This document provides an overview of Ayushman Bharat, India's national health protection scheme. It discusses the rationale for the scheme due to issues with access to healthcare and rising costs pushing families into poverty. The key components of Ayushman Bharat are the creation of 150,000 Health and Wellness Centers to deliver comprehensive primary healthcare and the Pradhan Mantri Jan Arogya Yojana, which provides health insurance coverage to poor families. The document outlines the initiatives, organization of primary healthcare services, and key features of Ayushman Bharat.
Launched as recommended by the national health policy 2017
To achieve the vision of universal health coverage (UHC).
This initiative has been designed to meet Sustainable Development Goals (SDGs) and its underlining commitment, which is to "leave no one behind.“
Ayushman bharat what an why ..we must know this programme it is important for all doctors and nurses and others...very important for MBBS students also
This ppt gives you the details about the NRHM scheme. The SWOT analysis has been done which helps you to know the strength and weakness part of the NRHM program.
BY: Dr.Pavithra R (M.H.A)
Launched as recommended by the national health policy 2017
To achieve the vision of universal health coverage (UHC).
This initiative has been designed to meet Sustainable Development Goals (SDGs) and its underlining commitment, which is to "leave no one behind.“
Ayushman bharat what an why ..we must know this programme it is important for all doctors and nurses and others...very important for MBBS students also
This ppt gives you the details about the NRHM scheme. The SWOT analysis has been done which helps you to know the strength and weakness part of the NRHM program.
BY: Dr.Pavithra R (M.H.A)
Launched by the ministry of health & family welfare, government of India, under the national health mission.
It envisages Child Health Screening and Early Intervention Services
The orderly process defining national Health problems, identifying the unmeet needs, surveying the resources to meet them, and establishing the priority goals to accomplish the purpose of proposed Programme.
Population policy in general refers to policies intended to decrease the birth rate or growth rate.
Statement of goals, objectives and targets are inherent in the population policy.
History
National Population Policy 2000
Objectives
National Socio-Demographic Goals
Conclusion
Launched by the ministry of health & family welfare, government of India, under the national health mission.
It envisages Child Health Screening and Early Intervention Services
The orderly process defining national Health problems, identifying the unmeet needs, surveying the resources to meet them, and establishing the priority goals to accomplish the purpose of proposed Programme.
Population policy in general refers to policies intended to decrease the birth rate or growth rate.
Statement of goals, objectives and targets are inherent in the population policy.
History
National Population Policy 2000
Objectives
National Socio-Demographic Goals
Conclusion
Students/professionals will understand the concept & key components of Ayushman Bharat Yojna. Understand about that, how a public healthcare system works in the community? How it protects and improves the health of individuals and the community.
Health and wellness center by Dr. Jitender, MD PGIMERYogesh Arora
Health and wellness center is one of the two component of Ayushmann Bharat. HWC ensures comprehensive, quality, and affordable care to be achieved by all.
Michigan Hospital Association Governance meetingMary Beth Bolton
Patient centered medical home activities in MI and Nationally and the opportunity to improve quality outcomes by increased access to primary care doctors who outreach members who are missing preventive and chronic care services.
We understand the unique challenges pickleball players face and are committed to helping you stay healthy and active. In this presentation, we’ll explore the three most common pickleball injuries and provide strategies for prevention and treatment.
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From navigating policy options to staying informed about industry trends, this comprehensive guide explores everything you need to know about the health insurance market.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
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The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
2. CONTENTS
• Total no. of slides:40
• Introduction
• About PM-JAY
• Rationale
• Aim
• Continuum of Care
• Organization of CPHC
• Initiatives
• Health and Wellness Centre
• National Protection Scheme
• Comprehensive Primary Health Care Team
• Beneficiary Level
• Health System
• Key Features
2
3. INTRODUCTION
• Ayushman Bharat Yojana or Ayushman Bharat –
Pradhan Mantri Jan Aarogya Yojana (AB-PMJAY).
• Ayushman Bharat is a fundamental restructuring of the
manner in which beneficiaries access healthcare
services at the primary, secondary and tertiary care
levels.
• It represents a transition from segmented, sectoral and
fragmented program implementation models towards a
comprehensive, holistic, need-based healthcare system.
