What is Aarogyasri Coverage for Treatments

Aarogyasri Health Scheme is an efficient model to enable the low-income families to avail medical treatment for serious ailments at a low cost or cashless manner, using medical infrastructure in both the public hospitals and private. The scheme provides financial protection to BPL (below poverty line) families of up to Rs 2 lakhs in a year for treatment of serious diseases that require surgeries and hospitalization. About 900 plus treatments are covered under this scheme.

Ailments covered under Aarogyasri:

The objective of Aarogyasri scheme is to improve access of BPL families to quality medical care for treatment of identified diseases involving hospitalization, surgeries, post-surgery rehabilitation and other therapies through an identified network of health care providers. The Aarogyasri scheme provides coverage for the diseases of following systems such as:

• Heart diseases
• Lung diseases
• Liver diseases
• Pancreas disorders
• Kidney disease
• Neuro-Surgeries
• Pediatric Congenital Malformations
• Burns
• Post -Burn Contracture Surgeries for Functional Improvement
• Prostheses (Artificial limbs)
• Cancer treatments (Surgery, Radio Therapy, Chemo Therapy)
• Polytrauma (including cases covered under MV Act)
• Hearing loss treatment: Cochlear Implant Surgery with Auditory-Verbal Therapy for Children below 2 years. All these pre-existing cases of the above-mentioned ailments are covered under Aarogyasri scheme.

Treatments Excluded from Aarogyasri:

Here is a List of high-end Diseases and Procedures that the Aarogyasri scheme does not cover:

• Hip replacement
• Knee replacement
• Bone marrow transplantations
• Cardiac transplantations
• Liver transplantations
• Assisted devices for failures of cardiac activities
• Neuro-surgery such as Gamma-knife procedures
• HIV/AIDS
• Leprosy
• Infectious diseases
• Malaria
• Filariasis
• Gastroenteritis
• Jaundice

Tynor ROM Knee Brace

The last seven have already been covered by the national programmes for health. Other than these, the other treatments have not been covered as their cost is much higher. However, Aarogyasri program does not cover a few procedures like Knee Replacement. A sizable population in India now suffers from a varied level of arthritis and other ailments that can damage critical joints such as the knee joint. A person suffering from osteoarthritis of the knee that has reached advanced stages has very limited options to overcome pain and maintain even a decent extent of mobility. Once the damage has crossed a certain level, procedures such as total or partial knee replacements alone can enable a person to live a relatively pain-free life and maintain mobility.

Tynor Knee Immobilizer 19″

Culturally, India’s elders have been accustomed to accepting the body pains and low mobility levels as part and parcel of growing old. The saving grace was that in earlier days, most of the families used to be joint families with a lot of people around to take care of the elder. However, times have changed. On the one hand, we now have a greater life expectancy which also implies that the years of sufferings have increased. On the other hand, due to changing economy, the young members of the family may not be around in the villages to take care of their elderly parents.

In such cases, knee replacement surgeries no longer remain a luxury that only a few need to undergo but become more of a necessity to allow the elder live a pain-free life and take care of herself. The challenge is that knee replacement is still a very costly procedure that is difficult to afford for low-income families. The cost of knee replacement can range anywhere between 1.8 Lakhs to 2.5 Lakhs based on the choice of hospital, implants, and other factors. Had Aarogyasri included knee replacement as a covered procedure, the 2 Lakh yearly limit would have applied, and it would have become sufficient to help an elder from a poor below poverty line family undergo this procedure.

Voices have been emerging now and then for and against the inclusion of Knee Replacement in Arogyrasri. A noted Orthopedic surgeon Dr. Chitaranjan Ranawat, who also performed the knee replacement surgery on former Prime Minister Atal Bihari Bajpayee, urged the government back in 2011 itself to provide a subsidy to the poor that need a knee replacement. Prominent doctors like Dr. K. J. Reddy, a senior orthopedic surgeon from Apollo Hospitals have made requests for inclusion of the Knee replacement procedure in Aarogyasri.

The arguments that are given for the exclusion of Knee Replacement in Aarogyasri include factors like possible misuse of the facility by hospitals, who may then over-prescribe the remedy to people. Much like other procedures that are covered under Aarogyasri, there are ways to keep a check and balance on this by having the cases reviewed by a government-sponsored panel.

The other aspect is related to the medical procedure itself. Knee replacement procedure comes with several risks, and a complete recovery may take even a year. Knee replacement rehabilitation also requires modalities like physiotherapy which may be required for several months after the procedure. This can pose an issue because the low-income families residing in villages will most likely not have access to good physiotherapy centers.

The debate as to whether knee replacement should be covered under Aarogyasri is likely to continue, but until then, does the poor have any options? Fortunately, there are some hospitals that are supported by non-profit organizations and foundations that offer a low-cost knee replacement surgery to the needy, provided they meet their eligibility criteria. Several such hospitals are present in major cities like Hyderabad and other metro cities. However, given that non-profits often support these, the volume of surgeries these institutions can support is very small.

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At HealthClues, we have helped many needy patients connect with such facilities. If you or anyone you know is in need of a knee replacement but is unable to afford the normal cost of the procedure, do get in touch with us through email at help@healthclues.net or message us on WhatsApp at +91-9640378378, or submit your question below.

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Dr Kaleem Mohd

Dr. Kaleem Mohammed graduated as a Bachelor of Physiotherapy in 2014 from Deccan College of Physiotherapy, affiliated to Dr. N.T.R. University of Health Sciences, Vijayawada, India. Dr. Kaleem is an expert at handling physiotherapy needs of patients suffering from orthopedic and spinal conditions and post-surgery rehabilitation. Dr. Kaleem is associated with HealthClues since its inception where he facilitates diagnosis and advanced consultation with senior doctors. He is also a medical researcher and prolific writer who loves sharing insightful commentaries and useful tips to educate the patient community about fitness, treatment options, and post-treatment recovery.