STATE LEVEL WORKSHOP 23 RD & 24 TH MAY, 2014 RAJIV GANDHI JEEVANDAYEE AAROGYA YOJANA

1. STATE LEVEL WORKSHOP23RD & 24TH MAY, 2014RAJIV GANDHI JEEVANDAYEE AAROGYA YOJANA DR. V. R. ZARE Deputy Director, Nagpur DR. D. V. PATURKAR Civil Surgeon, Bhandara

2. STATUS OF RGJAY IN BHANDARA Maha e sevacentres : 127 Sangramcentres : 542 Post offices (since 26th : 002 January, 2014) Total no. of health cards distributed : 2,04,117 (82.04%) No. of health camps scheduled in may, 2014 : 07

3. STATUS OF RGJAY IN BHANDARAAS ON 23RD MAY, 2014

4. STATUS OF RGJAY IN BHANDARAAS ON 23RD MAY, 2014

5. STATUS OF RGJAY IN BHANDARAAS ON 23RD MAY, 2014

6. STATUS OF RGJAY IN BHANDARAAS ON 23RD MAY, 2014

7. STATUS OF CLAIMSNAGPUR CIRCLE

8. TOTAL CASE COUNT.STATUS OF CLAIMSNAGPUR CIRCLE

9. SUM OF PRE AUTH APPR AMOUNTNAGPUR CIRCLE

10. CLAIM PAIDNAGPUR CIRCLE

11. PERCENTAGE OF CLAIM NAGPUR CIRCLE

12. ISSUES • RESPONSE BY ad@jeevandayee.gov.in • Dist. Hopspital, Bhandara has not been given approval for polytrauma cases despite availability of necessary infra structure. • Our response: polytrauma needs on call neurosurgeon which u have to hire and produce the documents to society. We will take it in Ec and open the polytrauma.

13. The limit of submission of documents after ETI is given and approved; is 72 hours and needs to be raised to at least 5 working days. The relatives of the patient are frequently unable to produce documents in time due to distance, unavailability of relatives etc. Also frequently; there is need for additional entry in the ration book by tahsildar regarding date of issue which is time consuming. • Our response:  Secretary (2) PHD mam is in process of circulating guidelines to District Collectors to streamline issue date certification process which will reduce the time lag. As per MOU the time relaxation over and above 72 hours appears difficult given the stringent stance taken by Insurer. But will make an attempt.

14.  Rejection on technical grounds such as advisability of one procedure as against another; evidence of compound nature of fracture in form of photograph, consideration of age factor while approving hysterectomy proposals and its certification by senior doctor with signature/seal are contentious issues which put a question mark on not only the clinical ability and judgement of treating doctors but their integrity as well. • Our response:  We agree that the preauth team should not suggest treatment modalities to treating surgeon/physician. Will take up with NIC and TPA. However, as an interim, ur team may respond quickly to the queries as well as the compliance in case of  documents deficiencies if any.

15. The seed money of Rs. 5 lakhs needs to be spent for the purposes expressly mentioned in the relevant letter AND also sometimes for other incidental purpose e.g. payment of charges for investigations outsourced; payment of outsourced speciality/super speciality services on event basis, printing of stationery etc. • Our response:   DHS will respond.

16. Cross speciality work for certain procedures is being routinely done and should be allowed for approval of the proposals. e.g. general surgeon performing lumbar sympathectomy or urological procedures etc. • Our response:   Secretary (2) PHD had set up a committee to review the issue of cross specialty and the committee has furnished the report on 13 Dec 2013. It may be noted that RGJAY aims to have high cost high end low event procedures and hence “can do” may or may not  result in “well done” in instances.

17. RAJIV GANDHI JEEVANDAYEE AAROGYA YOJANA SWOT ANALYSIS

18. STRENGTHS • Ready availability of infrastructure. • Availability of manpower. • Commitment to make scheme work. • A comprehensive exercise undertaken by the department to put in place the NABH standards

19. WEAKNESSES • Digitization of the data is an issue. • Gaps in the standards of clinical services and administrative aspects of the system in government sector. • Compulsory multitasking. • Present manpower in government sector lacks in skills required to undertake all procedures reserved for the sector.

20. WEAKNESSES • Over dependence on procedural and mundane details by preauthorization team; sometimes questioning professional integrity of doctors. • Negative media coverage and inadequate IEC. • Provision of only one way transportation costs .

21. OPPORTUNITIES • Training and deputation exercise aimed at enhancement and availability of skills. • Use of additional revenue generated towards TQM. • Establish a work culture and good clinical practices.

22. THREATS • Lack of cooperation by private sector and inclination to use the scheme only when convenient/beneficial. • Umbrella and nature of procedures reserved at present for the government sector resulting in loss to the exchequer.

23. THREATS • Absence of incentives to government employees may translate into less enthusiastic approach. • Issue of cross speciality: Stress on “well done” and refusing to allow the fact that “can do” does indeed many a times result into “well done”. • Inordinate and inexplicable delay by NIC in depositing claim amount.

24. SUGGESTIONS • Turn weaknesses into opportunities. • Issue of digitization of data of ration cards can be resolved by special campaign of data entry, considering off-line entry option for health cards, using unique no. of ration cards for search of details etc. • Quality of clinical and administrative performance can be enhanced by training, sensitization/advocacy exercises.

25. SUGGESTIONS • Multitasking in administrative area can be dealt with by hiring contractual manpower which will increase manpower of the institution. • Training the existing manpower in additional skills such as laparoscopic surgery, oncology, gastro-duodenoscopy, colonoscopy etc, will prove beneficial to the institution and the individuals as well. • The protocol in force for pre authorization etc can do without the some excessively elaborate conditions /riders and details required at present.

26. SUGGESTIONS • Negative media coverage and inadequate IEC are issues to be resolved with a systematic approach towards faster issue of health cards. The department of revenue and of food and civil supply can achieve this. IEC can be undertaken from the funds collected under the scheme to project it’s true status and benefits. • The scheme needs to provide for both ways transportation costs as the place of referral is out of district for procedures of super specialization. Also, district hospital at Gadchiroli needs to have an ambulance on rental basis exclusively for this purpose as majority of it’s work is done at Nagpur .

27. SUGGESTIONS • The strengths and the opportunities mentioned earlier are the obvious avenues to improve the performance. Strengths are already in place and the opportunities are beckoning. • Possibility of engaging expert services on visit/call/surgery basis should be explored

28. SUGGESTIONS • Efforts are necessary to eliminate/minimise the threats. • The referrals to the private sector can be routed through monitoring agency and claims regarding issues like waiting list etc need to be verified. • The list of procedures reserved for the government sector can be reviewed and modified.

29. SUGGESTIONS • The offer of incentives to government employees can dramatically improve the performance of the scheme. • The scheme needs to allow cross speciality work in view of the fact that the “can do “ status of the affairs has worked efficiently so far. This should be at least offered on interim basis till trained manpower is made available. • The delayed payment of claims needs urgent attention.

30. RAJIV GANDHI JEEVANDAYEE AAROGYA YOJANA IT CAN WORK EVEN BETTER (IF WE WORK ON IT!)

31. Thank you!