3
4. • It encapsulates a progression towards
promotive, preventive, curative, palliative
and rehabilitative aspects through access of
Health and Wellness Centers (HWCs) at the
primary level.
• It provides provision of financial protection for
access of curative care at the secondary and
tertiary levels through engagement with both
public and private sector.
4
7. Rationale
• Healthcare in India is largely underpenetrated
with government expenditure at around 1.25%
of the GDP(Gross Domestic Product).
• Nearly 55-60 million Indians are pushed into
poverty every year to meet medical needs.
• The hospitalisation expenses for critical
ailments had shot up by 300 per cent over a
decade.
• An estimated 6 million families sink into
poverty each year due to hospitalisation.
7
8. Aim
• Ayushman Bharat aims to undertake path
breaking interventions to holistically
address health( covering prevention,
promotion and ambulatory care), at
primary, secondary and tertiary.
8
12. Health and Wellness Centre
• The first component, pertains to creation of
1,50,000 Health and Wellness Centres.
• Comprehensive Primary Health Care (CPHC),
covering both maternal and child health
services and non-communicable diseases,
including free essential drugs and diagnostic
services.
• The first Health and Wellness Centre was
launched by the Hon’ble Prime Minister at
Jangla, Bijapur, Chhatisgarh on 14 April 2018.12
13. Launch of AYUSHMAN BHARAT
14th April 2018-Honorable Prime Minister launched the first Health
and Wellness Centre at Jangla, Bijapur, Chattissgarh
14. National Health Protection Scheme
• The second component is the Pradhan Mantri
Jan Arogya Yojana (PM-JAY).
• It provides health protection cover to poor and
vulnerable families.
• About 62.58% of our population has to pay for
their own health and hospitalization expenses
and are not covered through any form of health
protection.
• Source:www.abnhpm.gov.in
14
15. Comprehensive Primary Health Care Team
• Health & Wellness Centre –
SHC(Sub Health Centre)
Mid-level health provider 5: BSc/
GNM(General Nursing and
Midwifery) or Ayurveda
Practitioner trained in 6 months
Certificate Programme in
Community Health/ Community
Health Officer (BSc-CH).
MPW F- 2 per SHC IPHS
MPW M- 1 to be provided from
state resource
5 ASHAs as outreach team per
SHC
• Health & Wellness Centre – PHC
(@30,000) / UPHC (@50,000)
