Aarogya samrakshana ayalkoottam neighborhood health protection groups
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Aarogya Samrakshana Ayalkoottam Neighborhood Health Protection Groups. Making Difference Together. National Health and Allied Services Cooperative (Proposed) Toms K Thomas Founder CEO, MARG Mutual Assistance Resource Group Lala Appartments, Flat No-3

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Aarogya Samrakshana Ayalkoottam Neighborhood Health Protection Groups

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Aarogya samrakshana ayalkoottam neighborhood health protection groups

Aarogya Samrakshana AyalkoottamNeighborhood Health Protection Groups

Making Difference Together

National Health and Allied Services Cooperative (Proposed)

Toms K Thomas

Founder CEO, MARG

Mutual Assistance Resource Group

Lala Appartments, Flat No-3

P.O Ayyanthole-Thrissur- Kerala – India

www.margindia.org / www.margasia.org


Vision marg

Vision MARG

Community Transformation, through Mutual Assistance, CommunityNeighborhood Investment, Cooperation & Partnership.


Mission marg

Mission -MARG

Provision of Appropriate Human Development Services inclusive of Public Health for all segments particularly the most Vulnerable and Marginalized irrespective of caste, creed, religion or gender, thus Enabling the Communities to Identify and Pool Local Resources to develop Community Owned Health and Development Financing institutions.


Major entities

Major Entities

  • National Health and Allied Services Cooperative (NHASCO) – In the Process of Initiating a Multi State Cooperative which work exclusively on Health Care Financing. Registered under the Central Cooperative Societies Act.

  • Coverage – Kerala, Tamil Nadu, Chhattisgarh

  • Health Save International – In the process of initiating a Community Based Organized Savings for Health Care. This would facilitate Mobilizing of Health Investments at the local level through organized savings. Would be Registered as Company.

  • IMPORTANCE OF A REGULAR SAVING FOR HEALTH INSTEAD OF A ONE TIME PREMIUM


Facts

FACTS

  • 60-80% of illness do not require any hospitalization – OUT PATIENT CARE + HOME BASED CARE – APPROPRIATE CARE

  • Some 40% of ILLNESS do not require any treatment at all – BUT PREVENTION + PRECAUTION – HEALTH EDUCATION

  • Over 70% of the HEALTH CARE in Rural areas are Provided by QUACKS -JHOLA CHAAP / SELF TREATED – HEALTH SEEKING PRACTICE

  • OVER 50% REACH A FACILITY ON AN IN APPROPRIATE TIME – DIFFERENT LEVELS IN SOUTH AND NORTH. - HEALTH CARE HEIRARCIES


Health protection

Health Protection

  • Not equal to MERE Health Insurance!

  • A Basket with Diverse Products which address various associated issues

  • Beyond Finance

    - About Appropriate Services

    - Quality Perceptions – Costly Services!!

    - Right Understanding of Prevention

    - Awareness about Appropriate Time to Access

    A Care Hierarchy-

    - FANCY MEDICARE / APROPRIATE CARE

    - NOT A ONE TIME EVENT – BUT A LIFE TIME

    PROCESS


Aarogya samrakshana ayalkoottam belief

AAROGYA SAMRAKSHANA AYALKOOTTAMBELIEF

  • Insurance and Financial Protection is JUST ONE COMPONANT of Health Protection

  • Neighborhood Investment (MUTUAL HELP) is the best solution INCLUSIVE FINANCING

  • Institutionalizing Community based HEALTH Financing - COOPERATIVE

  • COMMUNITY CAPACITY and HEALTH AWARENESS

  • Insurance Literacy – BRIGDING RISK


Aarogya samrakshana ayalkoottam content

AAROGYA SAMRAKSHANA AYALKOOTTAMCONTENT

  • A group of 10 to 50 families living in a Neighborhood.

  • Who are concerned of the Health of One Another.

  • Willing to Mutually Invest in Health Protection (Not Taking Policy / Paying Premium).

  • Ready to Learn and Practice – Insurance Literacy & Health Awareness.

