National Health Authority (NHA) is the apex body responsible for implementing India’s flagship public health insurance/assurance scheme called “Ayushman Bharat Pradhan Mantri Jan Arogya Yojana”
it has been entrusted with the role of designing strategy, building technological infrastructure and implementation of “Ayushman Bharat Digital Mission” to create a National Digital Health Eco-system.
National Health Authority is the successor of the National Health Agency
Pursuant to Cabinet decision for full functional autonomy, National Health Agency was reconstituted as the National Health Authority on 2nd January 2019
NHA has been set-up to implement PM-JAY, as it is popularly known, at the national level. An attached office of the Ministry of Health and Family Welfare with full functional autonomy, NHA is governed by a Governing Board chaired by the Union Minister for Health and Family Welfare.
It is headed by a Chief Executive Officer (CEO), an officer of the rank of Secretary to the Government of India, who manages its affairs. The CEO is the Ex-Office Member Secretary of the Governing Board.
To implement the scheme at the State level, State Health Agencies (SHAs) in the form of a society/trust have been set up by respective States. SHAs have full operational autonomy over the implementation of the scheme in the State including extending the coverage to non SECC beneficiaries.
NHA is leading the implementation for Ayushman Bharat Digital Mission (ABDM) in coordination with different ministries/departments of the Government of India, State Governments, and private sector/civil society organizations.
Administrative and technical leadership to the Ayushman Bharat Digital Mission
Propose policy directions as required to the Mission Steering Group, Empowered Committee and MoHFW
Development of models for self‐financing of Ayushman Bharat Digital Mission
Implementation of policies and decision approved by the Mission Steering Group and Empowered Committee
Coordination with MoHFW and the States/UTs
Resolution of technical and operation issues
Recruitment of resources from Government and private sector at competitive market rates
Management of day-to-day operations of Ayushman Bharat Digital Mission (ABDM)
Capacity building of various stakeholders for health informatics
Engagement with all stakeholders including private sector and civil society organizations, and develop strategic partnerships to achieve the objectives of Ayushman Bharat Digital Mission (ABDM)
Formulation of various operational guidelines related to PM-JAY, model documents and contracts to ensure standardization and interoperability.
Determine the central ceiling for premium (or maximum central contribution for trusts) per family per year to be provided to the States/UTs and review it from time to time, based on field evidence and actuarial analysis.
Develop and enforce compliance with standards for treatment protocols, quality protocols, minimum documentation protocols, data sharing protocols, data privacy and security protocols, fraud prevention and control including penal provisions etc.
Develop mechanisms for strategic purchasing of health care services through PM-JAY, so as to get best return on Government’s investment. Create conducive conditions for strategic purchasing by preparing a list of packages and their rates and updating them from time to time using a transparent, predictable and evidence-based process.
Set up effective and efficient mechanisms to pay to the health care providers.
Set up systems and processes for convergence of PM-JAY with other health insurance/assurance schemes. This will include schemes being implemented by both State and Central Governments. National Health Authority will also develop a pathway to converge PM-JAY with schemes targeting workers from both, the formal and informal sectors.
Build a state-of-the-art health information technology ecosystem with requisite foundational components on which PM-JAY and other health systems can be hosted/linked; Information Technology standards will be developed in consultation with Ministry of Electronic and Information Technology (MeitY).
Explore options including ways to link PM-JAY with the larger health care system, especially primary care, in consultation with the Ministry of Health and Family Welfare, Government of India.
Work closely with Insurance Regulatory and Development Authority on development and implementation of Health Insurance Regulations targeting insurance companies, Third Party Administrators, hospitals and other stakeholders.
Effective implementation of PM-JAY across the country and its regular monitoring including taking course corrections actions, as and when required.
Coordination with various State Governments on regular basis for implementation of PM-JAY.
Capacity building of State Health Agencies and other stakeholders continuously.
Carrying out awareness activities for informing beneficiaries and other stakeholders about the scheme.
Prevention, detection and control of fraudulent activities and abuse.
Grievance redressal for all the stakeholders at various levels.
Set up an efficient monitoring system for the scheme.
