A compendium on govt schemes and national digital health mission (Pictures

and miscellaneous graphs included for PPT) - Uday Singh Cheema

NDHM Patient Experience Pathway

The National Digital Health Mission is a holistic, voluntary healthcare programme that will
reduce the existing gap between various stakeholders such as doctors, hospitals, and other
healthcare providers, pharmacies, insurance companies, and citizens by bringing them
together and connecting them in integrated digital health infrastructure.
The NDHM comprises five key components that include- Health ID, Patient Health Record,
Electronic Medical Record, Digi Doctor Platform, and Health Facility Registry. At a later
stage, it will also include e-pharmacy and telemedicine services, regulatory guidelines for
which are being framed.
Health ID (HID)
As per NHA, every patient who wishes to have their health records available digitally must
start by creating a unique Health ID. The Health ID will be a repository of all health-related
information of an individual. Each Health ID will be linked to a health data consent manager,
such as NDHM, which will be used to seek the patient’s consent and allow for a seamless
flow of health information from the Personal Health Records module.
The ID is to be created by using a person’s basic details and mobile number or Aadhaar
number. This will be used for the purposes of uniquely identifying persons, authenticating
them, and threading their health records (only with the informed consent of the patient)
across multiple systems and stakeholders. However, the ID’s which will be applicable across
states, hospitals, diagnostic laboratories, and pharmacies won’t be mandatory. Although, the
authorities hope that the feature will attract more users to it since it allows a person online
access to all their health records right from birth.
Apart from this, the government has also assured that the data provided will be protected and
health records will only be shared after authorisation by an individual.
Patient Health Record (PHR)
A PHR is an electronic record of health-related information on an individual that can be
drawn from multiple sources while being managed, shared, and controlled by the individual.
The functions that are supported by a Personal Health Record-System (PHR) are those that
enable an individual to manage information about his or her healthcare. The principal users of
these functions are expected to be individuals referenced as account holders; the patient or
subject of care and healthcare providers will have access to certain functions to view, update
or make corrections to their Personal Health Record.
Electronic Medical Record (EMR)
An EMR is best understood as a digital version of a patient’s chart. It contains the patient’s
medical and treatment history from a SINGLE health facility. EMRs allows physicians to:
 Track data over time
 Easily identify which patients are due for preventive screenings or checkups
 Check how their patients are doing on certain parameters—such as blood pressure
readings or vaccinations
 Monitor and improve the overall quality of care within the practice
The general approach is to create a web application that operates on a set of standards like the
data construct, interoperability standards, and standard medical terminologies. The EMR
envisages to be a comprehensive view of the patient’s Health Information at a given facility.
Digi-Doctor Platform
A single, updated repository of all doctors enrolled in the nation with all the relevant details
of the doctors such as name, qualifications, name of the institutions of qualifications,
specializations, registration number with State medical councils, years of experience, etc. The
doctor’s directory would be an essential building block of the digital health infrastructure of
the country. The directory will be designed to be kept up-to-date as doctors gain skills via
fellowships and map them to the facilities they are associated with.
Health Facility Registry
The Health Facility Registry is a single repository of all the health facilities in the country.
The registry would be centrally maintained and would also facilitate the exchange of
standardized data of both public and private health facilities in the country. The registry will
allow health facilities to access their profile and update it periodically with specialties and
services they offer, as well as provide a secure common platform to the facilities to maintain
all essential information. Facilities will be able to e-sign documents such as patient records,
apply for empanelment, have easier claims processing, as well as improve access to all
healthcare ecosystem elements.

Pradhan Mantri Garib Kalyan Package: Insurance Scheme for Health Workers
Fighting COVID-19

Due to COVID-19 pandemic, to combat the economic impact on the poor and needy, PM
Narendra Modi led government on 26 March, 2020 announced ₹1.7 lakh crore Pradhan
Mantri Garib Kalyan Yojana (PMGKY).

