Ayushman Bharat: Health Protection Mission Features, Implementation, Challenges, Study Guides, Projects, Research of Project Management

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Ayushman Bharat-National

Health Protection Mission (AB-

NHPM)

Core Features of AB-NHPM

A cover of Rs. 5 lakh per family per

year

Over 10 crore poor and vulnerable

families eligible

States given flexibility to decide on

mode of implementation

Benefits will be portable across the

country

Entitlement based scheme

Ease of Access & Transparency in Implementation  (^) No formal enrolment process required – entitlement through SECC data  (^) Intensive IEC to eligible families through multiple methods  (^) Identity validation through Aadhar (No denial in absence of Aadhaar)  (^) Transparent & seamless process to empanel/ pay hospitals online  (^) Cost control through fixing package rates in advance  (^) Robust fraud/abuse control & Grievance Redressal mechanism  (^) National Portability  (^) National Helpline

Target Group The following have been approved by Cabinet Rural (^) Urban RSBY Leftout Families Total Families in Deprivation Criteria D1, D2, D3, D4, D5 & D Automaticall y Included Families Families belong to 11 Occupational Criteria Mainly in States of Karnataka, Himachal, Kerala, Chhattisgarh etc. In line with budget announceme nt 8.03 cr 16 lakh 2.33 cr 22 lakh 10.74 cr

Percentage of Population to be Covered Under AB-NHPM and State Schemes % Population Covered States/ UTs Less than 50% Assam, Himachal Pradesh, Kerala, Uttar Pradesh 50%-60% Bihar, Gujarat, Madhya Pradesh, Punjab, Tripura, Uttarakhand, West Bengal 61%-70% Odisha, Rajasthan 70%-80% Andhra Pradesh, Karnataka, Meghalaya 80%-90% Mizoram, Tamil Nadu More than 90% Chhattisgarh, Goa, Jharkhand, Maharashtra, Telangana

Implementation Modes Insurance Mode (5) Trust Mode (22) Mixed Mode (3) Delhi Andhra Pradesh (^) Haryana Chhattisgarh Jharkhand Arunachal Pradesh (^) Tripura Gujarat Meghalaya Assam (^) Uttar Pradesh West Bengal Mizoram Bihar (^) Uttarakhand No Info (6) Nagaland Goa (^) Lakshadweep Odisha Karnataka Andaman & Nicobar Punjab Madhya Pradesh Chandigarh Kerala Manipur Dadra and Nagar Haveli Maharashtra Telangana Daman & Diu Rajasthan Sikkim (^) Puducherry Tamil Nadu Jammu & Kashmir Himachal Pradesh

Main Processes Informing beneficiaries about their entitlement Hospital empanelment Tendering by States Development of IT System Beneficiary identification system to identify beneficiaries Online hospital transaction and pre-authorisation Online claim management Collection of beneficiary feedback

Potential Challenges for AB-NHPM Issues in updation and correctness of SECC database Mapping of States’ own data with SECC data IT Platform design and alignment with State IT systems Convergence between AB-NHPM and State schemes Capacities of stakeholders Fraud and abuse Portability of benefits across the country Alignment with supply side of health care

Main Roles of the State Government

• (^) Tendering process to select Insurance company
• (^) In Assurance mode, start the process for hiring of Implementation Support Agency
• (^) Training and capacity building of SHA and district structures
• (^) Informing Target Beneficiary Families about their entitlements
  • (^) Primary responsibility for this purpose will be with the State Government
  • (^) One of the most critical task for SHA will be to inform beneficiaries about their entitlements

as there is no enrolment process

Main Roles of the State Government

• (^) Empanelment of Hospitals
  • (^) The responsibility for empanelment of hospitals is of the State/ SHA
  • (^) Support of insurance companies can be taken, if needed
• (^) Set-up IT systems
• (^) Set up a Complaint and Grievance Redressal Mechanism
• (^) Continuous Monitoring of Scheme

Suggested Constitution of State Governing Council S. No. Name / Designation Position 1 Chief Secretary Chairperson, ex-officio 2 Principal Secretary to Government, Health & Family Welfare Department Vice Chairperson, ex officio 3 Secretary, Finance Department Member, ex officio 4 Secretary, Department of Rural Development Member, ex officio 5 Secretary, Department of Housing and Urban Affairs Member, ex officio 6 Secretary, Department of IT Member, ex officio 7 Secretary, Department of Labour Member, ex officio 8 MD, NHM or Commissioner, Health Department Member, ex officio 9 Director of Medical Education or his/her nominee Member, ex officio 10 Director of Health Services or his/her nominee Member, ex officio 11 CEO (SHA) Member Secretary, ex officio 12 Representative of NHA Special Invitee 13 1 Subject matter expert as nominated by the State Government Special Invitee

Staffing of SHA at State Level

 (^) The Chief Executive Officer (CEO) will look after all the operational aspects of the scheme and shall be supported by a team of specialists. The SHA should hire the following team to support the CEO in discharge of different functions:

• (^) Operations Manager(s)
• (^) Monitoring & Evaluation Manager
• (^) Manager, Policy
• (^) IT Support cum Data Manager
• (^) Beneficiary Verification Manager
• (^) Grievance Redressal Manager
• (^) Medical Management & Quality Manager
• (^) IEC Manager
• (^) Capacity Development Manager
• (^) Finance Manager
• (^) Accounts Assistant
• (^) Administrative Officer

Thank You