The 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).
Key points
- 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.
- Under value-based care, the performance of AB PM-JAY empanelled hospitals will be measured based on five performance indicators such as: 1. Beneficiary Satisfaction; 2. Hospital Readmission Rate; 3. The extent of Out-of-Pocket Expenditure; 4. Confirmed Grievances and 5. Improvement in-patient’s Health-Related Quality of Life.
About Ayushman Bharat – Pradhan Mantri Jan AarogyaYojana (AB-PMJAY)
- Ayushman Bharat – Pradhan Mantri Jan AarogyaYojana (AB-PMJAY) was launched by the Prime Minister on 23rd September, 2018 at Ranchi, Jharkhand.
- Ayushman Bharat- Pradhan Mantri Jan ArogyaYojana (PMJAY) provides a cover of up to Rs. 5 lakhs per family per year, for secondary and tertiary care hospitalization.
- Over 10.74 crore vulnerable entitled families (approximately 50 crore beneficiaries) are eligible for these benefits. The benefits under AB-PMJAY are portable across the country.
- There is no cap on family size, or age or gender.
- The beneficiary families under Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) have been identified from the Socio Economic Caste Census (SECC) of 2011 on the basis of select deprivation and occupational criteria across rural and urban areas.
- AB-PMJAY is completely funded by the Government and costs are shared between Central and State Governments in the ratio as per the extant directives issued by Ministry of Finance.
