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Innovative grading for hospitals introduced under Ayushman Bharat PM-JAY

National Health Authority (NHA) has introduced a new system to grade the performance of hospitals empanelled under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) scheme.

The objective of this shift is to move the Indian health system from a volume-based to a value-based healthcare delivery system. 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.

A new system to measure and grade hospital performance:

Under value-based care, the performance of AB PM-JAY empanelled hospitals will be measured based on five performance indicators:

- Beneficiary Satisfaction

- Hospital Readmission Rate

- The extent of Out-of-Pocket Expenditure

- Confirmed Grievances

- Improvement in-patient’s Health-Related Quality of Life

The performance of the hospitals based on the above indicators will also be made available on a public dashboard. With this, the beneficiaries can take informed decision.

Significance of National Health Authority:

NHA is the apex body for the implementation of AB PM-JAY. NHA is also entrusted with the role of building technological infrastructure and implementation of “National Digital Health Mission” to create a National Digital Health Eco-system. Further, NHA has made a provision to incentivize best performing hospitals that provide quality care to patients.

Dr. R.S. Sharma, CEO, NHA said, “To ensure PM-JAY beneficiaries receive both cashless healthcare benefits and high-quality care, NHA has implemented various measures.”

The measures implemented by NHA includes, standardizing the cost of treatment under the PM-JAY scheme and also adding advanced treatment procedures.

AB PM-JAY: World’s largest health assurance scheme

The AB PM-JAY is the world’s largest health assurance scheme, fully funded by the Government. The Ministry of Finance has informed that so far more than 2.7 crore individuals availed free treatment under the scheme. Over 10 crore poor and vulnerable families have insurance cover under the scheme.

Features of the scheme:

AB PM-JAY scheme was launched in 2018, it was a paradigm shift from sectorial intervention to more comprehensive and need-based service delivery of secondary and tertiary care.

The scheme offers a sum insured of Rs.5 lakh per family for secondary care as well as tertiary care. Under PMJAY, cashless and paperless access to services are provided to the beneficiaries. It is an entitlement-based scheme that targets the beneficiaries as identified by the Socio-Economic Caste Census data. Once identified by the database, the beneficiary is considered insured and can get treatment in any empanelled hospital.

 

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