New Delhi: The Modi government will soon introduce biometric patient authentication to crack down on ghost admissions under Ayushman Bharat, its flagship health insurance scheme.
Under the new framework, patients will have to undergo biometric verification upon admission and discharge, Union Health Minister Dr Harsh Vardhan told ThePrint in an exclusive interview Monday.
Ayushman Bharat, described by the government as the world’s largest health insurance scheme, offers poor patients an annual medical cover of Rs 5 lakh/family at zero premium. Its implementation is overseen by the National Health Authority (NHA), which has full functional autonomy.
The scheme currently has 50 crore beneficiaries and covers secondary- and tertiary-care hospitalisation, including critical procedures like cardiac surgeries and organ transplants.
However, there have been several reports of fraudulent claims under the scheme — at times involving doctors and hospitals — which has led the government to de-empanel dozens of medical facilities and fine them.
“So far, around 100 hospitals have been de-empanelled and recoveries and penalties to the tune of Rs 2.5 crore have been levied. We will share the names of some of these hospitals with you soon,” Dr Harsh Vardhan said.
“The National Health Authority is issuing new guidelines as new patterns emerge and additional safeguards are introduced,” he added. “For example, we are going to introduce biometric authentication at the time of admission and discharge.”
The government, he said, was also looking at artificial intelligence tools to detect and curb fraud.
An ESI tie-up on the cards
Ayushman Bharat, also known as the Pradhan Mantri Jan Arogya Yojana (PM-JAY), completed a year Monday. As reported by ThePrint, the Modi government has plans to expand the scheme to 90 crore patients — or around 70 per cent of India’s population.
To cater to the growing number of beneficiaries, the minister said, the government is looking to add Employees’ State Insurance (ESI) hospitals to the list of medical facilities where Ayushman Bharat can be availed of.
India has a total of 154 hospitals and 1,500 dispensaries empanelled under the ESI Corporation and run by the labour ministry, together boasting of over 19,000 beds. A tie-up could double Ayushman Bharat’s current capacity, which stands at 18,000 beds.
“Convergence with ESI for sharing of hospitals will take place soon. Discussions are going on (regarding) other (state and central) schemes too for this purpose,” Harsh Vardhan said.
The “convergence” would mean sharing of resources, such as hospital beds, and developing common IT platforms.
“In the second year of PM-JAY, we are focused on reaching out to 50 crore eligible people… At the national-level, convergence, not merging, and development of a close coordination mechanism with various central health insurance schemes also needs to be done, which will result in improved effectiveness and efficiency for all such schemes,” he added.
“Even though the scheme has completed one year, there is a long way to go,” the minister said.
Data gathered fuels research
Over the past year, around 50 lakh patients have reportedly been compensated for different treatments under the scheme. The data from this pool, the minister said, is being used for medical studies on newborns and hysterectomy or uterus removal.
“We have initiated studies in partnership with WHO and World Bank,” he added. “For example, a study on neonatology and hysterectomy has been carried out and more are in the pipeline.”
Focus on quality
In the year ahead, the government’s efforts will focus on bringing on board the four states yet to sign up to Ayushman Bharat — Delhi, Odisha, Telangana and West Bengal. Another focus area will be improving the quality of hospitals in India.
To this end, the Modi government is planning to involve another government-run body — the Quality Council of India (QCI), a non-profit autonomous society that oversees adherence to quality benchmarks across different sectors — with an idea to subject hospitals to an accreditation exercise.
“In this regard, we have introduced an initiative for quality certification standards and a process for digital quality certification for empanelled hospitals, which will be carried out by the QCI,” he said. “This will also encourage other hospitals to seek accreditation.”
‘Ayushman Bharat has won global accolades’
Before the launch of the scheme, the central government had extensively studied the healthcare infrastructure in various countries, such as South Korea and Thailand. But Harsh Vardhan praised Ayushman Bharat as unique.
“Although there are health schemes doing very well in other parts of the world, none of them has the scale or the complexity of our country, considering the demographic profile and politico-administrative structure,” he said.
“Appreciation has poured in from various quarters of the international community, including the World Health Organisation (WHO) and World Bank,” he added. “They appreciate the sheer resources, planning and execution strength, plus the political will that has been invested into Ayushman Bharat.”