16/09/2019
نموذج اخر من إدارة ممارسة نشاط التأمين الصحي الإلزامي
Asia Insurance Review
News Life and Health
16 Sep 2019
India:Authorities recommend measures for effective healthcare through health insurance
16 Sep 2019
India Life & Health Technology
The National Health Authority (NHA) and the IRDAI in a joint report released last Saturday have recommended best practices, common standards, collaborative measures and IT framework for effective healthcare through health insurance in India.
The report states that such an arrangement will benefit all stakeholders – beneficiaries, policyholders, insurers, state health agencies, healthcare providers, implementing agencies and intermediaries, etc.
A joint working group of IRDAI and NHA was formed to work on key areas of mutual interest and co-operation, reported Press Trust of India. The group focussed on four key areas:
hospital network management;
data standardisation and exchange;
common IT infrastructure for health insurance claims management; and
fraud and abuse control.
In the segment on hospital network management, the experts recommend building a national database of empanelled hospitals under insurance/government schemes with defined standards for quality and package rates and codes.
The segment on data standardisation and exchange stresses creating standard data formats across health insurance payers for analysis and policy-making by developing standardised data tables to capture and report data, identifying data elements common with IRDAI and PMJAY. It also includes setting up a framework for capturing and exchanging data.
The section on fraud control focuses on detecting and deterring fraud through capacity building by developing a standard reporting format for fraud and abuse to be used across the industry and government schemes. It also recommends creating a database of fraudulent transactions, modus operandi and entities and developing standards for field verification and investigation and developing "name and shame" guidelines.
The section on common IT infrastructure for health insurance claims management focuses on increasing service efficiency and transparency among stakeholders in the delivery of health insurance services by defining the roadmap for electronic, paperless, codified data exchange between payer and provider, collation and analysis.
Dr Indu Bhushan, CEO of NHA, said, "The recommendations in the report are a step forward in enabling quality healthcare and access for patients. These reports would help further strengthen the transparency, efficiency and effectiveness of PMJAY, benefitting millions in India directly." The NHA manages the Pradhan Mantri Jan Arogya Yojana (PMJAY) or the national health protection scheme launched last year.
IRDAI chairman Mr Subhash Khuntia said, “We are confident that implementation of these recommendations shall create a positive impact and lead to further growth of health insurance in the country.”
With Compliments
Murtadha M J Ibrahim Al Jamalani, Muscat - Sultanate of Oman 🇴🇲
