Restructuring of National Health Agency as “National Health Authority” for better implementation of Pradhan Mantri – Jan Arogya Yojana (PM-JAY)

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Restructuring of National Health Agency as “National Health Authority” for better implementation of Pradhan Mantri – Jan Arogya Yojana (PM-JAY)

   

As the Pradhan Mantri – Jan Arogya Yojana (PM-JAY) completed its 100 days, the Union Cabinet today approved the re-structuring of existing National Health Agency as “National Health Authority”.

Through this decision, the existing society, “National Health Agency”,has been dissolved and its status now standsenhanced to that of an Authority. The National Health Authority shall have full autonomy, accountability and the mandate to implement PM-JAY through an efficient, effective and transparent decision-making process.

Welcoming the decision of the Cabinet, Shri J. P. Nadda, theMinister for Health and Family Welfare observed that “the world’s largest healthcare scheme rightfully deserves the most efficient and effective governance structure with total accountability.”

Dr. Indu Bhushan, Chief Executive Officer, NHA stated that “we are humbled by the faith reposed by the Cabinet in according the status of anAuthority to National Health Agency. We reaffirm our commitment torealise the ambitious vision of Hon’ble Prime Minister”.

The existing multi-tier governance structure has been replaced with a Governing Board (GB) chaired by the Minister of Health and Family Welfare (MoHFW)with representation from the Government and domain experts.Since the Authority is now fully autonomous, the post of Joint Secretary (NHA/ Ayushman Bharat) will be transferred from Ministry of Health and Family Welfare to the National Health Authority.

The creation of the National Health Authority will lead tofaster decision-makingandmore accountability and efficiency to ensure availability of quality services to beneficiary families through strategic purchase of healthcare services, preparation of list of health packages and their rates, robust fraud controland increase in private sector investment in healthcare.

Within 100 days of implementation of PM-JAY, 41.5 lakh e-cards have issued to the beneficiaries with more than 6.95 lakh beneficiaries having availed services under PM-JAY through a network of 16,157 empaneled (and in process) hospitals, amounting to the tune of Rs. 924 crores.

Annexure

Details of the Decision:

  • Through this decision, the existing society, “National Health Agency”, has been dissolved. Its status now stands enhanced to that of an Authority, the National Health Authority, which shall have full autonomy, accountability and the mandate to implement PM-JAY through an efficient, effective and transparent decision-making process.
  • The existing multi-tier governance structure has been replaced with a Governing Board (GB) chaired by the Minister of Health and Family Welfare (MoHFW), Government of India. This will enable decision-making at a faster pace, required for smooth implementation of the scheme. Led by the Governing Board, NHA will have full functional autonomy. The GB of the Authority, in addition to the Chairperson (Minister of Health and Family Welfare, Government of India), will have 11 other members as under:
    • Chief Executive Officer, NITI Aayog, ex-officio;
    • Secretary, Department of Expenditure, Ministry of Finance, Government of India, ex-officio;
    • Secretary, Department of Health and Family Welfare, MoHFW, Government of India, ex-officio;
    • Chief Executive Officer (CEO) of the Authority;
    • Two domain experts from fields such as Administration, Insurance, Public and Private Health care providers, Economics, Public Health, Management etc. to be appointed by the Government; and
    • Five Principal Secretaries (Health) of State Governments – one representing each of the five zones viz; North, South, East, West and North Eastern States on rotational basis.
  • All existing assets & liabilities (including the posts created) of the National Health Agency will be transferred to the National Health Authority.
  • The post of Joint Secretary (NHA/ Ayushman Bharat) will be transferred from Ministry of Health and Family Welfare to the National Health Authority.
  • A full-time CEO in the rank of Secretary to the Government of India, shall be appointed by Central Government. Subject to superintendence of the Governing Board, the CEO will have complete operational control of the Authority
    • The CEO shall be the ex officio Member Secretary to the Governing Board. The CEO shall exercise such administrative powers within the Authority and over its staff as may be delegated to him by the GB.
    • The CEO shall also exercise financial powers of Secretary to Government of India as envisaged under GFR and Financial Rules & regulations of Government of India.

Major functions of National Health Authority:

  • Formulation of various operational guidelines related to PM-JAY, model documents and contracts to ensure standardisation and interoperability.
  • 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 the 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 healthcare services through PM-JAY so as to get best value on Government’s investment. Create conducive conditions for strategic purchasing by preparing list of packages and their rates and updating those from time to time using a transparent, predictable and evidence-based process. Set up effective and efficient mechanisms to pay to the health care providers.
  • Set up systems and processes for convergence of PM-JAY with other health insurance/assurance schemes. This will include schemes being implemented by both State and Central Governments. Proposed National Health Authority will also develop a pathway to converge PM-JAY with schemes targeting both formal and informal sector workers.
  • Build a state-of-art health information technology ecosystem with requisite foundational components on which PM-JAY and other health systems can be hosted/linked.
  • Explore options including ways to link PM-JAY with the larger healthcare system, especially primary care.

Key outcomes from establishment of the Authority

  • The creation of the National Health Authority will lead to more effective implementation of PM-JAY as it will align the accountability with responsibility. In particular, the following outcomes will ensue:
    • Faster decision-making as the multi-layered structure has been simplified and the role of the Authority has been clarified.
    • Availability of quality services as the Authority will be able to specify treatment protocols and enforce their compliance.
    • Reduction in leakages as the Authority will have stronger mandate to prevent, detect and control frauds and abuse and redress grievances.
    • Increase in private sector investment in healthcare services, as the Authority will have the clear mandate to be a strategic purchaser and be able to set appropriate rates.

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