Stimulate cross learning, sharing of best practices amongst States and documentation of these practices.
Ensure interoperability, standardization and convergence amongst schemes of Central Ministries.
Conduct and facilitate policy relevant research and evaluation studies including knowledge sharing and information dissemination at the national and international level.
Develop strategic partnerships and collaboration with Central and State Governments, other public and private institutions including not-for-profit institutions, banks, insurance companies, academic institutions such as universities, missions, think tanks, and other national and international bodies of repute in areas relevant to the objectives of PM-JAY.
Generate evidence for the policy makers from schemes’ data and other research/evaluations so as to facilitate evidence-based decision making and policy formulation by the Government.
Act as apex body for State Health Agencies that have been set up to implement PM-JAY.
Take any decision related to the implementation of the scheme, recruitment rules and hiring of staff, disbursement of grant-in-aid to the States and issue relevant directions from time to time, as required.
And all other activities as assigned by the Government of India from time to time.
Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (lit. 'Prime Minister's People's Health Scheme' or PM-JAY; also referred to as Ayushman Bharat National Health Protection Scheme or NHPS) is a national public health insurance fund of the Government of India that aims to provide free access to health insurance coverage for low income earners in the country.
Roughly, the bottom 50% of the country qualifies for this scheme.
People using the program access their own primary care services from a family doctor. When anyone needs additional care, then PM-JAY provides free secondary health care for those needing specialist treatment and tertiary health care for those requiring hospitalization.
The programme is part of the Indian government's National Health Policy and is means-tested. It was launched in September 2018 by the Ministry of Health and Family Welfare. That ministry later established the National Health Authority as an organization to administer the program.
It is a centrally sponsored scheme and is jointly funded by both the union government and the states. By offering services to 50 crore (500 million) people it is the world's largest government sponsored healthcare program.
The program is a means-tested as its users are people with low income in India.
include the following— providing health coverage for 10 crores households or 50 crores Indians; providing a cover of ₹5 lakh (US$6,300) per family per year for medical treatment in empaneled hospitals, both public and private;
offering cashless payment and paperless recordkeeping through the hospital or doctor's office; using criteria from the Socio Economic and Caste Census 2011 to determine eligibility for benefits;
no restriction on family size, age or gender; all previous medical conditions are covered under the scheme; it covers 3 days of pre-hospitalisation and 15 days of post-hospitalisation, including diagnostic care and expenses on medicines;
the scheme is portable and a beneficiary can avail medical treatment at any PM-JAY empanelled hospital outside their state and anywhere in the country;
providing access to free COVID-19 testing
India's 28 states and 8 union territories each make their own choice about whether to participate in Ayushman Bharat Yojana.
In February 2018 when the program was announced 20 states committed to join. In September 2018 shortly after launch some states and territories declined to participate in the program.
Maharashtra and Tamil Nadu initially declined to join because they each had their own state healthcare programmes.
Those programs, Mahatma Jyotiba Phule Jan Arogya Yojana and the programme for Tamil Nadu, were already functioning well. These states later both joined Ayushman Bharat Yojana with special exceptions to make it part of their existing infrastructure.
In a similar way, Kerala, despite having its own health program agreed to begin using Ayushman Bharat Yogana from November 2019.
West Bengal initially joined the program but then opted out in favor of establishing their own regional health programme.
Telangana did the same.
By January 2020 Odisha had not joined the scheme.
In March 2020 Delhi announced that it would join the program.
Participation by local people In May 2020 Prime Minister Narendra Modi said in his radio show Mann Ki Baat that the Ayushman Bharat scheme had recently benefited more than one crore people.
By May 2020, the scheme had provided more than 1 crore treatments with a value of ₹13,412 crore.
The number of public and private hospitals empanelled nationwide stands at 24,432.
The Ayushman Bharat Yojana programme announced a special collaboration with the Employees' State Insurance programme in November 2019.
From June 2020, the program had entered a pilot to cover 120,000 workers with that insurance at 15 hospitals.
When Ayushman Bharat Yojana began there were questions of how to reconcile its plans with other existing health development recommendations, such as from NITI Aayog.
