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HIS
Through Health Insurance Services (HIS), Anytime Call Health empowers communities, strengthens healthcare access, and supports commitment to universal health coverage — ensuring Health for All becomes a reality.
Health Insurance Services (HIS)
Community Health Care Insurance Scheme is a Public Private Partnership (PPP) model to be funded by Government to provide quality health care by health insurance scheme for below the poverty line citizens. The Scheme utilizes government finances 100% of the premiums for the citizens who fall below the poverty level. The stake holders for such schemes are Government, Corporate Hospitals, Insurance companies and the beneficiaries, the B40 Group.
The Scheme beneficiaries have access to facilities they would not otherwise be able to utilize due to the financial barriers to access. For example, In India, one state is implementing such scheme and Apollo Hospital is a member of the Community Health Care Insurance Scheme network and provides care to hundreds of Scheme members. In fact, one third of the hospital’s volumes are comprised of below poverty line Scheme members.
So, even though network eligibility requirements are somewhat stringent, the benefits of being a network provider are many. Additional patient volumes (and thus revenues) alone are an attractive enough proposition for both public and private hospitals to improve their operating procedures to align with the eligibility requirements for Scheme.
Key Success Factors
Key innovations and success factors in launching Scheme are:
No Premium Collection
Collecting a premium would have required tremendous administrative costs (likely outweighing the amount of the premium itself); moreover, the cost of the premium would have prevented many of the poorest from enrolling even if the amount were nominal.
Collaborative Private Sector
The private sector should agree to low reimbursement rates for services provided and agree to conduct compulsory health camps where thousands of rural people would be screened every day.
Targeted Identification
Using “Certified Below Poverty Line Cards” to identify beneficiaries who need the scheme most. Can be existing targeting mechanism to be utilized by the state to identify the poorest to utilize the Scheme.
Technology-Driven Process
The technology utilized by scheme facilitates end‐to‐end cashless claims processing, from pre‐authorization to provider payment; the technology also facilitates a robust monitoring mechanism.
Health Camps
All empaneled hospitals are required to conduct free health camps in rural areas to screen patients, identify undetected illness, and refer patients to in‐network hospitals as needed.
Community Representation
Health Workers are patient advocates employed by Scheme to oversee each in‐network hospital and serve as representatives of the insured to help them navigate the system of care, receive quality care, prevent fraud, and conduct reviews and evaluations of service provision
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