In News
- A Joint Working Group has been constituted for better implementation of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY).
News Summary
- The union government has constituted an 11-member Joint Working Group (JWG) constituting members from IRDA and NHA.
- Primary aims
- To support implementation of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)
- To standardize protocols for health insurance services
- To strengthen the health insurance ecosystem in India
In Focus: Joint Working Group for AB-PMJAY
The JWG will make recommendations in the following areas:
- Network hospitals management
- I. National Repository of Empanelled Hospitals
- To consolidate different databases of hospitals including ROHINI, NHRR, NIN and PMJAY into a single National Repository of Empanelled Hospitals for insurance schemes.
- ROHINI: Registry of Hospitals in Network of Insurance is a data registry of hospitals in the health insurer and third-party administrator network in India.
- NHRR: National Health Resource Repository is basically a census of healthcare establishments, public and private.
- NIN: National Institute of Nutrition
- Impact
- Responsive: It will remove deficiencies like non-reporting, under-reporting and delays thereby making the health sector more responsive to citizen health needs.
- Leveraging Private Health Infrastructure: One national repository will help in leveraging private health infrastructure.
- Fraudulent Claims Management: Single national repository of empanelled hospitals will reduce fraudulent claims and thus reduce claim costs.
- II. Standardized Treatment and Package Rates
- Need: Currently, the health insurance sector is clogged with following deficiencies:
- Highly skewed package rates as a result of lack of standardized package rates
- Subjective decisions for treatments due to lack of defined clinical protocols
- Lack of standardized hospital infrastructure.
- Guidelines
- Around 1,350 treatments including surgical procedures are included for which package rates will be standardised.
- It will lay out Standarised Treatment Guidelines for safe and quality healthcare.
- It will define hospital infrastructure to understand capacity of hospitals and in turn help in facility audits.
- Impact
- The move will help to curb overcharging thus bringing in uniformity in treatment and hospitalization costs.
- As a result, it will significantly reduce out-of-pocket expenditure.
- It will bridge the trust-deficit between patient-health care providers.
- Need: Currently, the health insurance sector is clogged with following deficiencies:
- Data Management
- Guidelines
- JWG will recommend steps for IT-enabled data standardization and exchange in health sector.
- It will establish standard data formats across health insurance sector.
- It will also recommend a framework for capturing and exchanging data.
- Impact
- Linking patient data, hospital data and insurance companies will help in reduction of healthcare cost.
- Capturing patient data at meta-level will help in disease profiling of population.
- This will enable policy-makers to make future cost predictions and budgeting for health services.
- Fraud and abuse control
- Guidelines
- The committee will develop a standard reporting format for fraud and abuse.
- It will provide a framework for fraud repository.
- It will develop ‘name and shame’ guidelines for fraudsters
- Impact
- It will significantly help in detecting fraudulent transaction.
- It will act as deterrent for fraud.
- Computerization of claims management
- Guidelines
- JWG will define a roadmap for electronic, paperless, codified data exchange between payer and provider.
- It will also define a roadmap for creation of standard electronic personal health record of insured population with a common identifier.
- Impact
- It will help increase service efficiency and transparency in delivery of health insurance services.
In Brief: National Health Authority and IRDA
National Health Authority
- National Health Authority is the nodal agency for implementation of AB-PM-JAY.
- It is an attached office under the Ministry of Health & Family Welfare.
- The governing board of NHA is chaired by the Minister of Health & Family Welfare.
- It replaced the existing National health agency to overcome the problem multi-tier decision making and enable speedy and smooth implementation of PM-JAY.
- The CEO of NHA is an officer of the rank of Secretary to the GOI.
IRDA
- Insurance Regulatory and Development Authority is an autonomous body responsible for regulating insurance industry in India.
- It is further entrusted with the responsibility of protecting the interests of the policyholders and increase insurance penetration in the country.
- IRDA is a statutory body set up under the IRDA Act, 1999
Earlier related posts:
- In an earlier article, AB-PMJAY was comprehensively covered when the scheme was launched in September 201