  • Network of Care Provides & Insurance Providers

  • WILL BE BROUGHT UNDER NHASCO BRANCH STRUCTURE


The enrolment process

The Enrolment Process

  • Open Ended

  • Develop Connections with existing community based groups and associations.

  • Make Presentations before the local leaders and institutions like churches, Local Governments / Panchayat , SHGs etc..

  • 3 visits minimum before a group is prepared for enrolment


How does it work

How Does It Work

  • As a membership (Family) 4 – 2 below 60 Yrs and 2 Below 21 Yrs. WORKING ON LARGER INCLUSION.

  • Tamil Nadu – Annual Membership Fee INR.280 (INR 160 Insurance INR 100 Group Medical Fund, INR 20 Promotional Fee) – Processing Fee is raised Through Social Investment

  • Cost in Kerala – INR 500 (160 INS, 100 Processing Fee (INR 20 per Person), 100 Group Medical Fund, 120 OPD Fund) and INR 20 Promotional Fee.

  • Cost in Chhattisgarh – In the Process of working out


How it is collected

How It Is Collected

  • Collected in Three Installments

  • Waiting Period of Three Months

  • First Installment is Rs.100 per family

  • Through the Branch Offices and Field Staff


Entitlements

Entitlements

  • Family Floater Insurance = Rs.10000 through National Insurance Company

  • Insurance of assets and life Equivalent to Rs.10000

  • Access to a group owned medical fund (Loan / Grant) – Which would be put under NHASCO

  • Education and Awareness Sessions HEALTH

  • Medical Counseling Centers (Including Life Style Illness Monitoring) – Under Process

  • In Kerala – Free OPD Consultation for a year for a family of 4 in a preferred hospital in the panel hospitals (This is in the process)


How the settlements done

How The Settlements Done

  • IP Admissions are Informed over phone

  • Staff verify the admission and the procedures.

  • Will have a practitioner who would follow up the treatment proceduers (PROCESS)

  • Upon Discharge all the documents are submitted to the HBMC

  • Health Benefit Management Committee (HBMC) forwards the settlements to MARG – NIC

  • INR 100 is charged by the HBMC as Claim Processing per Claim.

  • HBMC meet once in two weeks.

  • Claims for less than 1000 is reimbursed immediately.


How is it financed

How Is It Financed

  • Cross Subsidizing of Premium

  • Mobilizing of Local Social Investment – In the process of developing an ECS Facility with HDFC Bank.

  • Local Donations


An ideal branch office

An Ideal Branch Office

  • Unit Coordinator – Branch Manger - 1

  • Community Organizers – 6

  • Accountant – 1

  • Insurance Officer – 1

  • HO Cost Apportion – 8000

  • District Office Cost Apportion – 5000

  • State Office Cost Apportion - 5000

  • Approximate cost would come to – 45000

  • Enrolment / Branch for Break Even = 450/ Month


Current area

Current area

  • Kerala

  • Tamil Nadu

  • Enrolments = 1000 families as on 30th November 2009.

  • Branches including HO = 4

  • Proposed Branched by 31st March 2010 =10

  • 3 Tamil Nadu

  • 4 Kerala

  • 3 Chhattisgarh

  • Catering to 54000 families (216000 members)


Other targets by march 2010

Other Targets By March 2010

  • Transformation in to a National Multi State Cooperative – NHASCO.

  • Registration of Health Save International in to a company.

  • Mobilizing of 3000 social investors who pay INR 100 a month for a year.


Aarogya samrakshana ayalkoottam other targets

AAROGYA SAMRAKSHANA AYALKOOTTAMOTHER TARGETS

  • Developing Alternative Care Tiers (In the Process)

  • Community Based LIFE STYLE ILLNESS COUNSELING CENTERS (In The Process)


Aarogya samrakshana ayalkoottam partnerships

AAROGYA SAMRAKSHANA AYALKOOTTAMPARTNERSHIPS

  • Insurance Providers

    -National Insurance Company

  • Health care Providers

    - Ashtamudi Hospital and Trauma Care

    Centre, Kollam

  • Health Practitioners (In the Process)


Aarogya samrakshana ayalkoottam neighborhood health protection groups

THA NK YOU.


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