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‘Ayushman Bharat Reduces Transaction Cost for Beneficiaries’

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Bhaskar LakshakarThere are around 1.2 crore families eligible for Ayushman, which means about six crore individuals. We are covering around 80 percent of population of Madhya Pradesh. That’s the outreach of Ayushman Bharat, says Bhaskar Lakshakar, MD, MPPHSCL & CEO, Ayushman Bharat, Government of Madhya Pradesh, in conversation with Elets News Network (ENN).

Q. How Ayushman Bharat is going to be a boon for beneficiaries?

Since Ayushman Bharat is an entitlement based scheme, the beneficiaries don’t need to go for separate registration and enrolment, that is, if I am eligible for it which is decided based on three parameters. One, if I am part of deprived category of SECC, 2011 then I am eligible. Second, if I am the unorganised labour, as per the MP Sambal Yojna, then I am eligible for the scheme. Third, if I am getting a food coupon under the National Food Security Act, I am eligible. Any beneficiary, every household knows whether they are eligible under any of these three categories for the scheme. Information is available with the families and they can identify easily whether they are part of the scheme or not.

If one has to avail the benefits of the scheme, they have to take simple steps. One has to walk into the hospital. It can be two kinds of hospitals, i.e government-owned or private-owned. If the private institutions are enlisted in the empanelled list of hospitals, they are duty-bound to cater Ayushman services to the beneficiaries. In case, one goes to government hospital, we identify the beneficiaries first with biometrics verification. Based on the same verification, the treatment is provided.

In Madhya Pradesh, entire medical expenditure is free in the government hospitals. Since the reimbursement against the packages is available, it further strengthens infrastructure of the hospitals because the Rogi Kalyan Samiti will have discretion to spend as per local requirement.

Q. If someone needs tertiary care treatment for diseases like cancer or cardiovascular diseases, what provision does the scheme entail?

If someone needs tertiary treatment then they need to visit some government medical college or empanelled private institution. This facility is available with both types of medical colleges, private and government. Both will be reimbursed by the Government for the kind of services they will be providing to patients. The best part is that patients don’t need to produce any kind of documents, any bills, evidence or certificate. Only thing we need is a valid photo ID to identify them whether they are beneficiaries or not.

Q. How far have we reached in empanelling hospitals, medical colleges? PSUs in the State have their own hospitals for employees. Is there any attachment with them as well?

There are two categories of hospitals, one is private hospital within the State. We decided to go with NABH accredited hospitals. There are around 100 plus accredited hospitals of which around 80 have been empanelled.

PSUs, BMHRC, AIIMS and others are with National Health Agency (NHA). An MoU is being signed between NHA and the State Government regarding the same.

Since there is portability system, even if NHA does the agreement, then also it comes under the purview of the State Government.

Q. How do you rate the scheme in comparison to previous such universal healthcare schemes in the State?

In Madhya Pradesh, there was no Rashtriya Swasthya Bima Yojna (RSBY). There is one SIAF (State Illness AID Fund). But the limitation of the erstwhile scheme was that they were given once in a lifetime. It was only Rs two lakh rupees. Under Ayushman Bharat, Rs 5 lakh coverage is being given annually. And the documentation work was huge in earlier schemes. In Ayushman everything is online and therefore I think the transaction cost for the beneficiaries has reduced substantially.

SIAF had its own limitations. It had limited coverage in comparison to Ayushman Bharat which has minimal human intervention.

Q. How is the State Government is planning to curb corrupt and fraud practices within the scheme.

Every scheme has some possibility of pilferage, so the only way to address these issues is to be vigilant and follow SOPs. We have focused on developing SOP/documentation and promote best practices in Ayushamn.

We will also conduct rigorous audits. There will be two layers of auditing system. One is by ISA (Implementation Support Agency). SHA will have its own team which will further conduct a secondary audit. Then we will have hospital audit also separately. We will conduct audit of five percent hospitals (out of total empanelled). We will check the infrastructure, whether proper information is being given to beneficiaries or not by the hospitals.

It will be two-pronged strategies — Hospital Audit and Claims Audit. These two audits will be conducted twice. Then we will have third party audit also. These will check any kind of fraudulent activities. Overpricing, inflated treatment and co-payment are major concerns. A prudent audit is needed. We are developing fraud checking and curbing systems with the help of expert agencies.

Q. Health schemes like Ayushman Bharat require a lot of things including skilled manpower. What kind of preparations are being done to implement the scheme?

We have developed our own IEC and training material and SOP. The training can’t be conducted for heterogeneous groups. We have segregated different clientele. For doctors, we need to have different kind of training and so is for Ayushman Mitra, nurses, managers of private hospitals and all. We have developed training calendar as well. It will be continuous and regular process, not a one-time affair.

In the divisions, they will conduct district-level training, a TOT, while in districts; they will conduct block-level training. My entire staff is well-versed with the processes of Ayushman Bharat. The main concern is to aware people about Ayushman Bharat — how they get benefitted and about its processes.

Q. What is Ayushman Mitra? Kindly share about their profile.

Ayushman Mitra is an interface between the hospital and patients. Ayushman Mitra have been employed by ISA. They are having decent communication skills and basic computer proficiency. They are supposed to help the beneficiary to avail the benefits through their golden record generation. Once the record is generated and the patient is admitted in the IPD (In-Patient Department), the details are entered in PMS. This kind of data updation and data management is done by the Ayushman Mitra. They will also be doing IEC activities. At hospitals, they will address the query of beneficiaries. We have designed uniform also for Ayushman Mitra so that they can be identified easily to assist beneficiaries. A total of 176 hospitals have been empanelled till now in the State.

Private hospitals will employ their own Ayushman Mitra while we have provided Ayushman Mitra in Government hospitals through our ISA (Implementation Support Agency). Every hospital will have at least four such Mitras at different time-interval. In medical colleges, the number would be more. We will have around 560 Ayushman Mitra at the month-end. Then we will have district coordinator also who will coordinate on the front of logistics or providing any other kind of assistance, if required.

Q. What is the role of MPPHSCL in making healthcare delivery efficient?

Ayushman can’t work in isolation. It has to have both supply and demand side. There is demand of services. It is generated by communication IEC activities. It is matched through medicine, equipment and HR.

We have scarcity of quality doctors. To fill the gap, we have made provisions of tie-up with local doctors or labs. If a hospital doesn’t have required expert to do particular surgery, they can hire the doctor on the promise of paying certain amount to him per case basis. Similarly, if some hospitals don’t have facility of certain tests, one can tie up with some local private labs.

For medicine, we have Jan Aushaudhi portal. There are 472 procedures in Ayushman Bharat which have been identified as reserve one. To match the supply side, it is required that my medicine should be easily available in the hospitals. If there will be clear information which hospitals lack which medicine, we can fill the gap easily. Same is for equipment also. There is portal, EMMS which we will use. On this portal, entire data is captured which hospitals lack equipment.

Q. Tell us about other measures which have been taken to boost patient care under Ayushman Bharat.

In a bid to strengthen healthcare delivery system, we have taken following steps:

  1. Extended the benefits to the beneficiaries of National Food Security Act (NFSA), unorganised labour (Sambal Scheme) and Socio Economic and Caste Census(SECC)
  2. Developed own functional website/ SOP/ manuals/detailed trainings/ process flow and process documents
  3. Only NABH compliant hospitals are eligible for empanellment
  4. We have started working for direct incentive transfer to employees
  5. Identified strategy and mechanism for fraud detection
  6. Advancing for integration of e-hospital with the Ayushman portals

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