Health and RTI Ayushman Bharat paves way for

Health and RTI: Ayushman Bharat paves way for transparency

01 Transparency in Healthcare 02 Need for transparency in Healthcare System 03 Transparency Index: Six key factors X 04 Right to Information Act, 2005 and Healthcare Transparency 05 Indian Healthcare System: Where do we stand? 06 Way forward: Moving ahead in a strategic way 07 Ayushman Bharat: Paving way for a transparent healthcare system

Transparency in Healthcare …is about striving for positive outcomes for both providers and governments Working towards: Reducing costs Improving quality Satisfaction of patients/consumers

Transparency enhancing values Identified 4 main effects 1 Public reporting encourages quality improvements efforts 2 Transparency is associated with improved outcomes. Sometimes there could be delays etc. 3 Publishing poor quality data diminishing transparency 4 Assessment of low risk patients by providers to show improvement in the overall performance

Transparency Index: Six key factors Communication of Healthcare Data Personal Healthcare Data Centered around 6 key dimensions Quality of Healthcare Patient Experience Finance Governance

Transparency Index: Six key factors Quality of Healthcare Communication of Healthcare Data Mortality/survival rates for individual medical conditions and treatments Patient Experience All-cause mortality/survival rates Hospital readmission rates Personal Healthcare Data Waiting times for emergency care ‘Adverse event’ reporting Governance Finance

Transparency Index: Six key factors Quality of Healthcare Communication of Healthcare Data Patient reported outcome measures Patient Experience Patient satisfaction Patient approval Personal Healthcare Data Patient complaints Finance Governance

Transparency Index: Six key factors Quality of Healthcare Communication of Healthcare Data Financial performance Prices patients are charged Patient Experience Prices health insurers/payers are charged Personal Healthcare Data Disclosure of payments, gifts and hospitality to healthcare staff/ insurance providers Governance Finance

Transparency Index: Six key factors Quality of Healthcare Communication of Healthcare Data Right to Information Patient rights Patient Experience Procurement processes and decision-making Public decision making Personal Healthcare Data Patient/Public involvement Governance Finance

Transparency Index: Six key factors Quality of Healthcare Communication of Healthcare Data Electronic patient records system Patient Experience Shared clinical documentation Patient data privacy and safeguarding policy Personal Healthcare Data Information on use of patient data Governance Finance

Transparency Index: Six key factors Quality of Healthcare Communication of Healthcare Data An accessible data portal Extent to which data is up-to-date Patient Experience Ease of comparing providers and services Personal Healthcare Data Use of open data file formats Permission for access Governance Finance

Heal. Indian th system transparency vari. Where es greatl around the world Healthcare System: doywe stand? India Score Country Overall No one health system is pursui ng it in a strategi c way Score • India gets grouped among the lowest tier performers along with China, South Africa, and Kingdom of Saudi Arabia. Among the 32 countries studied, India stands low at number 31. United Kingdom 69 • Four Scandinavian countries – Denmark, Sweden, Finland Norway scored the highest on the overall transparency index. However, there were significant disparities across the indicators. These countries generally scored higher in ‘Finance’ and ‘Governance’, and were average performing on indicators like ‘Quality of Healthcare’ and ‘Patient Experience’. Australia 68 Singapore 63 Brazil 61 Parameters of Transparency Assessment Germany 56 Japan 46 India 36 China 32 1. Personal Healthcare Data (HER, privacy & safeguard policy) 2. Finance (Prices charged, disclosure of payments, financial performance) 3. Quality of Healthcare (mortality rates, waiting time, adverse events) 4. Communication of Healthcare Data (Comparing providers and services, data portals) 5. Patient Experience (Patient satisfaction, complaints) 6. Governance (Freedom of information, patient rights, public decision making)

