Megha Health Insurance Scheme (MHIS) is a universal health insurance scheme in Meghalaya that utilizes the existing RSBY framework to provide coverage to all state residents, including categories covered under RSBY. It provides insurance of up to INR 160,000 per household for various medical costs and procedures. Public hospitals in the state have been empaneled under the scheme and are incentivized for their participation. Initial claims data shows that public facilities are actively raising claims under the scheme and utilizing incentive funds to improve infrastructure and services.
mHealth Israel_Medical Devices in Portugal_Rui Costa_GE HealthcareLevi Shapiro
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Hospital management system is a computer system that helps manage the information related to health care and aids in the job completion of health care providers effectively.
Hospital Management System brings together all the information and processes of a hospital, in a single platform.
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In a nutshell, Hospital Management System (HMS) creates a frictionless approach towards managing the entire hospital and solves all complexities in the process
The clinical establishments act was adopted in year 2012, still so many states are to implement this act. This act is equally applicable for all system of medicine including Ayurveda. Here are the standards for ayurveda clinics and hospital. Present presentation explain the standards for ayurvedic clinics and dispensaries only
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Presentation about the Medical Device sector in Portugal by Rui Costa, General Manager- Portugal, GE Healthcare, for the mHealth Israel community, June 2, 2020. Includes current trends, sales data, key changes, challenges, reflections, transitions, collaborations, etc
Hospital management system is a computer system that helps manage the information related to health care and aids in the job completion of health care providers effectively.
Hospital Management System brings together all the information and processes of a hospital, in a single platform.
It presents you with a unified 360-degree view for managing patients, doctors, inventory, appointments, billing information, finances and much more.
The system automatically generates a highly-efficient process and makes it quick. Thereby, allowing hospitals to provide quality service in addition to professional medical care.
In a nutshell, Hospital Management System (HMS) creates a frictionless approach towards managing the entire hospital and solves all complexities in the process
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171
PART VII
Case Study
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BACKGROUND
1. The Hospital System
Metropolis Health System (MHS) offers
comprehensive health care services. It is
a midsize taxing district hospital. Al-
though MHS has the power to raise rev-
enues through taxes, it has not done so
for the past seven years.
2. The Area
MHS is located in the town of Metropo-
lis, which has a population of 50,000.
The town has a small college and a mod-
est number of environmentally clean in-
dustries.
3. MHS Services
MHS has taken significant steps to re-
duce hospital stays. It has developed a
comprehensive array of services that
are accessible, cost-effective, and re-
sponsive to the community’s needs.
These services are wellness oriented in
that they strive for prevention rather
than treatment. As a result of these
steps, inpatient visits have increased
overall by only 1,000 per year since
1998, whereas outpatient/same-day sur-
gery visits have had an increase of over
50,000 per year.
A number of programmatic, service,
and facility enhancements support this
major transition in the community’s in-
stitutional health care. They are geared
to provide the quality, convenience, af-
fordability, and personal care that best
suit the health needs of the people
whom MHS serves.
• Rehabilitation and Wellness Center—for
outpatient physical therapy and re-
turn-to-work services plus cardiac and
pulmonary rehabilitation to get peo-
ple back to a normal way of living.
• Home Health Services—bringing skilled
care, therapy, and medical social serv-
ices into the home; a comfortable and
affordable alternative in longer term
care.
• Same-Day Surgery (SDS)—eliminating
the need for an overnight stay. Since
1998, same-day surgery procedures
have doubled at MHS.
• Skilled Nursing Facility—inpatient serv-
ice to assist patients in returning more
fully to an independent lifestyle.
• Community Health and Wellness—com-
munity health outreach programs that
173
CHAPTER 18
Case Study:
Metropolis Health System
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174 CHAPTER 18 CASE STUDY: METROPOLIS HEALTH SYSTEM
provide educational seminars on a vari-
ety of health issues, a diabetes education
center, support services for patients with
cancer, health awareness events, and a
women’s health resource center.
• Occupational Health Services—helping
to reduce workplace injury costs at
over 100 area businesses through con-
sultation on injury avoidance and
work-specific rehabilitation services.