A major challenge of implementing a national health care scheme would be starting with infrastructure in need of development to be part of a modern national system.
While Ayushman Bharat Yojana seeks to provide excellent healthcare, India still has some basic healthcare challenges including relatively few doctors, more cases of infectious disease, and a national budget with a comparatively low central government investment in health care.
Some of the problems lay outside the Health Ministry such as urban development or transport.
While many government hospitals have joined the program, many private corporate hospitals have not. The private hospitals report that they would be unable to offer their special services at the government low price, even with a government subsidy.
There has been misuse of the Ayushman Bharat scheme by private hospitals through submission of fake medical bills. Under the Scheme, surgeries have been claimed to be performed on persons who had been discharged long ago and dialysis has been shown as performed at hospitals not having kidney transplant facility.
There are at least 697 fake cases in Uttarakhand State alone, where fine of ₹1 crore (US$130,000) has been imposed on hospitals for frauds under the Scheme.
Initial analysis of high-value claims under PMJAY has revealed that a relatively small number of districts and hospitals account for a high number of these, and some hint of an anti-women bias, with male patients getting more coverage.
Despite all efforts to curb foul-play, the risk of unscrupulous private entities profiteering from gaming the system is clearly present in AB-PMJAY.
The Ayushman Bharat Digital Mission (ABDM) aims to develop the backbone necessary to support the integrated digital health infrastructure of the country. It will bridge the existing gap amongst different stakeholders of Healthcare ecosystem through digital highways.
To strengthen the accessibility and equity of health services, including continuum of care with citizen as the owner of data, in a holistic healthcare programme approach leveraging IT & associated technologies and support the existing health systems in a ‘citizen-centric’ approach, the Ayushman Bharat Digital Mission (ABDM) envisages the following specific objectives:
The National Health Policy (NHP) 2017 has the following goal: “The attainment of the highest possible level of health and wellbeing for all at all ages, through a preventive and promotive health care orientation in all developmental policies, and universal access to good quality health care services without anyone having to face financial hardship as a consequence.”
In a follow-up of the NHP’s specific goals for adopting digital technologies, the Ministry of Health and Family Welfare constituted a committee headed by Shri J. Satyanarayana to develop an implementation framework for the National Health Stack. This committee produced the National Digital Health Blueprint (NDHB), laying out the building blocks and an action plan to comprehensively and holistically implement digital health.
Taking forward the NDHB, this document describes the broad context, rationale, scope, and implementation arrangements for a digital ecosystem for healthcare services across the country. Since the implementation is envisioned to be in a mission mode, the initiative is referred to as the Ayushman Bharat Digital Mission (ABDM).
Vision To create a national digital health ecosystem that supports universal health coverage in an efficient, accessible, inclusive, affordable, timely and safe manner, that provides a wide-range of data, information and infrastructure services, duly leveraging open, interoperable, standards-based digital systems, and ensures the security, confidentiality and privacy of health-related personal information.
ABHA Number
It is important to standardize the process of identification of an individual across healthcare providers.
This is the only way to ensure that the created medical records are issued to the correct individual or accessed by Health Information User through appropriate consent.
In order to issue the UHID, the system must collect certain basic details including demographic and location, family/relationship, and contact details. Ability to update contact information easily is the key.
The ABHA(Ayushman Bharat Health Account) Number will be used for the purposes of uniquely identifying persons, authenticating them, and threading their health records (only with the informed consent of the patient) across multiple systems and stakeholders.
It is a comprehensive repository of all healthcare professionals involved in delivery of healthcare services across both modern and traditional systems of medicine.
Enrolling in the Healthcare Professionals Registry will enable them to get connected to India’s digital health ecosystem.
It is a comprehensive repository of health facilities of the nation across different systems of medicine.
It includes both public and private health facilities including hospitals, clinics, diagnostic laboratories and imaging centers, pharmacies, etc.
Enrolling in the Health Facility Registry will enable them to get connected to India's digital health ecosystem.
UHI is envisioned as an open protocol for various digital health services.
