Page 46 - The Insurance Times November 2024

FEATURE

Adequate reimbursement rates, timely

payments to hospitals key to success

W hile welcoming the Centre's move to expand healthcare providers and facilitate smooth implementation

coverage under Ayushman Bharat Pradhan
through targeted support and streamlined financial
Mantri Jan Arogya Yojana (AB-PMJAY) to all
processes will be key in ensuring these hospitals can continue
citizens aged 70 years or above, industry
insiders pointed out that the sustainability of the scheme to provide high-quality care while adapting to the broader
scope of the scheme," he added.
hinges on ensuring adequate reimbursement rates and
timely payments to hospitals. Experts pointed out that timely payments are critical as
delays can disrupt cash flow and hinder the ability of these
AB-PMJAY provides cashless and paperless benefit cover of hospitals to maintain the quality of care.
Rs 5 lakh per annum per family on a floater basis in
empanelled hospitals across India. "Without addressing these implementation challenges,
there is a risk that the expansion could overwhelm the
Under the expanded purview of the scheme, eligible senior system, making it difficult for smaller providers to continue
citizens, who belong to families already covered under AB- participating, ultimately affecting the availability and quality
PMJAY, will get an additional top-up cover up to Rs 5 lakh of healthcare services for the elderly," Mahajan added.
per year for themselves. All other eligible senior citizens,
whose families are not covered under the scheme, will also Public health experts felt that as India is ageing, covering
get a cover up to Rs 5 lakh per year on a family basis. senior citizens under health cover is critical.

Highlighting that the move would enable more families to "India's life expectancy at birth has increased continuously
access essential services without the burden of due to the decline in mortality and fertility. The mortality
overwhelming medical expenses, Dr Harsh Mahajan, chair and fertility transition clearly indicate that the population
of FICCI Health Services Committee and founder, Mahajan ageing will be accelerated in near future. As per the latest
Imaging and Labs pointed out that expanding the United Nations estimates, India's population aged 65 and
beneficiary base by such a significant margin would present above will increase from 104 million in 2024 to 246 million
challenges, particularly regarding the viability of the scheme in 2050 and 416 million in 2075. The latest estimate of
for smaller and medium-sized hospitals. Government of India's Sample Registration System for the
years 2016-20 shows that the life expectancy of the Indians
"These institutions often operate on tight margins, and the
at birth is 70 years and at age 70 is 11.9 years. It means
added pressure of accommodating a larger patient base,
that the Indians who have already reached the age of 70
especially with senior citizens requiring more intensive care,
years will live additionally for 12 more years," said Anjali
could strain their resources," he added.
Sane, Dean, School of Economics and Commerce, MIT World
Commenting on the issues being faced, Dr Girdhar Gyani, Peace University, Pune.
Director General, Association of Healthcare Providers (AHPI)
"Under such circumstances, the Government of India's
said that increasing the beneficiary base could bring
decision to cover the medical insurance for its senior citizens
additional considerations for the scheme's operational
dynamics. above the age of 70 is a welcoming decision. Not all the
senior citizens in the country have the income capacity to
"Ensuring that reimbursement rates are fair and that purchase health insurance from the private sector. The
payments are processed in a timely manner will help support decision will satisfy our long pending objective to achieve

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