IRDAI, NHA form joint working group on Ayushman Bharat

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:

  1. 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
    • NeedCurrently, 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.

 

  1. 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.

 

  1. 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.

 

  1. 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

Leave a Reply

Please log in using one of these methods to post your comment:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s