• Recovery Services—offering mental
health services, including substance
abuse programs and support groups
along with individual and family coun-
seling.
4. MHS’s Plant
The central building for the hospital is
in the center of a two–square block area.
A physicians’ office building is to the
west. Two administrative offices, con-
verted from former residences, are on
one corner. The new ambulatory ce.
eHealth as a tool to support health practitioners November 2013Rajeev Rao Eashwari
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Regulations , Standards & Codes “CLINICAL ESTABLISHMENT ACT” I.P.H.S and UCPMP by Dr. Mira Shiva MD
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Human Rights Law Network
http://hrln.org
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HMIS, the flagship of the Tamil Nadu Health System Project was implemented in a phased manner, started as Pilot (during the year 2008), followed by Phase- I (during the year 2009), Phase-II (during the year 2010) and finally Phase III (2011).
Health Management Information System “HMIS” is a judicious combination of Information
Technology (IT) and Management Systems, to deliver improved evidence based health care to the public at large. Health Management Information System also provides information based support for the implementation of cutting-edge reforms by the Tami Nadu Health Systems Project. Apart from Primary Health Centers and Secondary Care Hospitals, this project is envisaged to include all the Tertiary Care Hospitals including the Medical Colleges.
2. Presentation Flow
• Introduction
• MHIS (RSBY+UHIS)
• Participation of Public Hospitals
• Claims
• Progress of facilities
• IEC initiative
• Other Support Structure- Grievance Redressal……
• MIS structure
3. State profile - Meghalaya
Population 2964007
Total No. of Districts 11
Total no. of Blocks 39
Capital Shillong
Languages
Khasi, Pnar, Garo and
english
Literacy 75.48%
Total Households 768332
District Hospitals 11
Community Health
Centres 28
Primary Health Centres 108
ASHA 6258
5. Megha Health Insurance Scheme is a universal health insurance scheme in the
State of Meghalaya, utilizing the existing RSBY framework to provide health
insurance to all persons that are resident in the State, including existing categories
of RSBY beneficiaries.
Brief Description:
•Covers all residents of Meghalaya(APL as well as BPL) except government employees
•Covers all diseases covered by RSBY. Additional cover for critical care i.e. trauma cases,
cancer and heart diseases.
•Provides cover up to INR 160,000 (USD 2,667) per household (up to five members) with
a maximum claim size of INR 100,000 (USD 1,667)
•Inclusion of 20 day-care procedures, 70 tertiary-care packages and 1087 secondary-care
packages
•Provides transport expenses of INR 100 and economic loss compensation of INR 100
(INR 900 for critical care).
•Dedicated agency with 18 FTE under Department of Health and Family Welfare, set up
for implementationof MHIS-1
A Brief on MHIS
6. District Programme Officer
(11 nos.)
Finance &
Accounts
Manager
Jt. CEO
IT
Manager
Enrollment -
IEC Manager
Grievances
Redressal
Manager
Monitoring
& Control
Officer
Claims
Officer
State MHIS MgerState MHIS Manager
FKO
CEO - MHIS
Nodal Agency
►Formation of a state level MHIS State Agency to managethe programme
►The structure formed for the MHIS State agency as shown below
8. Progress of MHIS - Comparison of empanelled facilities
6
20
14
11
28
108
District Hospital CHC PHC
Public Facilities
MHIS
RSBY
9. Public Hospitals empanelled with MHIS
Empanelled Hospitals
• 11 DistrictHospitals
• 28 Community Health Centres
• 108 Primary Health Centres
In addition