PHC team – (Atleast - 1 MBBS
Doctor, 1 Staff nurses, 1 Pharmacist,
1 Lab Technician and LHV) + MPW
+ ASHAs s
Services (IPHS +) - Screening of
NCDs and wellness room
PHC
SHC
SHC
SHCSHC
SHC
16. 16
CPHC
through
HWC
Continuum of
Care –
Telehealth
/Referral Expanded
Service
Delivery
Expanding
HR - MLHP &
Multiskilling
Medicines &
Expanding
Diagnostics -
point of care
& new
technologies
Community
Mobilisation
and Health
Promotion
Infrastructure
Financing/
Provider
Payment
Reforms
Robust IT
System
Partnership
for
Knowledge &
Implementati
on
17. CPHC - ESSENTIAL PACKAGE OF SERVICES
1. Care in Pregnancy and Child-birth.
2. Neonatal and Infant Health Care Services
3. Childhood and Adolescent Health Care Services.
4. Family Planning, Contraceptive Services and other Reproductive Health
Care Services
5. Management of Communicable Diseases: National Health Programmes
6. General Out-patient Care for Acute Simple Illnesses and Minor Ailments
7. Screening, Prevention, Control and Management of Non-communicable
Diseases
8. Care for Common Ophthalmic and ENT Problems
9. Basic Oral Health Care
10. Elderly and Palliative Health Care Services
11. Emergency Medical Services including Burns and Trauma
12. Screening and Basic Management of Mental Health Ailments
18. Village/UrbanWard
ASHA/MPW
• Population Enumeration
• Outreach Services
• Community Based Screening
• Risk Assessment
• Awareness Generation
• Follow up of confirmed cases
• Counselling: Lifestyle changes;
treatment compliance
MLHP/CHO
SHCPHC/UPHC
• First Level Care
• Screening
• Use of Diagnostics
• Drug Dispensation
• Record keeping
• Telehealth
• Referral to MO at PHC for
confirmation/complications
• Diagnosis /
• Prescription and Treatment
Plan
• Referral of complicated
cases
• Telehealth
• Real time monitoring
CHC/SDH/DH
• Advanced diagnostics
• Complication assessment
• Telehealth
• Tertiary linkage/PMRSSM
Community – Facility: Maintaining Continuum of Care
18
19. Mid Level Health Provider (MLHP)
• Selection process of candidates for MLHP to be
designed so as to attract competent and motivated
candidates- Preferential Local Selection
• MLHPs trained in a six month, IGNOU accredited
“Certificate Programme In Community Health” to build
competencies in public health and primary care-
theory, Skill and experiential learning
• Career progression pathways for MLHPs in public
health functions to be charted at least up to district level
– to synergize with Public Health Cadre
21. Training of PHC Team- Staff Nurses, Medical Officers
Training for Five days for screening and Management of
NCDs.
21 days for screening for Cancer-VIA for CA Cervix and
further management
Online Training through Massive Open Online Courses
(MOOC) and Extension for Community Health Outcomes
(ECHO)
Other Distance mode certificate programmes in areas such as-
NCD management/MCH Care/Elderly Care/Mental Health etc.
to be planned in long term.
Additional Incentives/ rewards can be introduced
Partnerships with AIIMS/Regional Cancer Centres/Knowledge
networks to act as training resource centres.
22. Medicines and diagnostics require early attention
Essential List of Medicines to be expanded and in place across all states
MLHP to be able to dispense medicines for chronic diseases on the
prescription of the Medical Officer
Uninterrupted Availability of medicines to ensure continuation of care (Eg:
HT/DM/ Epilepsy/COPD)
DVDMS (Drugs and Vaccine Distribution Management System)implemented
in 28 states and implementation in remaining states to be completed over a
period of six months - Expansion to the level of HWC- PHCs/UPHC and
HWC-SHC
Robust Implementation of Free drugs and Diagnostics schemes in all states to
eliminate OOPE(Out of Programme Clinical Experience.)
23. Robust IT System – to meet diverse needs of different stake holders
Patient centric –
• Unique Individual ID
• Individual health record
• Family health folder-SECC data/mapping PMRSSM
• Facilitates continuum of care through alerts
• Facilitates access to patient care information
Service Providers -
• Enables continuity of care across levels
• Generates workplans/serves as job aids
• Facilitates use of platforms like MOOC and ECHO
• Facilitates follow up and compliance to treatment
• Decision Support System for service providers at various levels
Programme Managers-
• Dashboard for monitoring at different levels
• Provide monitoring reports to assess performance for payments
Overarching system – integration of all existing IT systems Eg-
RCH portal/ NIKSHAY/ IDSP/ HMIS/ PMRSSPM
24. Infrastructure
1. Branding / Colour code
2. Citizen Charting –commitements made by the
organization regarding the standards being
delivered to the people.
3. Space for –
Examination room with adequate privacy and
Telehealth
Diagnostics and medicine dispensation
Wellness room
Waiting area
IEC
Labour room at delivery points
4. 3-4 Alternate prototype designs will be provided
5. Display boards –
Contact Details of Primary Care Team and
referral centres
Jurisdiction of Gram Panchayat/ Urban Local
body representatives
25. Ayushman Ambassdors
25
Age appropriate, skill-oriented, theme based, graded curriculum for the
teachers (primary, middle and high school)
2 teachers in every school as “Health and Wellness Ambassadors”, trained
to transact health promotion/disease prevention through interesting
activities for one hour every week
20 hour sessions delivered through weekly interactive classroom-based
activities
All Tuesday -Health and Wellness Day in the schools
Students will act as Health and Wellness Messengers in the society.