Indian Healthcare System: Where do we stand? While ‘Governance’ and ‘Finance’ indicators scored highest, ‘Quality of Healthcare’ and ‘Communication of Healthcare Data’ scored lowest – suggesting this is where health systems are most cautious to release data 29% 31% 42% 44% 43% 29% Quality of Care Patient Experience Finance Governance Personal Healthcare Data Communication of Healthcare Data

Way forward: So what can health systems do to make transparency the powerful, positive change agent that it can be? A strategic, whole-system approach is needed to align and deliver the key dimensions of transparency 1. A consistent strategy 2. Take the lead from innovative providers 3. Measure what matters to patients 4. Fewer measures, more meaningful data 5. Provide personalized price transparency A give-and-take approach to 6. safeguarding patient data Promote independent narratives to 7. improve patient and provider understanding

Right to Information Act, 2005 and Health Systems Scope of RTI in Healthcare — The act empowers an Indian citizen to seek information from a public authority — Government hospitals carve a modest share of ~26 per cent (14, 379 hospitals) of the total number of hospitals in India whereas 74 per cent are privately run hospitals Considering that RTI is applicable only to public authorities, the ambit of the applicability of the Act remains limited to only ~26 per cent of hospitals

Ayushman Bharat: Paving way for a transparent healthcare system Increasing healthcare accessibility Ayushman Bharat Health and Wellness Centers Provisions of primary care: • Treatment • Diagnosis • Drugs and medicines • Patient electronic health records • Eventually, gatekeeping National Health Protection Scheme Provisions of secondary and tertiary care: • In-patient treatment (Surgeries and medical procedures) • Follow-up medication • Cover of INR 5 lakh …… will lead towards a better and transparent healthcare system by……. . Developing and maintaining patient health records Developing a transparent referral system Increasing patient awareness

AB-NHPM AYUSHMAN BHARAT: Continuum of Care – NHPM / CPHC AYUSHMAN BHARAT - NHPM TERTIARY SECONDARY FOLLOWUP REFERRAL PRIMARY: PREVENTIVE, PROMOTIVE, AMBULATORY CARE Comprehensive Primary Health Care System

Expand to 12 basic services Jan Andolan for Health Partnerships & Convergence Robust IT System COMPREHENSIVE PRIMARY HEALTH CARE THROUGH HEALTH AND WELLNESS CENTERS Mid-Level Health Provider (MLHP) & Payment Reforms Integrating AYUSH 17

Expanding Service Delivery Package and Promoting Wellness EXPANDING SERVICES • • • Maternal & Child Health Communicable Diseases (TB & Malaria) Non Communicable Diseases Oral Health ENT Eye Care Emergency Medical Care Mental Health Elderly Care Palliative Care PROMOTING WELLNESS • Ayushman Ambassadors in Schools • Integration with AYUSH and Yoga sessions in Community • Health Promotion – Life style modification, tobacco and alcohol cessation. 18

Health and Wellness Centres Equipped with: Consulting spaces /Ensuring Privacy Wellness rooms: Yoga, Physiotherapy, Group meetings Telemedicine Facilities Point of Care Diagnostics/Hub &Spoke Drug Dispensation Storage: Drugs and consumables Waiting area: 30 people + BRANDING Colour Code, Display boards, Citizen Charter ENGAGING PHILANTHROPY Promoting CSR/philanthropies to build Draft design Work in progress A Task force is drafting architectural designs to provide a menu of options for renovation/ new construction including 19 using prefab

IT System • NCD module of the IT system to be launched on April 14 th, 2018 • Individual health record/card- captures data including risk factors/ treatment history. • Family Health Folder-SECC data/mapping NHPS beneficiaries • Enables continuity of care, • Work plans and Job aids to facilitate clinical decision making • Population based analytics to measure service Delivery coverage and health outcomes • Service package based modules being developed • Telemedicine Facility

