Ayushman Bharat (Pm Jay) Scheme, Auxiliary Benefits

Ayushman Bharat (Pm Jay) Scheme, Auxiliary Benefits

Sonymol K, General Manager- Nursing, Continental Hospitals, 0

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Ayushman Bharat is a centrally sponsored scheme for the underprivileged and poor. It covers almost 500 million people for primary, secondary and tertiary care. The main principle of this scheme is cooperative federalism, a concept in which federal, state, and local governments interact cooperatively and collectively to solve common problems, rather than making policies and acting separately .This will help to focus and solve one common problem more effectively rather individual approaches by states.

1. Merging the Schemes: Many states like Kerala and Karnataka have decided to merge their state healthcare schemes into Ayushman Bharat so that the administrative costs of these schemes can be reduced and have a common scheme in place. The other benefit of a common scheme is that the citizens of those particular countries are well aware about the scheme, usage and process. This will in turn help for easy awareness to the public and the global monitoring. In countries like UK, the government directly gets involved in the healthcare system and delivery. The mode of logistics may vary from one country to other. Mainly, some of the countries use legislation, regulation and taxation for universal healthcare deliveries, while many other countries use public-private partnership as their strategy. In India, there is a drastic need for a universal healthcare, which is accessible to the common public.

2. Reach & Depth of Healthcare Insurance Ecosystem: As per the current statistics available, in India, almost 80 percent populations are not covered by healthcare insurance. More than 70 percent of the people have out-of-pocket expenses for treating ailments. After introducing this central scheme, people are aware about the importance of healthcare scheme. This indirectly improves the healthcare insurance ecosystem. After implementation of this scheme, now, the people from rural and village areas are aware about the benefits of insurance, and this will help for preventive care and early detection of diseases. Simultaneously, the reach and depth of insurance sector is also increased.

3. IT Backbone & Healthcare Turning to More Technology Based: Due to the large size of the scheme, its monitoring, use and analysis can be better done with technology. This will in turn help to gather a central level data pool for the improvement and changes of the programme, if required. At the same time, the payment portal become more efficient and delay in the payment duration can be reduced. The approval process, billing, credit and submission of bills to the insurance portal can be done with technology and ensures timely recovery to the hospitals, so that hospital also don’t end-up with large credits affecting their revenue. Again, this in turn helps to generate jobs in the IT sector, collaboration with IT and Healthcare and more employment opportunities.

4. Bring-down the Cost of Treatment: Due to collective bargaining, it lowers the cost of drugs/ implants and devices which are essential for treatment; thus, overall cost reduction is possible. This again channelizing for central procurement process and bulk purchasing. Scalability of the supply chain ensures better prizes and
quality of the materials, drugs and other supplementary items essential for treatment. Considering the rising cost of healthcare, health saving and OPD are two important areas in which India needs to focus more. The benefits of collective bargaining offers best prices after best negotiation and the whole process under laid-down laws and legislation gives transparency in the material management system. The ultimate outcome will be affordable healthcare for all.

5. Reduces the Inequalities of Healthcare Delivery: Inequalities like Rural & Urban, Rich & Poor, and Supply & Demand in healthcare delivery are reduced after implementation of this scheme. Due to availability of healthcare services to all sector of community, forecasting and centralized supply chain can ensure adequate stock of materials to which stock-out and delay can be prevented. This in turn results in the increased efficiency of healthcare delivery system.

6. It Ensures Power to Choose: The customer can choose the health care provider, private or public, which in turn reinforces the quality standards of public sector. Now in India, as per the current data available, private health sector is dominating the healthcare ecosystem by 70 percent. This again enhances the Public-Private Partnership (PPP) model for delivering healthcare, and this is one of the proven healthcare models to serve in rural population. This particular scheme will be available in both private and public sector, so users can have the leverage to choose the facility in terms of accessibility, quality and brand.

7. Data Collection & Research: This gives an opportunity to collect the data globally and analyse, so that we can interpret the disease pattern of each regions and prevention is more focused. This data pool is a reference for understanding the health status of the country, and budget allocation as per the need can be possible. Again, this reinforces the IT employments and R&D activities of the country. In India, especially in healthcare, we need to focus more towards preventive healthcare. This data and its analysis, interpretation and proper dissemination of results contributes to early detection of diseases and prevention. Again, this data can predict the conversion rates of secondary and tertiary care levels. Now, through collaboration with artificial intelligence, the data can forecast, predict and refer for seasonal trends, geographical influence and lifestyle of the people with occurrence of certain diseases.

8. Increased Efficiency in the Healthcare Sector: In terms of scalability, high volume and low margin, the entire healthcare system can be more productive, achieve more turnover and efficiency will be the result. Scalability results in high utilization of manpower and facility. In most of the private hospitals, the major reason for their negative EBITDA is low utilization of facility. Optimal usage of resources and lean management are the basic principles in effective healthcare usage. Collective bargaining in material management, drugs and equipment are some of the strategies in which low cost and maximum efficiency can assured. This universal insurance is contributing in this level too.

9. Promote Innovations: Exploring all methods of ensuring, monitoring the services using various platforms like IT and Social Media gives an opportunity for innovation. IT collaboration ensures fast reporting, referrals, and usage of insurance. Social media penetration gives fast dissemination of information, awareness of the programmes, changes adopted and visibility of the scheme. This interdependency of various sectors will contribute innovations, job opportunities, research areas and sound healthcare delivery system.

10. Large Size of the Scheme: Just due to the large size of the scheme, now, healthcare insurance sector and healthcare delivery is gaining lot of attention both socially and politically. Healthcare is a political core agenda first time in the history of India. It again ensures added benefits like budget allocation during government policy making, decision making, and implementation.

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