Dr. Harsh Vardhan observed that he knows many people who have not been able to avail of entitlement benefits despite the presence of well-intended government schemes. Due to lack of timely intervention through these schemes, delayed response and hurdle in these cases, the poor and needy people were not able to avail the benefits of the health schemes on time. He noted that these bureaucratic hassles stood in the principles of Antyodaya espoused by Shri Deendayal Upadhyay.

“Just like the Technological interventions in opening bank accounts, Public Financial Management System (PFMS), subsidies through Direct Benefit Transfer (DBT), Ayushman Bharat scheme for paperless treatment of patients, today’s initiative of convergence of CGHS, RAN and HMDG with NHA platform is also designed to with the vision of making the healthcare services available transparently and swiftly to the needy citizens.” He acknowledged the contributions of Shri Indu Bhushan, Former CEO, NHA whose work and recommendation laid the foundation for today’s development.

 

The Minister noted that the e-referral module developed by NIC has enabled CGHS dispensaries and wellness centres to issue an online referral to empanelled hospitals. The hospital’s processing of the application, submission of claims, CGHS team’s sanctioning, the release of payment would be done online on the platform henceforth.

He informed that under RAN, financial assistance up to Rs 15 lakhs is provided to poor patients suffering from major life-threatening diseases/cancer/rare diseases, for medical treatment at Government hospitals. The eligibility criteria to avail services under RAN had been based on State/UT-wise BPL threshold. But getting a state-specific BPL certificate from a competent authority has remained a time-consuming process. Similarly, under HMDG a maximum amount of Rs 1,25,000 is provided to patients whose annual income does not exceed Rs.1,25,000 to defray a part of the expenditure on hospitalization/treatment in Government Hospitals. Beneficiaries can apply for financial assistance under both schemes by providing their Ration card number and undergoing beneficiary verification process at any of the empanelled Govt. hospital. Their application will be processed in-house by the respective hospital and treatment can be started. On submission of the treatment details by the respective hospital, claims will be processed and payment would be released.

 

Ashwini Kumar Choubey called the digitized versions of these schemes a gamechanger and said, “It is extremely important moment today that from now onwards existing beneficiaries of RAN/HMDG and CGHS will not have to run from pillar to post. For the last three years, I used to feel pained whenever I used to see RAN files and the assistance could not be provided to the eligible beneficiary in a fix time manner and this led to delay/denial of treatment under the scheme for needy people.” He expressed his elation that AB PM-JAY beneficiaries would be able to avail the benefit under RAN scheme for the treatment beyond five lakhs that are not covered under the scheme. He noted that other similar schemes are being planned to be rolled out on NHA’s IT platform and will help in better utilization of resources, de-duplication of beneficiaries, standardized service delivery and will lead to economies of scale.

 

Dr RS Sharma, CEO, National Health Authority stated that verification of beneficiary’s identification, pre-authorization and their claim settlement through our IT system can now be carried out without any physical movement of files.