1-year-old national health insurance scheme receives upgrade

The government is upgrading its flagship health insurance scheme- Ayushman Bharat-Pradhan Mantri Jan Arogya Yojna (AB-PMJAY), a year after its launch on 23 September 2018. The National Health Authority (NHA) has revised the package of diseases eligible for treatment under AB-PMJAY, upgraded the information technology software and put in place better measures to prevent fraud and leakage of funds.

“The upgraded version of the scheme will be much smoother to navigate, more precise in terms of disease packages and their rates. We are upgrading our IT system, to IT 2.0, making it more secure and better integrated with the National Digital Health Blueprint. It will have the ability to adapt to future innovations,” said Dr Indu Bhushan, CEO of the AB-PMJAY.

AB-PMJAY provides medical coverage of INR500,000 ($7,060) per family per annum, and eligible families can seek treatment at any government hospital or at any empanelled private hospital. It is targeted at 107.4m poor and vulnerable families. From 5,000 hospital admissions a day in the first three months of the scheme, the number of admissions has gone up to 25,000 a day, reported Hindustan Times.

“In the next couple of years, when the scheme stabilises, we expect to receive about 35,000 to 40,000 patients a day,” Dr Bhushan said. While 18,026 hospitals are currently empanelled under the scheme, of which 53% (9,554) are privately run, the NHA’s focus is to get more tertiary care hospitals that provide speciality treatment under its ambit.

Dr Bhushan said while government hospitals are by default a part of the scheme, private medical institutions are still not showing sufficient enthusiasm.

“We are trying to convince them that it’s not going to be a loss-making proposition. Many don’t have confidence that the government will pay them on time or are comfortable with the high-margin, low-volume model.“

Currently, 32 states and Union Territories have signed up for the scheme. Those which have yet to implement the scheme are Delhi, Odisha, Telangana and West Bengal. Attempts are being made to convince these territories to get onboard.

Source: Asia Insurance Review