National Health Authority

Subject: Government organisation

Context:

Building on the Ayushman Bharat platform, the Centre is looking to further expand health insurance to cover the “missing middle”. 

Concept:

• 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 ArogyaYojana.
• Functions of NHA
  • 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.
  • 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).
  • Coordination with various State Governments on regular basis for implementation of PM-JAY.
  • Capacity building of State Health Agencies and other stakeholders continuousl
  • 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.
  • 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.