UHC Forward: Towards Universal Health Coverage

The Mutuelle system is still voluntary, and thus steps must be taken to bring about large-scale enrollment of the people. Thus, the “national strategy to extend health coverage through Mutuelles” contains solutions for the slow pace at which Mutuelles grew in the past, for the poor capacities of the players involved in promoting the Mutuelle movement, the management of Mutuelle movement organizations, and the lack of information and awareness about the Mutuelle movement on the national level. It was found that the principal actors were not enlisted sufficiently at the local level in the past. Health care workers, the ASACOs, and the territorial governments were only marginally involved in promoting the Mutuelle movement. By organizing Mutuelles at the commune level, the strategy seeks to have the mayors and local elected officials play an active role in mobilizing the population. The main challenge in promoting the Mutuelle movement for large-scale enrollment thus continues to be implementing a major information and awareness campaign for Mutuelles at the national scale. This is part of the national strategy and advocacy activities that also include local and national leaders .

Since the AMO is mandatory, beneficiaries are enrolled automatically by withdrawing dues from their wages. Benefit eligibility begins on May 1, 2011 for those who have paid dues for six months.

With regard to identifying the indigent for RAMED, the social services in each commune routinely conduct a social survey to assess the situation after interested parties submit an application. The social services or other persons may also prepare an application on behalf of someone else who has not taken the initiative to do so for several reasons. Based on the social survey, the communal authorities issue an indigent card that serves as physical evidence to enroll the member and to obtain the card from the National Medical Assistance Agency (ANAM – the management agency for RAMED) and to obtain care (including the beneficiaries whose applications are submitted to ANAM staff). The status of indigence is always considered temporary, so that the insured member’s card is annual.

All South Koreans are eligible and required to have health coverage under the National Health Insurance Program (NHIP). NHIP is managed by the National Health Insurance Corporation, which is responsible for enrollment and communication. NHIC uses local branches to enroll individuals and to collect premiums. The insured are divided into two groups: employee insured and self-employed insured. The employee insured category composes about 59% of the total number of insured. Those in the self-employed insured category include about 41% of the total insured population.

Aarogyasri covers all below-the-poverty-line residents of Andrah Pradesh. The scheme has been implemented in all districts in the state. Upon enrollment, beneficiary households receive a Rajiv Aarogyasri Bhima Health Card, a mechanism through which patients are identified and medical records are kept. Aarogyasri covers all below-the-poverty-line residents of Andrah Pradesh. The state already had a mechanism for defining, identifying, and enrolling below-the-poverty-line families. Each eligible family is issued a “White Card” (a ration card) to identify them as below-the-poverty line. Aarogyasri uses the “White Card” as a targeting mechanism for its scheme.

Families in the state who already have “White Cards” are provided with Rajiv Aarogyasri Bhima Health Cards. Everyone in a household can be included in the Rajiv Aarogyasri Health Card. This means the head of the family, spouse, dependent children, and dependent parents. The Health Card captures the family’s data and pictures of each family member. It is presented by beneficiaries when they arrive at a health facility to identify them. The card is also used to store patient visit records and transmit utilization information.

Once enrolled, beneficiaries are guided through the process of seeking care. In order to ensure that beneficiaries know what benefits they are entitled to, and are able to navigate the system of care, Aarogyasri has developed a team of 4,000 Aarogya Mithras. Aarogya Mithras are health workers representing the community of the insured. One Aarogya Mithra sits in each primary health center across the state. These health centers are most often the first points of contact for most families seeking care. In addition, district hospitals and network hospitals also have help desks manned by Aarogya Mithras to facilitate smooth service delivery for Aarogyasri beneficiaries. Aarogya Mithras help to guide beneficiaries through the network of care and inform them about their insurance benefits.

In addition to contacts with Aarogya Mithras, beneficiaries can visit health screening camps that are set up by network providers in rural areas. Under the scheme, all network hospitals are required to undertake a specified number of village health camps in order to maintain their network status. Beneficiaries and potential beneficiaries attend the health camps to be screened for diseases and are provided with preventive care. Those that can be treated at the camp are treated; those that require further treatment are referred to network hospitals where their ailment will be treated free of cost under their Aarogyasri benefits. As of November 2009, there have been more than 15,000 camps and nearly 2.5 million people have been screened.