 Amid COVID-19 lockdown, the Government of India has announced Rs 20 lakh crore
relief package under 'Atma Nirbhar Bharat Abhiyan' to make a self-reliant nation. 
For all establishments, EPF relief with Rs 2,500 crore liquidity support.
 Pradhan Mantri Garib Kalyan Yojana (PMGKY) was launched by the Government of
India in 2016.  Income taxpayers are given an opportunity to forgo prosecution by
declaring their illegal money.
 The Scheme provides an opportunity to persons having undisclosed income in the
form of cash or deposit in an account maintained with a specified entity (which
includes banks, post office, etc.) to declare such income and pay tax, surcharge, and
penalty totaling in all to 49.9 percent. of such declared income. Besides, the Scheme
 provides that a mandatory deposit of not less than 25% of such income shall be made
in the Pradhan Mantri Garib Kalyan Deposit Scheme, 2016 (hereinafter ‘the PMGKY
Deposit Scheme’) which has separately been notified by the Department of Economic
Affairs
 As per recent corona relief, ‘Garib Kalyan Package’ announced by the FM Nirmala
Sitharaman:

I. Provision to open the bank branches.

II. For Building and Construction workers: The central government has given orders
to the state government for building and construction workers to use funds of ₹31,000
crores to provide relief to them.
III. PMGKY will include the transfers of cash to the poor and migrants.
IV. Under the PMGKY (food scheme) around 80 crore, people benefitted. Additionally,
everyone will get 5 kg of wheat/rice for free of whatever they are already getting. The
government will also provide 1 kg of a pulse of their choice to each household till
November end. 
V. Medical insurance cover of ₹50 lakh per healthcare worker.

Pradhan Mantri Garib Kalyan Package FAQ’s

Question 1: What does this Scheme cover?

This accident insurance scheme covers;

 Loss of life due to COVID19, and

 Accidental death on account of COVID-19 related duty.

Question 2: What is the definition of Accident?
An accident is sudden, unforeseen and involuntary event caused by external, visible and

violent means.
Question 3: Who all are covered under the scheme?

 Public healthcare providers including community health workers, who may

have to be in direct contact and care of COVID-19 patients and who may be at
risk of being impacted by this.

 Private hospital staff and retired /volunteer /local urban bodies/ contracted
/daily wage /ad-hoc/outsourced staff requisitioned by States/ Central hospitals/
autonomous hospitals of Central/ States/UTs, AIIMS and INIs/ hospital of
Central Ministries can also be drafted for COVID 19 related responsibilities.

Question 4: Who can be a volunteer under this scheme?

Volunteers are those who are drafted by the Government Official authorized by
Central/State/ UT Government for care and may have come in direct contact of the
COVID-19 patient

Question 5: Who are ‘Private persons’ under this scheme?

• Private persons are those who are engaged by both public & private health care
institutions/organization through an agency and were deployed /drafted for care and may
have come in direct contact of the COVID-19 patient (with the proof that the service of the
agencies were engaged by the institution/organization).

Question 6: When does insurance coverage policy begins and ends?

• The duration of the policy is for a period of 90 days, starting from March 30, 2020.

Question 7: Is there any age-limit for health workers under this scheme? • There’s no age
limit for this scheme.

Question 8: Is individual enrolment required?

• Individual enrolment is not required.
Question 9: Whether an individual is required to pay any premium to be eligible under the
scheme?
• The entire amount of premium for this scheme is being borne by the Ministry of Health

and Family Welfare, Government of India.

Question 10: What is the benefit available to the insured persons?

• INR 50 LAKHS will be paid to the claimant of the insured person.

Question 11: Is COVID-19 laboratory test mandatory for claiming the benefit?

• Laboratory report certifying positive medical test is required for loss of life on account of
COVID-19. However, it is not required in case of Accidental loss of life on account of
COVID-19 related duty.

