Ayushman Bharat is a flagship scheme of the Government of India, which was launched as per the framework recommended by the National Health Policy 2017 . The scheme was introduced to achieve the vision of Universal Health Coverage (UHC) in the country and to meet Sustainable Development Goals (SDGs), and its commitment of “leave no one behind” . The major components of the programme are the Health and Wellness centres and the Pradhan Mantri Jan Arogya Yojana (PMJAY) . The scheme encompasses three major objectives; equity in access, quality, and financial risk protection .
As per the government sources, PMJAY is the world’s largest fully government-funded health insurance scheme which provides coverage to nearly 10.74 crore poor families by providing financial protection for selected secondary and tertiary care hospitalisations . So how does a small organization contribute to the gargantuan national level health insurance scheme like PMJAY? It turns out, Dakshas plays a very significant role!
One of the major components of the PMJAY is the reimbursement of the pre- and post-hospitalization costs for the beneficiary. However, as per the reports, there were certain discrepancies where a comparison of the cost of select procedures and the reimbursement tariffs offered under Ayushman Bharat shows that only 40-80 per cent of the total cost is covered by the tariff and this is lower than the variable cost (which includes cost of materials – drugs, consumables, implants, patient food, linen and clinician payout). As a result, many private hospitals are starting to opt-out of the PMJAY insurance program.
However, partnering with Dakshas would allow hospitals and specialists to contain these costs substantially. Most of the preventive and primary care would be shifted to community and clinics. The protocols save the specialists 80% of the time on evaluating such cases. Those patients who need detailed specialist evaluation are referred with preliminary workup, counselling and after primary treatment. Almost all patients seen by specialists would need some sort of investigations and/or interventions. Similarly, all patients referred to hospitals would require admission and or surgical intervention. Surgical process and efficiency is enhanced with Dakshas’ checklists for operation theatres. Specialists only have to focus on their core surgical contribution. Postsurgical care and rehabilitation are again shifted to clinics, close to the patient’s residence.
All these processes will allow specialists and hospitals to focus on their core activity. The resulting increased efficiency and cost control will enable wide-spread adoption of Ayushman Bharat.
1. Gupta, SubodhSharan, and VikashR Keshri. “Ayushman Bharat And Road To Universal Health Coverage In India”. Journal Of Mahatma Gandhi Institute Of Medical Sciences, vol 24, no. 2, 2019, p. 65. Medknow, doi:10.4103/jmgims.jmgims_44_19.
2. Bharat, Ayushman. “About Pradhan Mantri Jan Arogya Yojana (PM-JAY) | Ayushman Bharat”. Pmjay.Gov.In, 2020, https://pmjay.gov.in/about-pmjay.