Results and Cross-Cutting Issues
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Table 3.3 India: Number of Covered Treatment “Packages” and Maximum Benefit Coverage, 2009–10
Scheme Benefit type Central government sponsored
No. of inpatient packages
Coverage extends beyond specified packages
Maximum annual coverage (Rs.) No annual limits (or lifetime limits) No annual limits (or lifetime limits) 30,000/Family
ESIS
Comprehensive
1,900a
Yes
CGHS
Comprehensive
1,900
Yes
RSBY
Inpatient Secondary
727
Yes
938b
No
402b,c
No
412b
No
1,229b
No
326
No
n.a.
No
State government sponsored Rajiv Aarogyasri (AP) Vajpayee Arogyashri (KA) Kalaignar (TN) Yeshasvini (KA)
RSBY Plus (HP)
ASBY (Delhi)
Inpatient Tertiary Inpatient Tertiary Inpatient Tertiary Inpatient Secondary, limited Tertiary Inpatient Tertiary Inpatient Tertiary
150,000/Family+ 50,000 buffer 150,000/Family+ 50,000 buffer 100,000/Family (floating over 4 yrs) 200,000/Person
175,000 over the RSBY cover of 30,000 150,000 over the RSBY cover of 30,000 (proposed)
Source: Authors’ elaboration from schemes’ documentation and data. Note: n.a. = not applicable. a. As defined by CGHS. This number includes diagnostic and outpatient department procedures. b. Mostly surgical. c. Does not include 50 follow-up packages.
gynecology (OBGYN) possess relatively few treatments and procedures, together accounting for only about 9 percent of the total. The number of defined inpatient packages for the disease groups range from 326 (RSBY Plus, HP) to 1,229 (Yeshasvini, KA). Surgical procedures dominate all categories, representing 96 percent of all inpatient packages. However, RSBY, CGHS, and ESIS also cover residual forms of inpatient treatment beyond the common, packaged conditions. Treatment for nonpackaged conditions is paid for on a feefor-service basis, using rules and payment structures prescribed by the schemes. For example, unlike the tertiary-focused state schemes, RSBY