Ayushman Bharat Pradhan Mantri Jan Arogya Yojana

Why is in news? National Health Authority (NHA) introduces new system to measure and grade performance of hospitals empaneled under Ayushman Bharat PM-JAY scheme.

With an objective to shift the focus of measuring performance of hospitals from volume of services provided to the value of healthcare services, National Health Authority (NHA) is introducing a new system to measure and grade hospital performance under the flagship scheme Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY).

Traditionally, from the payer’s perspective, the healthcare model has been focussed on the quantity of services delivered, where case-based bundled payment is made on the basis of the number of services provided.

The new initiative will introduce the concept of ‘value- based care’, where payment will be outcome based and providers will be rewarded according to the quality of the treatment delivered.

Under the new model, the providers will be rewarded for helping the patients improve their health, which consequently will reduce the effects of disease in the population in the long term.

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana:

Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is a Centrally Sponsored Scheme having central sector component under Ayushman Bharat Mission anchored in the Ministry of Health and Family Welfare (MoHFW).

It is an umbrella of two major health initiatives, namely Health and wellness Centres and NationalHealth Protection Scheme.

PM-JAY is the world’s largest health insurance/ assurance scheme fully financed by the government.

Launched in February 2018, it offers a sum insured of Rs.5 lakh per family for secondary care (which doesn’t involve a super specialist) as well as tertiary care (which involves a super specialist).

Under PMJAY, cashless and paperless access to services are provided to the beneficiaries at the point of service, that is, hospital.

Health Benefit Packages covers surgery, medical and day care treatments, cost of medicines and diagnostics.

It is an entitlement-based scheme that targets the beneficiaries as identified by latest Socio-Economic Caste Census (SECC) data. Once identified by the database, the beneficiary is considered insured and can walk into any empaneled hospital.

The National Health Authority (NHA) has been constituted as an autonomous entity under the Society Registration Act, 1860 for effective implementation of PM-JAY in alliance with state governments.

The State Health Agency (SHA) is the apex body of the State Government responsible for the implementation of AB PM-JAY in the State.