Health
Insurance

OUR WORK

Support to Odisha

Biju Swasthya Kalyan Yojana (BSKY) Since November 2018, HSTP has supported the Biju Swasthya Kalyan Yojana (BSKY) by driving evidence-based improvements, producing knowledge products and providing training for clinical and program personnel. HSTP has prepared guidelines and modules for supporting the BSKY for enhancements in claims processing, fraud detection, and prevention measures. HSTP also created an Implementation Roadmap to assist the state health agency (SHA) with these changes. Discussions were held to improve pre- and post-hospitalization benefits to strengthen financial protection. Moreover, revised health benefits packages have increased private hospital participation expanding beneficiary access. Claim Adjudication Manual was developed and submitted to SHAs in August 2023. The manual aims to strengthen the adjudication team’s capacity to ensure accurate, timely claim settlements by integrating key concepts, system functionalities and human intelligence under BSKY. Guidelines on Hospital Empanelment and De-empanelment were developed and submitted to SHAs in December 2023 to ensure BSKY beneficiaries have consistent access to quality healthcare services that adhere to established care standards. These guidelines also promote accountability and transparency among EHCPs by establishing clear contractual obligations, performance standards and monitoring mechanisms.

Support to Rajasthan

State Health Assurance Agency for Strengthening Chiranjeevi Yojana (Health Insurance Scheme)
HSTP has provided technical assistance to Rajasthan for the evaluation of their UHC scheme which was conducted in partnership with CRISP with whom we have an MOU for collaboration.

What’s limiting the achievement of better health outcomes? A study of the Mukhyamantri Chiranjeevi Swasthya Bima Yojana (MMSBY) in Rajasthan, India

It was conducted with the support of HSTP and submitted as a dissertation thesis by a student under the mentorship of Dr Sudha Chandrashekhar in collaboration with IIPS Mumbai. This report is an attempt to investigate the dichotomy by systematically examining the various policy levers of the MMSBY using a mixed methods approach.

Support to Karnataka

HSTP supports the SAST Karnataka in strengthening the implementation of the Suvarna Arogya Suraksha Scheme within the state. A report on the Online Referral System of Ayushman Bharat- Arogya Karnataka PMJAY was prepared with collaboration with Heidelberg University, Germany. It is under review by the WHO.

Support to Meghalaya

HSTP analysed the existing Employees Medical Reimbursement Scheme in Meghalaya to identify the feasibility of implementing a cashless health insurance model for government employees within the MHIS framework. A cabinet note was prepared on the on the convergence of the Employee Medical Reimbursement Scheme with the MHIS and submitted to the government for approval. A concept note on the transition from Health Assurance to Health Insurance mode was prepared for the SHA in Meghalaya and submitted to the state to support the government in implementing health insurance services in the state.

Support to Bihar

A study on trends and differentials in health insurance coverage in Bihar was supported by HSTP and submitted as a dissertation thesis by a student under the mentorship of Dr Sudha Chandrashekhar in collaboration with CRISP. The study highlights the need for an inclusive health insurance system in Bihar that addresses coverage fluctuations and ensures fairness and sustainability, particularly for vulnerable populations.

Latest Updates

Odisha: Claim Adjudication, Medical Audit and ICD-11 Training for BSKY Workshop:

The main objective of this workshop was to improve the efficiency, effectiveness and transparency of claim adjudication and medical audit processes within the BSKY scheme. The workshop also introduced the International Classification of Diseases (ICD-11) for standardized diagnosis documentation, which is expected to improve the transparency of these Processes.

Odisha: Strengthening BSKY Operations, Grievance Redressal

This document aimed to strengthen BSKY grievance redressal processes as part of HSTP’s program for enhancing the capacities of practitioners and functionaries at the state-level health programs.
In collaboration with the Odisha government, HSTP documented the state’s journey toward universal health and gender equity through the Biju Swasthya Kalyan Yojana (BSKY). This was showcased at the 2024 Prince Mahidol Award Conference (PMAC), highlighting Odisha’s commitment to equitable healthcare access and aligning with SDG 3.8.

Currently HSTP is supporting the SHA in smooth transition to PMJAY-GJAY scheme across the state by providing inputs in incorporating PMJAY guidelines and mechanisms for establishing a robust Health Assurance model for Odisha.

Strengthening BSKY Operations, Grievance Redressal: This document aimed to strengthen BSKY grievance redressal processes as part of HSTP’s program for enhancing the capacities of practitioners and functionaries at the state-level health programs.

In collaboration with the Odisha government, HSTP documented the state’s journey toward universal health and gender equity through the Biju Swasthya Kalyan Yojana (BSKY). This was showcased at the 2024 Prince Mahidol Award Conference (PMAC), highlighting Odisha’s commitment to equitable healthcare access and aligning with SDG 3.8.
Currently HSTP is supporting the SHA in smooth transition to PMJAY-GJAY scheme across the state by providing inputs in incorporating PMJAY guidelines and mechanisms for establishing a robust Health Assurance model for Odisha.