Working Group 5

1. Working Group 5 Strengthening Public Hospitals through PM-JAY

2. Working Group 5 Represented States

3. Terms of Reference What is being done for strengthening public hospitals through PM-JAY What are the present reimbursement systems prevalent in different states What was being done by Public Hospitals before the advent of PM-JAY How to promote development in Public Hospitals What should be the roadmap for the future What challenges are being faced currently Vision Key questions to be answered

4. Problems being faced by Public Hospitals Deficiencies in Infrastructure Deficiencies in manpower Mismatch between capacity and patient load Equivocal quality of services High out of pocket expenditure Long lead time in upgradation Declining confidence on Public Healthcare

5. Measures adopted before the advent of PM-JAY Before PM-JAY • Online Procurement: Government e-Marketplace, eProcurement System etc. • Outsourcing of Services: Engaging specialist providers for allied services • Public Private Partnerships: Collaboration with private players • Quality Management: Standardization through NQAS, LaQshya, Kayakalp etc. State Specific Measures: Other isolated state specific measures

6. Changes brought in by AB PM-JAY • FINANCES • Direct access of funds to hospitals • Augmentation of the RKS Fund • GOVERNANCE • Smaller approval cycle for changes in infrastructure, manpower & equipment procurement Patient care Governance • PATIENT CARE • Introduction of claim executives and patient care managers Motivation • MOTIVATION • Incentives for hospital quality • Motivational incentives for workers Finance Decongestion • DECONGESTION • Load sharing with Private Providers • Improved infrastructure and capacity 6

7. Key Success Stories Re-designed and Air-Conditioned Pediatric Ward Bhoirymbong CHC, Ri-Bhoi District, Meghalaya Dedicated ward for Ayushman Bharat IGIMS Patna, Bihar Advanced diagnostics for cancer under PPP Wenlock hospital, Mangalore, Karnataka Repair & Renovations across the hospital Gauhati Medical College, Guwahati, Assam Civil Hospital to share load of GMCH-32 Chandigarh Profit making High-end labs under PPP Mode District Hospital, Pulwama, J&K

8. Model Guidelines 1/2 • All Public Health Institutions to be standardized in terms of: Manpower, Equipment, Infrastructure & Services offered • Hospital head to ensure all expected services are available, if there is any deficiency then empower him to utilize AB fund • Organic integration of HWC and PM-JAY. Every beneficiary to be mapped to a Health & Wellness Center (HWC). Patient to preferably be referred to appropriate PM-JAY hospital by parent HWC and follow up in HWC post-treatment • All Public Hospitals to be online so that they can communicate with each other utilizing PM-JAY software • Instill a sense of competition amongst Public Hospitals: Incentivization of staff, AB fund to • lapse after 4 months of the Financial Year and open to other Public Hospitals etc.

9. Model Guidelines 2/2 • At present, hospitals do not have clarity, or capacity to optimally utilize these funds. States to define clear guidelines on how these funds can be used by the hospitals • States to create capacity and empower the hospital to be able to use these funds • A dedicated team at hospitals for raising and monitoring of claims can be deployed for improved, efficient and error free processing • Hospitals can use these funds to create infrastructure that can further augment their income from AB PM-JAY

11. Thank You