National Health Claim Exchange (NHCX)

17.11.2023

National Health Claim Exchange (NHCX) , Daily Current Affairs , RACE IAS : Best IAS Coaching in Lucknow 

Why in the news?

The National Health Authority (NHA) and the Insurance Regulatory and Development Authority of India (IRDAI) have joined hands to operationalize the National Health Claim Exchange (NHCX).

About National Health Claim Exchange (NHCX)

• It is a digital health claims platform developed by the National Health Authority.
• It will serve as a gateway for exchanging claims-related information among various stakeholders in the healthcare and health insurance ecosystem.
• It is designed to be interoperable, machine-readable, auditable and verifiable, as well as help ensure the information exchanged is accurate and trustworthy.

Key points about the National Health Authority (NHA)

• It is the apex body responsible for implementing Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY).
• It has been entrusted with the role of designing strategy, building technological infrastructure and implementation of “National Digital Health Mission” to create a National Digital Health Eco-system.
• It is the successor of the National Health Agency, which was functioning as a registered society. According to the Cabinet decision for full functional autonomy, the National Health Agency was reconstituted as the National Health Authority in January 2019.
• It is an attached office of the Ministry of Health and Family Welfare with full functional autonomy.
• It is governed by a Governing Board chaired by the Union Minister for Health and Family Welfare.
• It is headed by a Chief Executive Officer (CEO), an officer of the rank of Secretary to the Government of India, who manages its affairs.
• The CEO is the Ex-Office Member Secretary of the Governing Board.
• To implement the scheme at the State level, State Health Agencies (SHAs) in the form of a society/trust have been set up by respective States.

Pradhan Mantri Jan Arogya Yojna (PM-JAY)

• The scheme was launched in September 2018 and recommended by the National Health Policy 2017, to achieve the vision of Universal Health Coverage (UHC).
• It is a Centrally Sponsored Scheme having a central sector component under Ayushman Bharat Mission
• PM-JAY was earlier known as the National Health Protection Scheme (NHPS) before being rechristened.
• It subsumed the then-existing Rashtriya Swasthya Bima Yojana (RSBY) which had been launched in 2008.

Key Features:

• It is the world’s largest health insurance/ assurance scheme fully financed by the government and the cost of implementation is shared between the Central and State Governments.
• It provides a cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization across public and private empanelled hospitals in India.
• It covers up to 3 days of pre-hospitalization and 15 days of post-hospitalization expenses such as diagnostics and medicines.
• There is no restriction on the family size, age or gender.
• The RSBY had a family cap of five members.
• All pre-existing conditions are covered from day one.

Eligibility:

• The households included are based on the deprivation and occupational criteria of Socio-Economic Caste Census 2011 (SECC 2011) for rural and urban areas respectively.
• The coverage mentioned under PM-JAY, therefore, also includes families that were covered in RSBY but are not present in the SECC 2011 database.

Cover Under PM-JAY

• The cover under the scheme includes all expenses incurred on the following components of the treatment.
• Medical examination, treatment and consultation
• Pre-hospitalization
• Medicine and medical consumables
• Non-intensive and intensive care services
• Diagnostic and laboratory investigations
• Medical implantation services (where necessary)
• Accommodation benefits.
• Food services
• Complications arising during treatment
• Post-hospitalization follow-up care up to 15 days

Aims and Objectives:

• To accelerate health system preparedness for immediate responsiveness for early prevention, detection and management, with a focus on health infrastructure development including for Paediatric Care and with measurable outcomes.

Benefits:

• It provides cashless access to health care services for the beneficiary at the point of service, that is, the hospital.
• It envisions to help mitigate catastrophic expenditure on medical treatment which pushes nearly 6 crore Indians into poverty each year.

                                                                      Source:PIB