Regular reinforcement of messages/themes through IEC/BCC activities such as
interactive activities/posters/class room/Assembly discussion
26. Quality of Care
• Key principles -
Provision of Patient Centred Care
Enable Patient Amenities at HWC
Adhere to standard treatment guidelines and clinical
protocols for care provision
Achieve Indian Public Health Standards with regards
to HR, infrastructure, equipment, service delivery and
supplies
• National Quality Assurance Standards for HWCs will
be developed
• Patient satisfaction to be captured through IT systems
27. Task Forces
• Care for Common Ophthalmic and ENT Problems
• Basic Oral Health Care
• Elderly and Palliative Health Care Services
• Screening and Basic Management of Mental Health Ailments
• Emergency Medical Services including Burns and Trauma –
under process
Operational Guidelines/Training Manuals for Primary Health
Care Team –is being developed
27
28. Task Forces
• Review existing packages for care at community, HWC and secondary
levels
• Define specific interventions and organization of services at each level of
care
• Delineate referral pathways from primary to secondary care levels
• Review existing STGs(Standard Treatment Guidelines) for each disease
condition –recommended updation or new development
• Highlight key areas that require preventive and promotive action,
• Recommend areas for research to enable the delivery and effective
coverage of primary health care
• Identify institutions at state and national level to support states in enabling
effective integration, research and service delivery for Comprehensive
Primary Health Care
29. HWCs in Urban Areas
• One UPHC for every 50,000-60,000
• All existing Urban Primary Health Centers (roughly 4000) to be
strengthened as HWCs by March 2020
• Where dispensaries exist, they could be upgraded to serve as H&WC, based
on the HR available and geographical context
• Frontline workers- 4-5 ASHAs and 1 MPW(F) for 10,000 population -
trained to deliver preventive and promotive services through outreach,
including monitoring drug compliance for chronic diseases.
• MLHP would not be required, as MO MBBS is already approved for
UPHCs
30. Immediate Next Steps
Strengthen Programme Management (2 consultants in small states and 3-5
in big states as per requirement)
Establish technical support from Training institutions/ Research
Organizations / SHSRC(State Health System Resource Centre)/ Medical
College
Based on annual Targets of HWCs- commensurate selection/ enrolment in
IGNOU Certificate Programme in Community Health
Completion of training of ASHAs, MPWs, PHC Staff-Medical Officers and
Staff Nurses in NCD
Undertake gap analysis against the requirement of equipment/medicines/
consumable.
Roll out of IT Systems and Training of Providers in NCD App/MO Portal
31. Key Areas for Priority Action
Appoint Senior State Nodal Officer : Director/Additional Director/Joint
Director level officer
Periodic reviews by Principal Secretary at all levels
Road Map for converting all SHCs to HWCs by Dec,2022
Annual Plans for financial year 19-20, 20-21, 21-22 and 2022-23 (up to
December,2022)
Prioritizing Aspirational Districts/ NPCDCS( National Programme for
Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and
Stroke) Districts
Resources Mobilization from non –Health sources
Sources-Urban Local Bodies/ State Development Programmes/District Mineral
Funds/District Innovation Funds
32. Beneficiary Level
• Government provides health insurance cover of up
to Rs. 5,00,000 per family per year.
• More than 10.74 crore poor and vulnerable families
(approximately 50 crore beneficiaries) covered across
the country.
• All families listed in the SECC(Socioeconomic Caste
Census) database. No cap on family size and age of
members.
• Priority to girl child, women and senior citizens.
• Free treatment available at all public and empanelled
private hospitals in times of need.
32
35. Process Flow at Empanelled Hospital
35
Source :www.abnhpm.gov.in
36. • Covers secondary and tertiary care hospitalization.
• 1,350 medical packages covering surgery, medical
and day care treatments, cost of medicines and
diagnostics.
• All pre-existing diseases covered. Hospitals cannot
deny treatment.
• Cashless and paperless access to quality health care
services.
• Hospitals will not be allowed to charge any additional
money from beneficiaries for the treatment.
• Eligible beneficiaries can avail services across India,
offering benefit of national portability.
36
37. Health System
• Ensure improved access and affordability, of
quality secondary and tertiary care services
through a combination of public hospitals
• Significantly reduce out of pocket expenditure
for hospitalization.
• Mitigate financial risk arising out of
catastrophic health episodes and consequent
impoverishment for poor and vulnerable
families.
37
38. • Enhanced used of evidence based health care and
cost control for improved health outcomes.
• Strengthen public health care systems through
infusion of insurance revenues.
