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Ayushman Bharat set for restart with faster reimbursement, incentives for model hospitals

Ayushman Bharat, the world’s largest public health insurance scheme, is set to restart with the goal of bringing more private hospitals on board to increase its presence.

“We need to increase the number of hospitals. More hospitals should be involved to create a balance on the demand and supply side,” RS Sharma, chief executive officer of the NHA, told

The flagship health program of the government of Narendra Modi provides annual health coverage of Rs 5 lakh per family to 10 crore of poor and vulnerable families (in total 50 crore of beneficiaries) for hospitalization in secondary and tertiary care.

Union Health Minister Mansukh Mandaviya, since taking office in June, has pressured officials for a massive acceleration of the program in line with the Prime Minister’s vision to provide free health insurance of Rs 5 lakh to more than 50 million beneficiaries in the country.

Working on the same, the government in October revised the tariffs for around 400 procedures under the program and added a new medical package related to black fungus management, describing the move as one that will “strengthen established hospitals. to provide better health services “.

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

Incentives in sight

In an effort to alleviate hospital cash flow, Sharma said, the turnaround time in terms of reimbursing hospital expenses will be significantly reduced. “The reimbursement period will be reduced from 15 to 10 days because it will be attractive for hospitals to join.”

In addition, hospitals that have never been charged with “fraud” will enjoy more benefits. “We plan to pay half of their claims as soon as they submit the claim,” Sharma said.

“We share an ongoing relationship with hospitals. Even though an additional amount of claims has been paid in advance, it can be supported with claims submitted next month,” he added.

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

“Focus on identifying a larger number of beneficiaries”

Drawing up an ambitious plan for a larger deployment of the Ayushman Bharat program to cover more beneficiaries this year, the NHA has already issued 4 crore of Ayushman Bharat cards in the past 11 months. Approximately 17 crore of cards has been generated so far – 10.66 crore of PM-JAY cards and 5.85 crore of state cards.

According to the official PM-JAY website, more than 87,000 cards have been issued in the past 24 hours. “Our goal is to identify more beneficiaries who are part of the program but who are still unaware,” said Sharma.

“Previously, we generated one card per family. However, our new goal is to issue an electronic card for each beneficiary. This makes them feel empowered,” Sharma said, adding that it “would also help patients and hospitals. within the hour need faster admissions “.

First publication: STI


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