of any information in this article.

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