IMPACT ON HEALTH INSURANCE INDUSTRY

While the demand for health insurance is expected to increase considerably, underwriting
thresholds may also go up and thus the negative movement may not be offset.
It may be noted that India has traditionally been an underinsured country, with private health
insurance schemes covering only 18% of the population in urban areas and a little over 14%
in rural areas. Although the gap has been bridged somewhat by Ayushman Bharat, which has
attempted to insure the poor and vulnerable, most of India continues to be underinsured when
it comes to health.
Due to the widespread COVID-19 pandemic, health insurance companies are facing various
challenges and are foreseeing an impact in the following areas:
1. Claim payout and liquidity
In order to dispel any general misconceptions about the applicability of health insurance
policies to cases of COVID-19, the IRDAI has instructed insurers to accept COVID-19
related claims under active health insurance policies. Since the risk of COVID-19 is not
currently priced under active products, these claims may cause an additional burden on the
books of insurers if treated outside government hospitals.
Apart from various other things, a nationwide pandemic can result in a significant increase in
claims for health insurance companies beyond just COVID-19. Some studies have shown that
COVID-19 affects those with co-morbidities such as diabetes, renal and other chronic
diseases adversely, and hence prolonging of such co-morbidities can result in a longer trail of
non-Covid-19 chronic claims for an extended period beyond COVID-19, says the report.
Moreover, the Ayushman Bharat scheme may see a greater number of claims compared to
private health insurance companies due to widespread coverage. This scheme may not have
factored in the cost of setting up isolation wards. Given that isolation of hospitalised patients
is crucial to prevent further community spread, this cost will create an additional burden
which has to be borne by the government. Many insurers are running the scheme with a PPP
arrangement with the government and they will have to recalibrate their financials.
Also, in view of the country-wide business disruption owing to the pandemic, the IRDAI has
advised insurance companies to extend the grace or delay period by 30 days in case of policy
lapse or renewal. This might pose some immediate liquidity challenges for insurance
companies.
2. Product development
In the wake of the pandemic, there has been greater concern and awareness about health, and
enquiries about health insurance policies have increased by 30–40%. The pandemic also
provides an opportunity for insurance companies to innovate and serve the evolving needs of
a more informed population. Several insurance companies have launched COVID-19
insurance products in March 2020. Other companies may follow suit and introduce such
products. These products tend to be short term and carry fixed benefits, covering a fixed
amount in excess of the hospitalisation schemes. The IRDA Sandbox has been useful at this
time as many companies had filed and obtained approvals for risk cover in special situations.
A few product considerations for health insurance companies are discussed below:
a) Since details around COVID-19 treatment and prognosis are still emerging, insurance
companies do not have data related to patient profiles, morbidity rates, cost of treatment, etc.
This data is required to underwrite the risk and determine the premium for products
specifically targeting this disease. Companiesare consequently at risk of under or overpricing
their products.
b) Based on clinical research and in conjunction with the healthcare and pharma industries,
insurance companies should calculate the possibility of a long trail of chronic disease
escalation which may require health insurers to reprice their existing hospitalisation products.
As of now, insufficient data may hinder such research but collaboration between insurers and
their actuaries and healthcare professionals and institutions can create models which had not
been attempted until now.
c) There is a clear opportunity for insurance companies to partner with their corporate
customers for employee benefits to be fortified with healthcare activities in order to increase
the health quotient as well as improve the possibility of weathering the COVID-19 situation
better.
As a result, the value of policies will be increased, and claims will tend to go down with an
increased level of awareness of the situation as well as chronic diseases and co-morbidities.
Many corporate customers of employee health insurance are investing separately in such
activities. Insurance companies can use this opportunity to increase client stickiness as well
as improve their portfolio and retention ratios.
3. Reserves requirement
Due to the pandemic, the government has taken actions towards reducing bond interest and
repo rates, which will lead to challenges for insurers in terms maintaining higher reserves
(higher for a life insurer compared to a health insurer), liquidity risk, credit risk, etc. In view
of these challenges, the regulator may have to provide some
temporary relaxation on the reserving requirement for insurers who were very close to the
margin of solvency.
Here are a few considerations related to the fiscal status of health insurance companies:
a) If COVID-19 has an impact on the profitability of insurance companies due to an increase
in claims and policy liabilities, etc., resulting in a lower tax liability, then that could affect
their ability to declare dividends to shareholders. Where insurance companies choose to claim
a deduction for dividends received under the proposed section 80M of the Income-tax Act,
1961, their inability to in turn declare dividends to their shareholders could constrain the
quantum of deduction that the insurance companies may be able to claim in their income-tax
returns. This could result in higher tax leakages for insurance companies
b) Since the level of regulations for both policyholder protection as well as solvency and
governance of insurance companies is very stringent, no governance failure or structural
difficulties are anticipated in the industry as yet.
c) The profits of the health insurance industry in the long term are dependent on portfolio
profitability. This can be impacted in both ways.
d) The collapsing bond rates would have a cascading effect on the business of insurers and
their balance sheets. A decrease in their value will result in a realised loss as insurers may end
up selling these investments to manage increased claim liabilities. For investments that
companies continue to hold, they may still have to record a provisional loss for a decrease in
the value of the assets, the PwC India report says.