NHA to relook health packages under flagship Ayushman Bharat programme

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From converging “fragmented” Central health schemes into one digital platform, to reviewing health benefits under the Ayushman Bharat insurance programme, the National Health Authority is examining many initiatives. And some of these are set to roll out before this year runs out, or by early 2021.

“We are trying to converge the various fragmented schemes running for the diverse beneficiaries of the central government ministries. We are also running our insurance pilot with the support of private insurance companies to explore the possibility of providing affordable insurance to the missing middle population,” Vipul Aggarwal, NHA Deputy Chief Executive told BusinessLine.

NHA is the implementing body for the Government’s flagship Ayushman Bharat– Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), that provides health insurance for the economically weak. It is in consultation with multiple ministries including Social Justice and Empowerment; Labour and Employment and Home Affairs to bring the health schemes onto the NHA’s IT platform, he explained.

Convergence of information regarding ESIC beneficiaries, construction workers and the para-military into the IT backbone, respectively, will start by end-2020, or early next year, he said. Proposals have come in from 10-plus ministries to work for their beneficiaries and this too would materialise in the coming year, he said.

Explaining the rationale, Aggarwal said, it would help map the various treatments, demographics and disease patterns; help spot frauds and in the long term strengthen government’s “bargaining power” to procure medical products cost-effectively.

“Despite being such a big scheme we have not been able to work on a single mode of procurement for various healthcare providers. So we want to explore how these Government schemes can converge and thereafter we can have a platform through which a single point of Government sourcing can be done for stents, implants, medicines etc,” he said, indicating that strategic purchasing would also bring in savings to the exchequer.

“Once convergence becomes a reality, we are in a better position to bargain. We want to explore that also in the next year,” he added.

HBP 3.0

Another significant exercise on the cards involves relooking at ABPMJAY’s health benefit packages (HBP) and come up with version 3.0, he said. The exercise would start in January and is expected to end by July-August, he said, adding that it would involve surveys across village, taluka, district, city and state levels to help understand cost and pricing structures. A pet peeve for private suppliers and hospitals looking to partner with the Government programme is that the pricing did not make it viable for them, and the relook at HBP attempts to address this concern, while keeping it cost-effective for the Government as well.

Missing middle

Against the backdrop of the pandemic, he said, ABPMJAY had imparted ₹1,000 crore to cover Covid-19 testing and treatment for those under the scheme. On bringing the 30-million odd middle-class population under some form of affordable insurance, he said, they were working with about 10 private insurance companies to design a health insurance scheme where people could pay discounted premiums and get the benefit of health packages also at discounted rates.



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