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100 days of Ayushman Bharat

Achievements and Challenges

Disclaimer: The views expressed in this paper/presentation are the views of the author
and do not necessarily reflect the views or policies of the Asian Development Bank
(ADB), or its Board of Governors, or the governments they represent. ADB does not
guarantee the accuracy of the data included in this paper and accepts no responsibility
for any consequence of their use. Terminology used may not necessarily be consistent
with ADB official terms.
60 million Indians fall below poverty line every year due to
catastrophic health expenditure

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India facing triple burden of disease

An epidemiological transition from

1 communicable diseases to non-


communicable diseases

Non – Communicable Disease

2 burden has grown from 30% to 55%


between 1990 and 2016

Epidemiological trends indicate

3 greater need for hospitalisation for


serious NCDs

Source: National Health Profile 2018

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Relevance of PM-JAY for India’s poor

6%

5%
Unmet health care needs of poorest 40%
4%

Unmet • Chronic Morbidity – The incidence of chronic


3%
needs? morbidity between the poorest 40% and richest 40%
is comparable
2%

• Hospitalization Rate – It is significantly lower in


1%
poorest 40%. Reason could be related to awareness,
access and affordability of health care services
0%

Poorest - 40% Richest - 40%


Hospitalization Rate Chronic Morbidity

Source: Chronic morbidity: IHDS 2011-2012


Hospitalization Rate: NSSO 71st (excludes childbirth)
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Benefits under PM-JAY

537 500
Million people Thousand
Poor and Vulnerable Cover per family per
year for serious
people across 107.4 illnesses
Improved million families
Access to
Affordable
Quality
Care Portable No Cap
Benefits can be availed On Family Size, Age or
in all empaneled Gender and covers pre-
hospitals across the existing diseases
country

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Increasing access
01
PM-JAY
Fulcrum of reform for Reducing catastrophic
02 health shocks
health care in India

06 Infusing quality,
Future is irreversibly 03
affordability &
locked to UHC
accountability
05 04
Changing the healthcare Reducing fragmentation
ecosystem
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Evolution of scheme
Hon’ble Prime Minister’s Scheme Launch Speech February 1
Union Budget March 21
Announcement
Cabinet Approval
March 27
CEO Appointed; Team Size of 2
May 11
NHA Incorporated

June 14
Ministers’ Conclave
August 15
PM Announces PM-JAY &
September 23 Pilot Launch

“ Today I pray that that no poor has to face any PM-JAY Launched by
PM
such problem that they have to knock doors of December 11
the hospital. But if they do, then Ayushman 5 Lakh Hospital
Bharat is at your doorstep. The poor of my Admissions
2 January 2019
country must get all facilities that the rich get ” 100 days of PM-JAY Launch;
Formation of Authority
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Challenges in designing and launching

Ambitious scheme with ambitious timelines


Strong political
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Lack of institutional structure and personnel

Challenge of getting 36 States / UTs on-board Support from multiple


MITIGANTS development partners
Convergence with State schemes

Building a robust IT system: Learnings from RSBY and


Secure, interoperable & scalable various state schemes

Resistance from certain important stakeholders

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Working Model of PM-JAY

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Ecosystem of PM-JAY

NHA
SHA
Insurer
Payer

IT platform

Pradhan Mantri
Arogya Mitra Beneficiary

Public
Private

Provider

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Building blocks of PM-JAY

SETTING THE RULES:


Operational and Institutional Framework

CREATING IT BACKBONE:
Linking beneficiaries with service providers and States with
Centre

BRINGING STATES ON-BOARD:


Negotiation and agreements with States and Union Territories

CAPACITY BUILDING AND AWARENESS GENERATION:


Building stakeholder capacity for implementation and spreading awareness
to beneficiaries

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1. Setting the rules of the Game
Capacity Monitoring & Data Security
Contracting Fund flow
Building Evaluation & Privacy

Fraud Awareness
NHA
prevention Generation
SHA

Quality Insurer State Scheme


Assurance Payer Convergence

Service
IT platform Portability
Delivery

Grievance
Empanelment Beneficiary
Redressal
Public
Benefit Package
Private Call Centre
& Rates
Provider
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2. IT INFRASTRUCTURE DEVELOPMENT (1/5)

