1. The Andhra Pradesh Government has decided to provide comprehensive health care to all Government Employees, Pensioners, and their family members, on cashless basis through an appropriatescheme in lieu of the present medical reimbursement system. In order to implement the Scheme effectively, the Government has held a series of meetings with the Joint Action Committee of Employees, Teachers, Workers and Pensioners, and A.P. Secretariat Employees’ Co-ordination Committee representatives to discuss the scheme and its implementation modalities. Based on the inputs received during these meetings, the Government has decided to operationalise the scheme for comprehensive health care for employees, pensioners and their families in a time bound manner.
2. Accordingly, the Government hereby constitute a Committee with the following members to analyse all aspects of the scheme and make comprehensive recommendations for its effective implementation:
1 Smt. Y. Srilakshmi, IAS Commissioner of Health& Family Welfare Chairperson
2 Dr. Venkatesh, Principal, Gandhi Medical College, Secunderabad Member
3 Dr. Rammohan, Prof. of Surgery, Osmania Medical College, Hyderabad Member
5 Dr. Sai Babu, Additional Director (Population Stabilisation), Commissionerate of Health & Family Welfare, Hyderabad
6 Dr. P. Padmaja, Superintendent, Govt. Maternity Hospital, Sultan Bazar, Hyderabad
7 Dr. Ranganath, Professor of Paediatrics, Niloufer Hospital, Hyderabad
8 Dr. G. Balaramaiah, President, Indian Medical Association
9 Dr. P. Visweswara Rao, President, APNA
10 Dr. Bhaskar Rao, President, A.P. Speciality Hospitals Association Member
11 The Addl. Secretary/Joint Secretary to Government, General Administration (SW) Department
12 The Addl. Secretary/ Joint Secretary to Government, Finance (Expr. M&H) Department
13 The Joint Secretary to Government, HMFW Department
14 The Additional Director of Medical Education, O/o Director of Medical Education, Hyderabad
15 The Joint Director (Medical), O/o Director of Medical Education, Hyderabad
16 The Joint Commissioner (Medical), O/o Commissioner, A.P. Vaidya Vidhana Parishad, Hyderabad
17 The Chief Executive Officer, Aarogyasri Health Care Trust, Hyderabad Member- Convener
3. The Committee will conduct a series of focus group discussions with specialists from the Government and Private Hospitals, representatives of employees and pensioners, with the administrators of the private and public sector hospitals, experts on health insurance, health economists, IRDA officials and insurance companies to consider all aspects of the scheme and make appropriate recommendations on the following Terms-of-Reference (TOR):
a) Define the contours and content of comprehensive health cover for employees – both current and retired – and their families, duly considering the benefits provided under the existing regime;
b) Review the existing medical reimbursement scheme with reference to its coverage, content, costs, methodology, institutional arrangements, etc., and recommend appropriate design in terms of coverage – diagnostic, curative, rehabilitative, supportive care – quality of care, cost of care, institutional architecture for efficient management of cashless medical packages in order to extend the coverage to all employees and pensioners eligible under the existing reimbursement scheme.
c) Defining the packages for high-end high cost procedures such as replacement and transplant surgeries.
d) Identify, design and recommend protocols and packages for chronic ailments such as Hypertension, Diabetes, Rheumatoid Arthritis, etc., requiring long term on out-patient basis and recommend the content of preventive health check-ups.
e) Methodology for approval of treatment costs above the financial limit prescribed by the Government and the modalities for treatment outside the state for employees and pensioners living in boarder districts and outside the State, including New Delhi.
f) Examine the existing referral system and recommend appropriate system for the referral of employees – both serving and retired – and their family members, along the health service system.
g) Recommend the most effective and efficient institutional architecture for implementation of the scheme
h) Indentify and enumerate the risk factors that could affect the implementation of the scheme.
i) Any other matter that the Committee deems appropriate based on its deliberations with stakeholders and experts.
4. The Committee is advised to obtain necessary technical advisory services from the National Health Systems Resource Centre (NHSRC), Administrative Staff College (ASCI), Access-Health International, ISB, Gachibowli, etc., as deem appropriate. The Committee is required to complete its deliberations with all stakeholders and experts and submit a comprehensive report on or before 30 June 2011. The Government directs that all costs incurred for technical consultations and advisory services shall be paid from the Arogya Sri Trust funds.
5. While the above process is under way, the Government directs the Chief Executive Officer of Arogya Sri Health Care Trust to launch the process for issue of Health Cards for the serving and retired employees and their families in consultation with all concerned. Download GO MS NO: 1049,dt.31.05.2011