10 Private hospitals inMeghalayaand13 Private hospitals (Critical Care) outside Meghalayahave alsobeen
empanelled
10. • Incentive structure for doctors and staff of Public health facilities
• IEC/ awareness initiatives
• Timely settlement and payment of Claims by Insurance company
• Capacity building of staff of DH/CHC/PHC and constant support
from the staff of SNA
• Regular monitoring of DH/CHC/PHC
• Regular follow up and monitoring with regards to Claims and
payment/rejection of claims
• Monitoring of Insurance Company for regular claims settlement
• Increased facilities in public hospitals because of the use of the 70%
infrastructure fund
• In Several areas FKO’s (ASHA) motivate the patients to utilise MHIS
smart card in public facilities
• Provision of transportation charges and reimbursement of
medical/lab bills motivates beneficiaries to utilise the smart cards
Main Reasons for participation of Public facilities
11. Sl.No Incentive for Staff (Case base) 50%
1 Surgeon/MainPhysician/Doctortreating the case 25%
2 Surgeon assisting the surgery/other physician/doctors involvedin
treating the case/ else will go to main doctor
10%
3 Anaesthetist/Doctorsof other dept. actively involvedin case
management through case referrals/ else will go to administrativepool
15%
Sl.No Incentive for Staff (Shared out to the rest of the staff from the remaining
pool)
50%
4 Consultations/call duty,etc (if amountnot sufficient, money from
unspent amount from item 3 above can be given)
5%
5 Staff Nurses 12%
6 Nursing Asst & HospitalAttendant (Grade I&II) 8%
7 Lab Tech 5%
8 X Ray/ Ultra Sound Scanners/CT/ECG/ScanTechnician 5%
9 AdministrativePool(including) Record keeping/ System Management 10%
10 PRO1 5%
11 TOTAL (of the 30% of the claims received through MHIS) 100%
100 % Claims : 70% for Infrastructure & 30% for Staff
MHIS I: Incentive Method in Public Hospitals
12. 12
MEGHA HEALTH INSURANCE SCHEME
MHIS I: Claims Raised
No of Hospitals raising Claims
61 Public Hospitals in Meghalaya
9 Private hospitalsin Meghalaya
3 Private (Critical Care) hospitalsoutside Meghalaya
Public Hospitals
No. of patients– 5928
Amount of Claim raised – ₹ 2,62,93,186
Private Hospitals
No. of patients– 10314
Amount of Claim raised – ₹ 5,42,5,2706
All Districts are Raising Claims
18. Tura Civil Hospital
No. of MHIS patients - 542
Amount of Claims raised - 3535625
Purchased Laptop(MHIS),
Xerox machine, cupboard
from MHIS infrastructure
fund
Tie Up with pharmacy for
purchase of medicines not
available in hospital
Free investigation from
private labs for MHIS
patients
Improved Services – District Hospitals
Forms to be filled by Lab or pharmacy
for reimbursement by hospital
19. Improved Services – District Hospitals
NongpohCivil Hospital
Amount of claims raised - 86375
Utilised funds for
purchase of furniture
Improving facilities at the
hospital
20. Improved Services – CHC
Ampati CHC
No. of patients – 702
Amount of claims raised - 2469750
Purchase of new mobile
phone for upload of data
Tie Up with pharmacy for
MHIS patients
Purchase of Medicine rack
Improvement of
infrastructure at hospital
Purchase of wheel chair, x
ray film and other
equipment needed at
facility
21. Improved Services – CHC
Bhoirymbong CHC
No. of Claims –
Amount of claims raised -
Purchased a laptop from
MHIS fund
Purchase of electrical
wires for provision of
electricity
Tie up with pharmacy, for
provision of medicines
22. Improved Services – PHC
Tikrikilla PHC
No. of MHISpatients – 98
Amount of claims raised - 511000
Purchase of mobile (2G) for
raising claims
Construction of canteen for
beneficiaries from
infrastructure fund
Tie up with pharmacy, for
provision of medicines.