• Enable creation of new health infrastructure in
rural, remote and under-served areas.
• Increase health expenditure by Government as a
percentage of GDP.
• Enhanced patient satisfaction.
• Improved health outcomes.
• Improvement in population-level productivity and
efficiency
• Improved quality of life for the population 38
Ayushman Bharat encapsulates a progression towards promotive, preventive, curative, palliative and rehabilitative aspects of Universal Healthcare through access of Health and Wellness Centers (HWCs) at the primary level and provisioning of financial protection for accessing curative care at the secondary and tertiary levels through engagement with both public and private sector.
A 2015 survey by the NSSO(National Sample Survey Organisation) presented some alarming statistics on the extent to which medical emergencies batter the finances of poor families at Bharat. The survey showed that hospitalisation expenses for critical ailments had shot up by 300 per cent over a decade. With over 80 per cent of the households not covered by any health scheme, most of the cost was met out-of-pocket. An estimated 6 million families sink into poverty each year due to hospitalisation. Ayushman Bharat, by targeting the 40 per cent of India’s households at the lower rungs of the socio-economic ladder, tries to pre-empt this battering to family finances from sudden healthcare costs, by ensuring cashless treatment.
www.thehindubusinessline.com/opinion/columnsss
NHPS : National Health Protection Scheme
CPHS : Comphrenhensive Primary Health Care
Health and Wellness Centre:- The National Health Policy, 2017 has envisioned Health and Wellness Centres as the foundation of India’s health system. Under this 1.5 lakh centres will bring health care system closer to the homes of people. These centres will provide comprehensive health care, including for non-communicable diseases and maternal and child health services. These centres will also provide free essential drugs and diagnostic services. The Budget has allocated Rs.1200 crore for this flagship programme. Contribution of private sector through CSR and philanthropic institutions in adopting these centres is also envisaged.
The second flagship programme under Ayushman Bharat is National Health Protection Scheme, which will cover over 10 crore poor and vulnerable families (approximately 50 crore beneficiaries) providing coverage upto 5 lakh rupees per family per year for secondary and tertiary care hospitalization. This will be the world’s largest government funded health care programme. Adequate funds will be provided for smooth implementation of this programme.
Source: http://pib.nic.in
Source :www.abnhpm.gov.in
Source:www.abnhpm.gov.in
The Health and Wellness Centres will play a critical role in creating awareness about PM-JAY, screening for non-communicable diseases, follow-up of hospitalisation cases among others.
PM-JAY seeks to accelerate India’s progress towards achievement of Universal Health Coverage (UHC) and Sustainable Development Goal - 3 (SDG3).
HR and MLHP : Mid level Health Provider
Pradhan Mantri Swasthya Suraksha MISSION
MOOC
ECHO
PMRSSPM
HMIS : Health Management Information System
IEC :
BCC :
In order to assist the roll out of the 12 packages, Task Forces (7) have been constituted to develop operational guidelines for newer packages, training material, identification of training hubs and creation of online content for MOOC, The Task Forces have held several meetings and are in the process of drafting OGs and material.
In addition, a Task Force has been set up to explore payment reforms (addressed in a later slide)
To ensure that interventions are cost effective and enable addressing DALYs, another Task Force has been set up.
STG :
SHSRC :State Health System Resource Centre
Seventh Package NCD Care :
Officer-Assistant Mission Director/ Joint / Deputy Director with minimum 15 years of experience who can coordinate with SNOs of other programmes
Empanelled
Health insurance companies are well aware that private medical set-ups tend to charge more from patients with health insurance cover rather than those without it. This naturally translates to losses for insurance providers. In order to ensure profitability and avoid incurring unnecessary losses, health insurance providers tie up with certain hospitals, making them a part of their ‘network’.
Taking into consideration which hospital maximum number of policyholders go to in specific areas, insurance companies negotiate treatment and stay costs with these select network hospitals to prevent their expenses from spiraling.
These chosen network hospitals become a part of the broad hospital network that specific insurance companies are associated with. All other hospitals outside this mutual network are referred to as non-network hospitals.
MEDCO
pmam
Can reach out for information, assistance, complaints and grievances to a 24X7 helpline number - 14555