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Ayushman Bharat Set for Reboot With Faster Reimbursement, Incentives for Model Hospitals

Prime Minister Narendra Modi cheers on doctors and healthcare staff during a visit to Ram Manohar Lohia Hospital in New Delhi on October 21, 2021. (News18)

Prime Minister Narendra Modi cheers on doctors and healthcare staff during a visit to Ram Manohar Lohia Hospital in New Delhi on October 21, 2021. (News18)

The Health Ministry has been pressing upon officials for massive acceleration of the Ayushman Bharat scheme in line with PM Narendra Modi's vision of providing free health insurance of Rs 5 lakh to over 50 crore beneficiaries.

Ayushman Bharat, the world’s largest public health insurance scheme, is set for a reboot with the objective of bringing more private hospitals on board to increase its foothold.

The National Health Authority (NHA), which implements the scheme officially known as Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY), has designed several incentives to attract more hospitals.

“We have to increase the empanelment of hospitals. More hospitals should come on board to create a balance from both demand and supply side,” RS Sharma, Chief Executive Officer at NHA, told News18.com.

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The Narendra Modi government’s flagship health scheme provides an annual health cover of Rs 5 lakh per family to 10 crore poor and vulnerable families (total 50 crore beneficiaries) for secondary and tertiary care hospitalisation.

Union Health Minister Mansukh Mandaviya, since taking over in June, has been pressing upon officials for massive acceleration of the scheme in line with the PM’s vision of providing free health insurance of Rs 5 lakh to over 50 crore beneficiaries in the country.

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Working on the same, the government in October revised the rates of around 400 procedures under the scheme and added a new medical package related to black fungus management, describing the move as one that “will strengthen the empanelled hospitals to provide better healthcare services”.

Treatment worth Rs 25,000 crore has been provided under the scheme, which was launched on September 23, 2018.

Incentives in the offing

Aiming at easing the cash flow of hospitals, Sharma said, the turnaround time in terms of reimbursing the expenditures of the hospitals will be reduced significantly. “The time for reimbursement will be reduced from 15 to 10 days as it will be attractive for hospitals to join.”

Also, hospitals that have never been charged with “fraud” will be given more benefits. “We plan to disburse half of their claims as soon as they submit the request,” Sharma said.

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“We share a continuous relationship with hospitals. Even if some extra amount of claims was disbursed in advance, it can be taken care of during the claims submitted next month,” he added.

At present, 23,000 hospitals are empanelled under the health insurance scheme. This includes 9,361 private and 13,470 public hospitals empanelled to provide secondary and tertiary care to patients.

’Focus on identifying more beneficiaries’

Working out an ambitious plan for a bigger rollout of the Ayushman Bharat scheme to cover more beneficiaries this year, the NHA has already issued 4 crore Ayushman Bharat cards in the last 11 months. Around 17 crore cards have been generated so far — 10.66 crore PM-JAY cards and 5.85 crore state cards.

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According to the official website of PM-JAY, more than 87,000 cards were issued in the last 24 hours. “Our focus is on identifying more beneficiaries who are part of the scheme but still are unaware,” Sharma said.

“Earlier, we were generating one card per family. However, our new objective is to issue e-card for every single beneficiary. It makes them feel empowered,” Sharma said, adding that it will also “help patients and hospitals in the hour of need for faster admissions”.

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first published:November 23, 2021, 09:16 IST