Experts Call for Tighter Norms in Ayushman Bharat for Hospital Accountability
Experts advocate for stricter norms and monitoring for hospitals under Ayushman Bharat to prevent fraud and ensure quality care.
Photo by New Ruby Hospital
त्वरित संशोधन
Experts call for tighter norms for hospitals under Ayushman Bharat
Concerns about fraud, overcharging, and denial of services
Need for robust regulatory oversight and transparent grievance redressal
Scheme aims to provide affordable healthcare to vulnerable populations
दृश्य सामग्री
AB-PMJAY Service Delivery & Accountability Gaps
This flowchart illustrates the typical patient journey under Ayushman Bharat PMJAY, highlighting critical stages where robust regulatory oversight, transparency, and accountability are essential. It also pinpoints potential junctures where issues like fraud, overcharging, or denial of services, as highlighted by experts, can occur, undermining the scheme's objectives.
- 1.Beneficiary Identification (SECC 2011 Data)
- 2.Empanelment of Hospitals (Public & Private)
- 3.Beneficiary Seeks Treatment at Empaneled Hospital
- 4.Pre-authorization Request by Hospital to SHA/NHA
- 5.SHA/NHA Approves Pre-authorization
- 6.Treatment & Service Delivery to Beneficiary
- 7.Hospital Submits Claim to SHA/NHA
- 8.Claim Verification & Processing by SHA/NHA
- 9.Payment to Hospital
- 10.Beneficiary Receives Intended Quality Care
- 11.Grievance Redressal Mechanism (Beneficiary/Public)
- 12.Continuous Quality Checks & Monitoring (NHA/SHA)
परीक्षा के दृष्टिकोण
Governance and accountability in public schemes
Social sector initiatives and their implementation challenges
Healthcare policy and universal health coverage
Role of technology in public service delivery and fraud detection
Constitutional provisions related to health and welfare
विस्तृत सारांश देखें
सारांश
This article highlights the call from experts for tighter norms and more stringent monitoring mechanisms for hospitals operating under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) scheme. The concern stems from instances of fraud, overcharging, and denial of services, which undermine the scheme's objective of providing affordable healthcare to vulnerable populations.
Experts suggest that while the scheme has expanded access to healthcare, robust regulatory oversight, transparent grievance redressal, and continuous quality checks are essential to ensure accountability and prevent misuse of public funds. Strengthening these norms would help maintain the integrity of the scheme and ensure that beneficiaries receive the intended quality of care.
पृष्ठभूमि
नवीनतम घटनाक्रम
बहुविकल्पीय प्रश्न (MCQ)
1. With reference to the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), consider the following statements: 1. It provides a health cover of up to ₹5 lakh per family per year for secondary and tertiary care hospitalization. 2. The scheme is entirely funded by the Central Government, with States acting only as implementing agencies. 3. It aims to cover the bottom 40% of poor and vulnerable families based on the Socio-Economic Caste Census (SECC) 2011 data. 4. Portability of benefits across different states is a key feature of the scheme. How many of the statements given above are correct?
- A.Only one
- B.Only two
- C.Only three
- D.All four
उत्तर देखें
सही उत्तर: C
Statement 1 is correct: AB-PMJAY provides a health cover of ₹5 lakh per family per year for secondary and tertiary care. Statement 2 is incorrect: The scheme is jointly funded by the Central and State Governments. The Central Government contributes 60% in most states, 90% in Himalayan and North-Eastern states, and 100% in Union Territories without legislature. Statement 3 is correct: It targets the bottom 40% of poor and vulnerable families identified based on the SECC 2011 data. Statement 4 is correct: The scheme offers portability of benefits, allowing beneficiaries to avail cashless services from any empanelled hospital across the country. Therefore, three statements are correct.
2. In the context of ensuring accountability and quality in public health schemes like AB-PMJAY, which of the following mechanisms are generally considered effective? 1. Leveraging Artificial Intelligence and Machine Learning for fraud detection. 2. Establishing a robust, independent grievance redressal system. 3. Mandatory empanelment of only public sector hospitals. 4. Regular, independent third-party audits of hospital claims and services. Select the correct answer using the code given below:
- A.1, 2 and 3 only
- B.1, 2 and 4 only
- C.3 and 4 only
- D.1, 2, 3 and 4
उत्तर देखें
सही उत्तर: B
Statement 1 is correct: AI and ML can analyze large datasets to identify suspicious patterns in claims, helping detect fraud proactively. Statement 2 is correct: An independent and accessible grievance redressal system is crucial for beneficiaries to report issues like denial of service, overcharging, or poor quality, ensuring accountability. Statement 3 is incorrect: AB-PMJAY operates on a mixed model, empanelling both public and private hospitals to expand access. Mandatory empanelment of only public sector hospitals would severely limit the scheme's reach and is not a mechanism for ensuring accountability in the current framework. Statement 4 is correct: Regular, independent third-party audits provide an unbiased assessment of hospital compliance, quality of care, and accuracy of claims, which is vital for maintaining integrity. Therefore, statements 1, 2, and 4 are correct.
3. Consider the following statements regarding the National Health Authority (NHA): 1. It is an attached office of the Ministry of Health and Family Welfare. 2. It is responsible for the implementation of the Ayushman Bharat Digital Mission (ABDM). 3. Its governing board is chaired by the Union Minister for Health and Family Welfare. Which of the statements given above is/are correct?
- A.1 and 2 only
- B.2 only
- C.2 and 3 only
- D.1, 2 and 3
उत्तर देखें
सही उत्तर: B
Statement 1 is incorrect: The National Health Authority (NHA) is an autonomous body under the Ministry of Health and Family Welfare, not an attached office. It was constituted as an autonomous entity to give it greater operational freedom. Statement 2 is correct: NHA is indeed the apex body responsible for implementing the Ayushman Bharat Digital Mission (ABDM), which aims to develop the backbone necessary to support the integrated digital health infrastructure of the country. Statement 3 is incorrect: The governing board of NHA is chaired by the Union Minister for Health and Family Welfare, but the CEO of NHA is also the CEO of AB-PMJAY and has significant operational autonomy. The NHA is headed by a CEO who is of the rank of Secretary to the Government of India. The governing board is chaired by the Union Minister for Health and Family Welfare. Wait, let me recheck statement 3. The NHA website states: 'The NHA is headed by a Chief Executive Officer (CEO), who is of the rank of Secretary to the Government of India, and a Governing Board chaired by the Union Minister for Health & Family Welfare.' So, statement 3 is correct. My initial thought was incorrect. Let me correct the explanation and answer. Revised Explanation: Statement 1 is incorrect: The National Health Authority (NHA) is an autonomous body under the Ministry of Health and Family Welfare, not an attached office. It was constituted as an autonomous entity to give it greater operational freedom. Statement 2 is correct: NHA is indeed the apex body responsible for implementing the Ayushman Bharat Digital Mission (ABDM), which aims to develop the backbone necessary to support the integrated digital health infrastructure of the country. Statement 3 is correct: The governing board of NHA is chaired by the Union Minister for Health and Family Welfare. The CEO of NHA is also the CEO of AB-PMJAY and has significant operational autonomy, but the overall governing board is chaired by the minister. Therefore, statements 2 and 3 are correct.