Ayushman Bharat - rates rationalisation to be done

The government is happy with progress of PM-JAY, and is ramping it up aggressively now.

 Ayushman Bharat - rates rationalisation to be done

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• The story: To encourage private hospitals to take part in Ayushman Bharat-Jan Arogya Yojana (JAY), the government will rationalise the rates of health benefit packages under the scheme and also resolve issues with payments.
• Problems: Private hospitals have raised concerns with the health ministry that the rates of treatment under the health scheme are not viable and becoming a hindrance for their participation in the initiative. The government said it won't rationalise the rates so much that it becomes very profitable for hospitals, as it was providing a lot of volumes in terms of patients.

1. R S Sharma, chief executive officer (CEO) of the National Health Authority, said the process was being handled by experts.
2. In an event marking the milestone of 20 million hospital admissions under the Ayushman Bharat-JAY programme in the last three years, new milestones were set.
3. The health authority plans to set up standardised rates and treatment protocols across hospitals so that the total spent by the exchequer can also be ascertained easily.

• Details: Efforts were also being made to revamp the claim adjudication system in the scheme in order to smoothen the processes for private hospitals. The scheme was launched by Prime Minister Narendra Modi on September 23, 2018. So far, 23,000 hospitals have been empanelled under the scheme, 40 per cent of which are from the private sector. The health authority will also start joint review missions, headed by a retired government official, to increase monitoring and evaluation of the scheme. In order to resolve payment issues and enable faster disposal of claims, the government is considering setting up a green channel for hospitals with a clean track record.

1. Fifty per cent of the claims of such hospitals can be cleared immediately. It will encourage them to ensure proper billing as well.
2. The Jan Arogya Yojna provides a cover of Rs 5 lakh per family per year. The government is also planning to set up beneficiary facilitation agencies in empanelled public hospitals to increase the uptake.

• Process improvement: Many government hospitals do not want to bother about beneficiary cards or raising bills because the thinking is that this treatment is free. These agencies can facilitate billing for these hospitals which can then use that money for providing better services. The scheme targets to cover 107 million families. The government has so far issued 160 million Ayushman cards and plans to issue another 100 million during 2020-21.
• Impact of the pandemic: Covid also impacted hospital admissions under the scheme that went down from around 2.4 million during the fourth quarter of 2019 to 1.3 million during the initial wave and then to 1.6 million during the second wave. The health authority also wants to realise the synergies in convergence of health programmes such as National Health Mission and the Jan Aushadhi scheme.

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