The central government has formed a panel to evaluate the implementation of its flagship health insurance scheme, Ayushman Bharat. The National Health Authority, which is the apex body responsible for implementing the PM Jan Arogya Yojana, has formed an expert committee chaired by Niti Aayog member Dr VK Paul to review the scheme’s “design and implementation, and suggest modifications…”
The panel will discuss important issues, including expansion of the scheme’s beneficiary base, apart from suggesting measures to prevent fraud, abuse or misuse. Launched in September 2018, Ayushman Bharat extends secondary and tertiary care hospitalisation benefits of up to Rs 5 lakh to at least 10 crore families (50 crore Indians), depending on their socioeconomic status.
According to a letter issued by the National Health Authority (NHA) dated March 8, which has been accessed by News18, 10 areas have been outlined for review, based on which the panel must suggest measures within 45 days. The panel has top government officials and representatives of the Insurance Regulatory and Development Authority of India (IRDAI) as well as group directors of corporate hospitals like Apollo and Yashoda.
Health secretary Apurva Chandra, NHA CEO Deepti Gaur Mukerjee, Andhra Pradesh chief secretary MT Krishna Babu and IRDAI’s BC Patnaik are on the panel along with Dr Indu Bhushan, who served as the inaugural CEO of Ayushman Bharat, and Nishant Jain from the Asian Development Bank (ADB).
What will the focus of the panel be?
Out of the 10 broad areas defined by the NHA, the first focus is to review and strategise roles and responsibilities of the Centre and state in terms of scheme policy, design and implementation. The panel also has to review the “progress of the scheme in terms of beneficiary identification, hospitalisation, equity in access to healthcare services, scheme awareness, saving in out-of-pocket expenditure due to healthcare costs and participation of private sector”.
It will discuss the modes of implementation such as trust, insurance and hybrid mode along with another crucial decision over beneficiary base expansion and its convergence.
The scheme seeks to improve services and benefits by streamlining packages, coordinating with related health programmes, and reducing out-of-pocket expenses. It also focuses on refining payment methods, hospital grading, promoting value-based care, ensuring continuity of care, and implementing differential pricing based on care costs.
The panel will also focus on “linkages with the Ayushman Bharat Digital Mission (ABDM) and Aayushman Aarogya Mandir (AAM)” along with suggesting measures to prevent fraud, abuse or misuse. It will also suggest other areas or issues not outlined by the NHA.
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