UHI Network will be an open network of End User Applications (EUAs) and participating Health Service Provider (HSP) applications.
UHI will enable a wide variety of digital health services between patients and health service providers (HSPs) including appointment booking, teleconsultation, service discovery and others
A PHR is an electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be drawn from multiple sources while being managed, shared, and controlled by the individual.
The most salient feature of the PHR, and the one that distinguishes it from the EMR and EHR, is that the information it contains is under the control of the individual.
The users of eSanjeevani can create their 14-digit unique Ayushman Bharat Health Account (ABHA) and use it to link their existing health records
The National Health Authority (NHA) announces the successful integration of eSanjeevani with its flagship scheme – Ayushman Bharat Digital Mission (ABDM).
This integration allows the existing users of eSanjeevani, the telemedicine service of Ministry of Health and Family Welfare (MoHFW) to easily create their Ayushman Bharat Health Account (ABHA) and use it to link and manage their existing health records like prescriptions, lab reports, etc.
The users would also be able to share their health records with doctors on eSanjeevani which will help in better clinical decision making and ensuring the continuum of care.
Speaking about the significance of this integration, Dr. R. S. Sharma, CEO, NHA said – “ABDM aims to build digital highways to bridge the gaps in existing digital health solutions and stakeholders in India. The integration of eSanjeevani with ABDM is one such example where the 22 crore ABHA holders can link and store their health records created via eSanjeevani directly in the health lockers of their choice. The users can also share their previously linked health records with the doctors on eSanjeevani making the entire consultation process paper-less.”
eSanjeevani service is available in two variants. The first one is eSanjeevani Ayushman Bharat-Health and Wellness Centre (AB-HWC) – the Doctor-to-Doctor telemedicine service through which the beneficiaries visiting a HWC can virtually connect to doctors/ specialists in the Hub that could be at tertiary healthcare facility/hospital/medical college.
This enables the government to provide general and specialised health services in rural areas and isolated communities. The second variant, eSanjeevani OPD is serving patients across the country, connecting them directly to doctors from the comforts of their homes. Both versions – eSanjeevani AB-HWC and eSanjeevani OPD have been integrated with ABDM platform.
The eSanjeevani telemedicine platform now joins other 40 digital health applications that have completed their ABDM integration. Together, these health tech services are building a robust, inter-operable and inclusive digital health ecosystem for the country.
Population-wide, real-time, cloud-based telemedicine platform
Enables Video-Audio consultations between Doctor-Patient
Implemented in Hub & Spoke architecture
To enable access of quality health services for populace in rural areas
To reduce out of pocket expense (on health services) for patients
To bridge rural-urban digital health divide
Ushered a digital health revolution in the country
People can avail healthcare from anywhere anytime basis
e-Prescriptions generated by eSanjeevani are free from medical errors
Served over 45 million patients
Established 11,193 Hubs & Operationalised in 92,232 Health & Wellness Centres as Spokes
Nomination of State Admin / State Nodal officer for telemedicine at Health & Wellness Centres/Hub/OPD
Listing health facilities ready for operationalisation of telemedicine
Remote training of doctors and paramedics - eSanjeevani's tech support team remotely trains the users or master-trainers on the staging server/demo application
After training, a dry run is conducted with dummy patients for around a week to ensure that the users are familiar with eSanjeevani
Profiles of users are created on eSanjeevani (production server)
Upon a go ahead by the State Nodal Officer, the launch /go live is planned, besides communication & awareness through electronic and print media
eSanjeevani is a cloud-based telemedicine system.
It has been developed using open-source tools/stack.
Modalities of implementation in other Allied countries
eSanjeevani can be deployed in the two modalities:
Provider/Doctor to Doctor teleconsultation system
Patient to Doctor teleconsultation system
Financial: Depend upon the requirements/customization required. Certain third-party integrations/licenses like Video Conferencing, SMS gateway, Cloud hosting etc. are as per usage & are billed as per actuals/usage.
Operational: Backend operations & configurations are to be managed by implementing agency and Clinical & medical aspects are to be managed by the participating agency i.e., user
Legal & other aspects: Would depend upon the participating agency & requirements