Page 15 - RMAI BULLETIN Oct - Dec 2019

RMAI BULLETIN OCTOBER TO DECEMBER 2019

1. It has a defined benefit cover of Rs. 5 lakh per needs of the population which remained hidden
familyperyearwithnorestrictionoffamilysize. duetolackoffinancialresourceswillbecateredto.

2. Benefits of the scheme are portable across the
All these entire insurance procedural requirements has
country and a beneficiary covered under the led to a dedicated, dormant & dominant role for all the
scheme will be allowed to take cashless benefits
Indian Insurers by this time have introduced a formal
from any public/private empanelled hospitals
program to evaluate and record their most significant
acrossthecountry.
risks and will have involvement of senior management
3. National Health Protection Mission is an commitment. The first step is the Risk Management is
entitlement based scheme with entitlement always the Risk Identification. Risks that may be
decided on the basis of deprivation criteria in the identifiedbythemwilldefinitelyinclude:-
SECCdatabase. 1. Loss of IT systems, e.g. frequent down-time of
computerworking.
4. The beneficiaries can avail benefits in both public
andempanelledprivatefacilities. 2. Breach of systems security, e.g. cyber threats &
hackingoninternet.
5. To control costs, the payments for treatment will
be done on package rate (to be defined by the 3. Poorprioritizationofsystemsdevelopment.
Governmentinadvance)basis.
4. Failure of partner/third party relationships, e.g. in
6. One of the core principles of this National Health performancedelivery.
Protection Mission is to co-operative federalism
5. Failureineffectivelymanagingrelationships.
andflexibilitytostates.
6. Loss of key personnel, e.g. technical insurance
7. For giving policy directions and fostering
expertthroughretirement/otherwise.
coordination between Centre and States, it is
proposed to set up Ayushman Bharat National 7. Damage to reputation, e.g. loss of trust from mis-
Health Protection Mission Council (AB-NHPMC) at selling, demonstrating unfairness to customers,
apex level Chaired by Union Health and Family fines,non-compliancewithlegalrequirementsetc.
WelfareMinister.
8. Loss of competitive advantage by failing to
8. States would need to have State Health Agency innovate, loss of monopoly/ tie-up arrangements,
(SHA)toimplementthescheme. etc.
9. To ensure that the funds reach SHA on time, the 9. People issues, e.g. moral issues, lack of resources
transfer of funds from Central Government leadingtostressfulsituations.
through Ayushman Bharat to State Health
10. Lack of management information or poor,
Agencies may be done through an escrow account
inaccurate management information which
directly.
cannotbereliedupon.
10. In partnership with NITI Aayog, a robust, modular,
11. Financial statement could be wrong, for example,
scalable and interoperable IT platform will be theamountofdisclosurescouldbewrong.
made operational which will entail a paperless,
cashlesstransaction. Examples of other business risks are fire, flood,
11. Increased benefit cover to nearly 40% of the litigation, IT viruses or anything that could have a
population (mainly for the poorest & the damaging impact on the business. Part of evaluating
vulnerable). the processes is to mitigate the threats and determine
the exposures and this should also help to identify and
12. Covering almost all secondary and many tertiary
exploit opportunities. The main responsibility for both
hospitalizations (exclusions are specifically
risk management and implementation of the actions
stated).
from the risk management programme rests with
13. This is expected lead to increased access to quality operational management. They are, in this respect, as
health and medication. In addition, the unmet in other situations, the first line of defence. This Risk

13