National Health Authority Decided to Grade the performance of All hospitals enrolled under the PM-JAY Scheme.
The flagship scheme of the National Health Authority (NHA) Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY), has introduced a system in which the system will measure and grade the performance of hospitals.
The vision behind it is to shift the focus of measuring a hospital’s performance from the services provided to the value of healthcare services.
The new approach will introduce the concept of ‘value-based’ hospitality, in which the payment will be ‘outcome-based’ and providers will be rewarded according to the quality of the treatment delivered.
In a value-based healthcare system, the payers can also control strong cost controls. This will lead to a healthier population with fewer claims translates into less drain on payers’ investments.
Hospitals would benefit from being able to align their products and services with positive patient outcomes and reduced costs. Altogether, value-based care promises to significantly improve the healthcare landscape in India by incentivizing and encouraging healthcare providers to focus more on delivering patient-centric services.
The new model will acknowledge the work of staff who helped the patients improve their health, which eventually will reduce the spread of any dangerous disease in the population further in the long term.
The initiative is likely to increase overall health gains and is expected to be a Win-Win situation for patients and healthcare providers.
Who Can Be A PM-JAY beneficiary?
Those living in scheduled caste and scheduled tribe households. Families with no male member aged 16 to 59 years. Beggars and those surviving in hand-to-mouth situations can be the beneficiaries.
One can register for the scheme by using PAN and Aadhaar Card as far as age and identity proof are concerned.
The other necessary proof it needs is the Income certificate (in which the maximum annual income of an individual should be up to Rs. 5 lakhs), the family’s current status (joint/nuclear), and a supportive document regarding the same is mandatory.
Pradhan Mantri Jan Arogya Yojana (PM-JAY) is the second component under Ayushman Bharat. This scheme was launched in 2018 in Ranchi, Jharkhand.
Ayushman Bharat is the largest government-funded healthcare program in the world with over 50 crore beneficiaries. The beneficiaries can avail of the benefits at any of the scheme-enrolled public and private hospitals.
The beneficiaries receive a card called Ayushman Bharat National Health Protection Mission ID (AB-PMJAY ID) is also a parameter that enables identifying a beneficiary family.
This will only be available to find the family of a beneficiary who has already been verified and whose PMJAY ID has been generated by the system.
The scheme will cover financial protection for availing healthcare services at the secondary and tertiary levels.
To ensure beneficiaries receive both cashless healthcare benefits and high-quality care at every enrolled hospital, NHA has implemented various measures. Such as an ABHA card.Â
These measures include standardizing the cost of treatment under the scheme and adding new and advanced treatment procedures.
Dr. R. Sharma, CEO of the National Health Authority (NHA) has made a provision to incentivize best-performing hospitals that provide quality care to patients.
What will be the PM-JAY measures?
There are five performance measures chosen by NHA as follows:
- Beneficiary satisfaction
- Hospital’s re-admission rate
- Out-of-pocket expenditure limit
- Confirmed grievances
- Improvement in-patient’s health.
These measures might be also available on the public dashboard so that needy beneficiaries can make an informed decision, by this way, the hospital’s performance shall not only determine the financial incentive of the hospital but also create a demand for quality treatment of beneficiaries under PM-JAY.
