Under its multistate Capacity Assistance Program to strengthen government sponsored health insurance schemes in the country, ACCESS Health is set to support the adoption of standard treatment guidelines (STGs) in the implementation of the Ayushman Bharat- Pradhan Mantri Jan Aarogya Yojana in the state of Gujarat. In partnership with the State Health Protection Society, Government of Gujarat and Centre for Global Development, ACCESS Health has commenced facilitating the adoption and adherence to STGs for all health benefit packages under the scheme.
The focus of the initiative is to assist the state to create an acquiescent environment for all relevant stakeholders to understand, strategize, train, and implement the guidelines smoothly and eventually promote standardization of care. The program prioritized most utilized health benefit specialities and reviewed corresponding reference guidelines, customized and adapted standards for 42 procedures offered by PMJAY program in three specialities- Cardiology, Ear Nose and Throat and Neonatology. Over the next few months the focus is to create awareness through consultative meetings and orientation of network providers, government officials and to support and strategize the process of implementing the guidelines and build a facilitative environment to implement the guidelines.
As India strives to move toward universal health coverage, it has witnessed considerable increase in access to healthcare in the recent past. In September 2018, India launched Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), one of the largest health assurance programs in the world. AB-PMJAY provides a health cover of INR 500,000 /family /year for secondary and tertiary care hospitalization to approximately 500 million poor and vulnerable families. The target population is the bottom forty percent of the Indian population. Although access to healthcare is improving in India, quality of care remains marred with wide gaps and inconsistencies. Stark contrast in quality of care includes but is not limited to unsystematic clinical practices, poor diagnosis, and irrational use of medicines, eventually leading to substandard treatment which affects the patient outcomes adversely.
The National Health Authority (NHA)is the apex body responsible for implementing AB-PMJAY endorsed standard treatment guidelines (STGs) for all AB- PMJAY health benefit packages. This was in view of need for clear and uniform clinical guidance and monitoring mechanisms to: improve quality of care, reduce cost, and curtail malpractice. While developing the standards, the NHAhad referred variousclinical protocols and guidelines available with the Department of Health Research, Indian Council of Medical research (DHR/ICMR); National Cancer Grid;Ministry of Health and Family Welfare (MOFHW), state health departments, professional associations, and international agencies such as the World Health Organization. The general objectives of introducing the quality guidelines by AB-PMJAY is to:(1) Help insurance functionaries in creating standard process of claim adjudication, identification of fraud and abuse during pre-authorization & claims management; and (2) Improve quality of patient care by providing standardized tools to the providers.
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