New Delhi: Six years after the launch of its flagship health insurance scheme Ayushman Bharat-Pradhan Mantri Jan Aarogya Yojana, the Modi government has now formed a panel to review its implementation and suggest modifications, ThePrint has learnt.
The panel headed by Dr V. K. Paul, member (health) of the Niti Aayog, has various current and former officials from the Union health ministry and the National Health Authority (NHA) — which operationalises the scheme — as well as representatives from the Insurance Regulatory and Development Authority as members.
Health officials from some states and group directors of corporate hospitals Apollo and Yashoda have also been offered seats in the committee, apart from the president of Nathealth, a network of private healthcare providers in the country.
ThePrint has a copy of the circular issued last week.
Under the scheme which was launched in September 2018, nearly 10 crore families or 50 crore Indians, based on their socio-economic status, are offered a secondary and tertiary care hospitalisation benefit of up to Rs 5 lakh.
According to the details shared by the health ministry, 6.2 crore free hospital admissions have saved out-of-pocket expenditure of more than 1.25 lakh crore of poor and vulnerable population till mid-January this year.
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Multiple tasks assigned
The panel, which is to submit a report within 45 days, is tasked with reviewing the roles and responsibilities of the Centre and state in terms of scheme policy, design and implementation.
It will analyse 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 the private sector, according to the circular.
The modes of implementation of the scheme will also be examined. Currently, the states adopt either trust, insurance or hybrid mode to execute the programme.
Importantly, the panel has also been asked to prepare recommendations related to beneficiary base including expansion and convergence.
Review of extending services and benefits under the scheme such as package rationalisation process, convergence with other schemes run by the health ministry, components of package like diagnostics, drugs with the objective of eliminating out-of-pocket-expenditure are also on the agenda.
The committee has also been asked to come up with suggestions related to provider payment mechanism, hospital grading, incentivising value-based care, among others.
Additionally, aspects related to scheme funding and financial sustainability, sharing of expenditure between the Centre and states, managing Central ceiling, financial projections and strategic purchasing from private healthcare providers will also be examined.
Apart from suggesting measures for prevention of fraud, abuse or misuse in the scheme, the committee will also recommend ways to link the insurance scheme with Ayushman Bharat Digital Mission — a programme aimed at developing the backbone necessary to support the country’s integrated digital health infrastructure — and Ayushman Arogya Mandirs, more commonly known as primary health and wellness centres.
In its audit of the scheme for the period between September 2018 and March 2021, the Comptroller and Auditor General (CAG) had flagged issues like concerns about beneficiary identification and registration.
Tabled in the Lok Sabha in August last year, the CAG report also highlighted that delayed action in weeding out ineligible beneficiaries resulted in ineligible people availing of benefits, and excess premium payment to insurance companies.
(Edited by Tony Rai)