GRIEVANCE FRAUD CONTROL MONITORING

Hospital Empanelment
HARDWARE & CLOUD Module PORTABILITY
Simple Registration Process Transaction
Management System
Real-time & Secure
Beneficiary
Identification System
PREPARATION OF DATA Demographic & Bio-metric Based STATE IT INTEGRATION

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Live 360Ο Monitoring (2/5)

Operations Dashboard Hospital Empanelment Pre-Authorization Dashboard Portability Dashboard

District Dashboard Operations Dashboard PM Letter Tracking Approved Hospital List

SECC State Demographics

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PM-JAY Monitoring – Operations Dashboard (3/5)

36,118 51.4 L

• 9 Real time dashboards and 10+ case level reports for center and states
• 10+ customized reports made available to states on request

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PM-JAY Monitoring – Portability Dashboard (4/5)

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“Am I Eligible” : mera.pmjay.gov.in (5/5)
Live Demo of Mera PM-JAY Interface

• Mera PM-JAY is an online


portal for beneficiaries to
quickly check their PM-JAY
entitlement

• The programme runs on


phonetic search to enable a
swifter ease of navigation

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3. Bringing States / UTs On-board
19 Trust Mode 09 Mixed Mode
07 Insurance Mode 03 MoU yet to be signed

Andaman & Nicobar Manipur Chhattisgarh


Andhra Pradesh Sikkim Gujarat
Arunachal Pradesh Tripura Jharkhand
Assam Uttar Pradesh Kerala
Bihar Uttarakhand Maharashtra
Chandigarh Punjab
Goa Rajasthan
Haryana Tamil Nadu
Himachal Pradesh West Bengal
Karnataka
Lakshadweep
Madhya Pradesh

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4. Capacity Building

• Multiple trainings of:


• State Health Administration
• District Officials
• Insurance Companies
• Hospital Administrators and Staff
• Pradhan Mantri Arogya Mitras
(PMAM): 16,000+ Trained
• Bank Officials
• Common Service Centre (Village
level Entrepreneurs)

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Building Awareness for PM-JAY (1/2) 6 modes
• 7.5 Crore personalized PM letters sent
• 24*7 Multilingual Helpline Number 14555
• Endorsement by Influencers such as Shri
Amitabh Bachchan
• Advertisement campaigns in
Newspapers, Radio, TV, Cinema Halls
and Airports
• PM-JAY outreach at empanelled hospital
• Partnership with Common Service
Centres to generate eCard
• ‘Ayushman Bharat Day’ celebrated at
village level

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PM-JAY Report Card

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PM-JAY Report Card (1/3)

Hospital Admissions E-Card (Gold Card) Issued Hospital Empanelment

800 thousand 5.4 million 16,227


worth 11 billion
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PM-JAY 100 Days Report Card (2/3)

55% 65% 77%


Private Hospitals Treatment in Private Amount for Tertiary
Empanelled Hospitals Cases

2.2K+ 69% 82%


Multispecialty Hospitals E-Card Issued Using
Portability Cases
Aadhaar

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PM-JAY 100 Days Report Card (3/3)

‘Am I Eligible’ webpage Calls Received at Call PM Letters Dispatched


(mera.pmjay.gov.in) Center

4.4 million 1.3 million 75 million

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PM-JAY Growth Trends (1/2)

Beneficiaries Admitted in Hospitals e-Cards Issued


900,000

800,000
783,069 5,141,272

700,000
685,807
4,038,450
600,000

500,000

386,924
400,000

300,000

200,000
144,924 1,116,154
100,000
25,407 339,613
42,352
0

30-Sep-18 31-Oct-18 30-Nov-18 31-Dec-18 30-Sep-18 31-Oct-18 30-Nov-18 31-Dec-18

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PM-JAY Growth Trends (2/2)

Hospitalisation Benefits Availed


(in crores)
Top packages utilised
1,058.9
912.1 Top five tertiary specialities
77%
1. Cardiology
2. Cardio-thoracic surgery
1,059 3. Orthopaedics
531.3
Crores 4. Urology
23% 5. Neurosurgery
225.2

41.6 Secondary Care Tertiary Care

30-Sep-18 31-Oct-18 30-Nov-18 31-Dec-18

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Challenges Ahead

1 Beneficiary Awareness

2 Capacity Building

3 Quality Assurance

4 Fraud Control and Abuse

5 Private Sector Fully On-Boarded

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Thank You

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