ASHA • • • Population Enumeration Awareness Generation Follow up of confirmed cases Counselling: Lifestyle changes; treatment compliance • • Advanced diagnostics Complication assessment Telemedicine Tertiary linkage/NHPS • • First Level Care Outreach support and mentoring of ASHA Drug Dispensation/record keeping Telemedicine Referral to MO at PHC for confirmation/complications Diagnosis / treatment initiation Referral of complicated cases Telemedicine Supervision of CHO/MPW Real time monitoring PHC/CHC SDH/DH CHO/MPW H&WC Village/Urban Block Community – Facility: Maintaining Continuum of Care

AB-NHPM ABOUT AB-NHPM • Cabinet has approved NHPM on 21 ST March 2018. • Salient features of the approved mission are § Provide a cover of Rupees 5 lakh per family per year § Entitlement based scheme with no enrolment required § Targeted to cover 10. 74 crore poor and vulnerable families, based on SECC Deprivation data § Service through both public and empaneled private hospitals § The scheme will have portability of benefits across the country § Alliance between AB-NHPM and State health insurance/ protection schemes is allowed • IEC activity will be a critical activity

AB-NHPM Ease of Access & Transparency in Implementation • Identity validation through Aadhar (No denial in absence of Aadhaar) • Transparent & seamless process to empanel/ pay hospitals online • Cost control through fixing package rates in advance • Robust fraud/abuse control & Grievance Redressal mechanism • National Helpline

AB-NHPM PARTNERING STATES Implementation mode: • States be allowed flexibility on o Insurance or o Trust mode or o Mixed - States are allowed to break 5 lakh cover in two parts to implement one part through insurance and another through Trust Alliance : • Alliance with State Schemes is proposed to be permitted (Ayushman Bharat in alliance with Arogya Sri) • This could be be part of Mo. U to be signed between Mo. HFW and States 24

AB-NHPM STRATEGIES FOR OVERCOMING HEALTH INFRASTRUCTURE • Special focus on 101 aspirational districts • Money received as claims to be retained in the hospital. • NHPS to be a tool to strengthen public sector infrastructure. • NHM will focus to set up health infrastructure in aspirational districts to improve public health infrastructure • It is also envisaged that private hospitals may set up new hospitals or strengthen existing ones due to demand generated by NHPS 25

How it will bring transparency to the healthcare system? 1 Transparent and standardized protocols With the launch of NHPS scheme all the procedures, protocols, packages and its cost will be made available to the patients. 2 Building a robust and genuine provider network • The scheme will also develop a transparent process of empanelment. This will allow hospitals to check their eligibility based on a framework/matrix that will detail out the required capabilities such as emergency room, blood transfusion, beds, staff ratio etc. • The coverage of INR 5 lakh provided by the scheme will encourage establishment of hospitals in Tier II and tier III cities, overcoming the apprehension of the providers in terms of smooth operation. 3 Effective and transparent claim settlement Payment and claims management process will be made transparent. Claim settlement will be made online and system generated. 4 Selection of insurance companies through online tender process 5 Developing IT backbone as a key enabler for transparency

Ayushman Bharat will strengthen the key factors of Healthcare transparency in a long run Quality of Healthcare Communication of Healthcare Data ü ü Providing information to patients about protocols, procedures and packages Developing platform for access of health records both for patients and providers Personal Healthcare Data ü ü Ayushman Bharat & Healthcare Transparency ü ü By building a better provider network Covering the healthcare continuum (health wellness center and secondary & tertiary care) Patient Experience ü ü ü Improving the healthcare access for poor Making patient aware of the healthcare provisions through comprehensive IEC and call centers Developing a better public grievance and redressal mechanism Finance Developing and maintaining patient healthcare data Ensuring safety of sensitive patient data ü ü ü Governance ü Developing a transparent process for claim settlement Leveraging the established RTI Act to strengthen patients’ rights Transparent hospital empanelment mechanism Online tender process for insurance companies

Thank you

Common practices of highest scoring countries included…. . Lowest scoring countries typically don’t….