ACCESS Health announces new publication in collaboration with WHO India Country Office and National Health Authority

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ACCESS Health International proudly reveals the launch of two significant publications in collaboration with the World Health Organization (WHO) India Country Office and the National Health Authority (NHA), Government of India. The team at ACCESS Health, comprising Maulik Chokshi, Arun B Nair, and Tushar Mokashi co-authored the publications along with colleagues from WHO India office and NHA. Titled, “Determinants of Private Sector Engagement and Empanelment under PMJAY”, the publications are in the forms of a report and a policy brief.

The study investigates the intricate dynamics of private sector engagement and empanelment within the Pradhan Mantri Jan Arogya Yojana (PMJAY), aiming to understand motivations, constraints, and system-wide factors influencing scheme enrolment. It also seeks feedback from empanelled hospitals to enhance day-to-day engagement.

Comprehensively exploring motivations, constraints, and perspectives at the policy and process level, the report sheds light on the private sector’s engagement with the PMJAY scheme. It identifies constraints faced by ‘inactive’ hospitals, crucial for optimizing scheme effectiveness. Additionally, the research addresses broader health system factors impacting scheme enrolment, including regulations and legal frameworks. Empanelled hospitals’ primary concerns and day-to-day engagement challenges are also scrutinized, offering actionable insights for refining stakeholder interactions.

 The study adopted a qualitative design with quantitative inputs, collecting primary and secondary information from NHA, SHAs, Third Party Administrators (TPAs), private hospitals, and private hospital association representatives.

 The study offers insightful recommendations to address structural and operational issues and enhance the enabling institutional architecture. Key recommendations include revising benefit packages, negotiating flexible contracts, implementing grade-based package rates, and strengthening institutional mechanisms for effective collaboration. The publications not only contributes to a deeper understanding of private sector engagement under PMJAY but also provides actionable recommendations for refining and optimizing the scheme.