Govt to rationalise rates under Ayushman Bharat to boost private participation

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The Centre is planning to onboard more private hospitals into the Ayushman Bharat-Jan Arogya Yojana (JAY) by rationalising the rates of health benefit packages. This plan was put in place after private hospitals had voiced their concerns to the Union Ministry of Health saying that the rates of treatment as outlined by the Ayushman Bharat-JAY were not feasible and thus impeding their participation. The government is also taking steps to address the issues regarding payments to participating hospitals.

RS Sharma, CEO of the National Health Authority (NHA), said that the rates will be rationalised but not to the extent that they become very profitable for the hospitals. He added that the hospitals are also getting higher volumes in terms of patients. Sharma assured that the measures will be taken only after consultation with the experts.

The NHA is also mulling to set up standardised rates and protocols for treatment across hospitals in order to ease the calculations related to the expenditure from the exchequer. Vipul Aggarwal, deputy CEO of NHA, stated that measures were put in place to ease the processes for private hospitals by overhauling the claim settlement system in the scheme.

Overhauling on the cards for the scheme

The NHA also plans on starting joint review missions led by a retired government officer to ramp up monitoring and assessment of the scheme. In addition to this, the government is also taking steps to set up a green channel of hospitals with an unsoiled reputation and to fast-track the disposal of claims.

The health authority will also start joint review missions, headed by a retired government official, to increase monitoring and evaluation of the scheme. In order to resolve payment issues and enable faster disposal of claims, the government is considering setting up a green channel for hospitals with a clean track record.

The Ayushman Bharat-Jan Arogya Yojana was launched in September 2018 by Prime Minister Narendra Modi and has so far empanelled close to 23,000 hospitals, out of which close to 40% belongs to the private sector. The scheme provides a cover of Rs 5 lakh per family per year.

Completed over 2 crore hospital admissions

AB-PMJAY has completed over 2 crores hospital admissions with treatments worth approximately Rs 25,000 crore, the union health ministry said on August 18, 2021.

“Ayushman Bharat PM-JAY is an ambitious scheme ensuring quality and affordable healthcare for the poor and underprivileged people. The scheme has empowered all eligible beneficiaries with cashless and paperless healthcare services benefits of up to Rs 5 Lakhs per family per year. Thus, many disadvantaged sections can afford treatment without turning to moneylenders,” said Mansukh Mandaviya, union minister for health and family welfare.