Plans to indent medicines for
diseases prevalent in the area
like malaria
Organisedawareness through
cricket tournaments
23. Improved Services – PHC
LaitlyngkotPHC
No. of Claims –
Amount of claims raised -
Purchase of tanks for
water storage
Purchase of medicines
from pharmacy
Purchase of lab reagents
for various tests
Purchase of utensils
IEC activities
24. Improved Services – PHC
Nogorpara PHC
No. of Claims – 53
Amount of claims raised - 278000
Purchase of desktop for
MHIS
Proposed to purchase
washing machine for PHC
Construction of canteen
at the facility
25. For staff of public hospitals
Subtitle of RSBY Hospital training film
Pamphlet about MHIS and incentive structure
Incentive Training workshops for doctor and staff
of all Public hospitals
TMS software training at hospitals
For Beneficiaries
Pamphlet about scheme
Leaflet about utilisation of card and list of
hospitals
Various IEC materials indicating public hospitals
empanelled with the scheme
Make them know about availability of public
hospitals
IEC initiatives
26. Grievance Redressal
CALL CENTER : 1800-345-3644
To providesupportthrough toll free for any enquiries and
complaints
GrievanceRedressalcommittee to address grievances of
beneficiaries ,hospitals etc and to make suregrievances
and complaints are being address within the giving time
frame
Feedback fromHospital, Beneficiary to improvethe service
of the scheme as well as the hospitals
Follow up with beneficiary and hospital ( pre-post
hospitalization)
27. MIS STRUCTURE - Enrolment DATAflow
Enrolment
station
Third Party
Administrator
SNA
server
MIC data
District
server
District DKMA
data
Ministry of
Labour & Employment
Insurance
Company
Excel
Report
SNA Finance
Department
Extraction of
Data from all
sources
28. MIS STRUCTURE – Claims data flow
TPA – TSE
ICICI Lombard Claims Processing Dept
District MHIS
Account
DPM
TPA
Server
SNA
Server
RSBY Server
Connection Available
Hospital Directlyuploadto Servers
Connection Unavailable
Data Email / Write onCD
DataProcessingbyILGIC
Details of Claims –
Rejected or approved
ManualPre-authorisationforms
Directpaymentofsettledclaims
forhospitalswithonlinefacilities
Claims Settled/Rejected
Settled Claims Report
Rejected/ApprovedClaims
ClaimsMoneytransferto
DistrictAccountforhospitlas
withoutonlinefacilities
ChequeofSettledClaims
DPMSettleClaimstoPHC/CHCbyCheque
Raw Data for reports
State Nodal
Agency
Analyseddata -
ClaimsReport
Claims
Officer
33. Progress of MHIS – Inclusion of new packages
MHIS I: Packages specific to Meghalaya have been included
MHIS 2: Further expansion of Packages:
1036
RSBY
(2010-11)
MHIS -1
@ signing of contract
MHIS -1
@ Sept 30, 2013
1288
MHIS 2
288$
1288
1579
106
146
1036
106
1036
125
160
6 MCH
34. 34
MEGHA HEALTH INSURANCE SCHEME
Empanelled Hospitals:
• 149 Public Hospitals in Meghalaya
• 10 Private hospitals in Meghalaya
• 13 Private hospitals (Critical Care) outside Meghalaya
Hospitals (Claims Raised):
• 61 Public Hospitals in Meghalaya
• 9 Private hospitals in Meghalaya
• 3 Private (Critical Care) hospitals outside Meghalaya(in Guwahati)
All Districts are Raising Claims
Most Public Hospitals of all districts are raising Claims
16,242 : Total No. of MHIS patients (as of 15th April 2014)
Rs.8,05,45,892/- : Total Amountof Claims Raised (as of 15th April 2014)
MHIS I: Claims
35. 35
MEGHA HEALTH INSURANCE SCHEME
Sl. No. District Female Male Total
Amount
Claimed(Rs.)
1 East Garo Hills 99 31 130 6,58,981
2 East Jaintia Hills 541 243 784 40,64,365
3 East Khasi Hills 3,236 1,636 4,872 2,38,82,875
4 West Jaintia Hills 1,651 721 2,372 1,07,00,403
5 North Garo Hills 204 75 279 17,07,226
6 Ri Bhoi 1,074 575 1,649 84,43,846
7 South Garo Hills 323 193 516 22,81,875
8 South West Garo Hills 1,286 648 1,934 93,82,762
9 South West Khasi Hills 307 146 453 23,54,415
10 West Garo Hills 483 225 708 46,50,189
11 West Khasi Hills 1,663 835 2,498 1,21,94,955
Non-Meghalayadistricts 18 29 47 2,24,000
Grand Total 10,885 5,357 16,242 8,05,45,892
MHIS I: District Claims (as of 15th April 2014)