Sir,
This is in reference to the article “All about biggest health insurance scheme,” DE March 19, 2019 Modi Government should be given full credit for bringing such a policy benefiting lower middle class section of society. This is an ambitious task taken on hand. Though it is world’s largest insurance scheme yet it needs judicious implementation and above all a motivated political will. Would like to mention few steps for better implementation:
* This has to be user friendly not only to patients but also to the hospitals which are empanelled under the scheme.
* If not monthly, quarterly review is must from Govt. to ensure proper and effective implementation. Users and hospitals to be asked to share their challenges encountered during reimbursement of claims, etc. so that these can be rectified time to time.
* Receiving inflated claims cannot be ruled out. Therefore, process to be made more transparent to avoid pilferage in the system. Regular audits may prevent false claims.
* Since majority of population (which are to be covered under this scheme) is not much educated and hence can not avail benefit of this scheme. Therefore, to reach out to this section is a big challenge before the government. Multiple programmes are required to create awareness among people regarding benefits of this scheme.
* At least 2 to 3 hospitals should be empanelled in each area / section where minimum strength of 100 or more persons residing.
* NIL involvement of cash from user is mandatory for effective implementation. It should cover pre and post medical expenses.
* Government should reach out to people once they admit patient to the hospital or each hospital should have independent cell to govern and help cases under this scheme.
* No third party involvement should be there for settling insurance claims. This is where most of the transactions / claims are either rejected or inflated to their benefit. Govt. should govern directly for preliminary period to encourage masses to avail benefit of this scheme.
Government has brought such a wonderful scheme to care for health of general masses. It should not be like other schemes that come and vanish in no time. A collaborative effort is required from all sections of society to make it a success. Hospitals should be made accountable of each claim rejected or processed and periodic audits should be in place to ensure effective implementation.
Anoop Singh Slathia
Jammu
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