We have made technological changes to our IT platform to liberalise and fast-track Ayushman card generation, said National Health Authority (NHA) Chief Executive Officer R.S. Sharma in an interview with The Hindu on how Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) — the national public health insurance fund — is now all set to launch a campaign to include the maximum number of needy persons.
The PMJAY is today one of the largest and most successful health care programmes. What are the new initiatives that the government propose to bring in?
The National Health Authority (NHA) is pursuing a twin-pronged approach to increase the scale and scope of Ayushman Bharat PMJAY. These include beneficiary identification and hospital utilisation. The NHA is launching Aapke Dwar Ayushman with renewed vigour. This time we are focussing on States such as Assam, Bihar, Gujarat and Uttar Pradesh. We are also learning from our previous experience and making necessary changes to ensure that the campaign will once again prove to be a resounding success.
We have made technological changes to our IT platform to liberalise and fast-track Ayushman card generation. Village-wise beneficiary data of SECC 2011 is now accessible. This will make it easier for the district, block and panchayat-level officials to plan and implement localised beneficiary identification drives. We have launched “Open BIS” platform for self / assisted verification. This will allow beneficiaries to generate Ayushman cards, subject to necessary verification, in a hassle-free manner.
The Authority will extend full financial assistance to States / Union Territories for issuing co-branded Ayushman card to all eligible beneficiaries (identified from and tagged in the SECC 2011 database). This will lead to wider distribution of Ayushman cards and thereby increase the awareness of the scheme. Also, as part of a continuous process of revisiting the health benefits packages (HBP) under the AB-PMJAY, the NHA launched HBP 2.2 in November 2021. Under this, rates for more than 400 treatment packages were increased to make them viable for healthcare service providers. We are now going to see further changes to treatment package rates. In the coming year, we will strengthen our engagement with the network of providers. We are also bringing in Green Channel of Payments. Under this, a partial payment of 50% of the claim amount will be released automatically to hospitals through the system at the time of claim submission, while the balance will be released following the usual claim adjustment process.
India faces the unique challenges of a large population which is catered by urban-centric health care system. How does the PMJAY plan to bridge this gap?
The creation of the Ayushman card still remains the best way to increase awareness of the scheme and this is being done on mission mode. Particular emphasis has been placed on States with higher rural populations such as Bihar, Chhattisgarh, Madhya Pradesh and Uttar Pradesh. The last 4.7 crore cards prepared were majorly from these States. Under the PMJAY, nearly 26,000 hospitals (pan India network) have been established to make sure that medical facilities are provided to the rural as well as urban areas.
We have relaxed hospital empanelment guidelines for remote/rural areas (tribal areas) — 15-bed hospitals are relaxed to 5-bed hospitals. Hospitals under the aspirational districts have been provided with increased 10% incentives on the base package rates. Also, pan India card portability has allowed the beneficiaries (the majority of whom are from rural areas) to access quality health care services across India.
What are the major challenges that the system faces today? Have any other countries shown interest in replicating this programme and are we working at knowledge transfer?
Although a lot has been done under the PMJAY ecosystem to make it more accessible and acceptable to the beneficiaries we still have a few issues. Much more focus is required on the beneficiary saturation by reaching out to all eligible beneficiaries and issuing maximum Ayushman cards. There is also a need to increase empanelment of the hospitals in the underserved areas. We are also working at increased uptake of scheme in government hospitals and see that they are able to utilise the funds reimbursed for upgradation of their infrastructure. For the private sector we are working at revising the HBP rates so that they are more acceptable for the private sector hospitals. We have received interest from various countries in the Asian and African regions who have been working closely with the NHA/the Health Ministry and evinced interest in various health sector-related programmes, including Ayushman Bharat - PMJAY.
Is PMJAY looking to work with preventive healthcare and aligning it with the Prime Minister’s recent call for vocal for local and local for global?
Ayushman Bharat, a flagship scheme of the Government of India, was launched as recommended by the National Health Policy 2017, to achieve the vision of Universal Health Coverage (UHC). This initiative has been designed to meet Sustainable Development Goals (SDGs) and its underlining commitment, which is to “leave no one behind.” It is an attempt to move from a sectoral and segmented approach of health service delivery to a comprehensive need-based health care service. During the last few years, we have observed that the implementation of the PMJAY has stabilised and now necessary steps are under consideration for the continuum of care which will help in improved population coverage.
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