Explainer on Ayushman Bharat Health Accounts (ABHA)

Ayushman Bharat Health Accounts (ABHA) is an integral component of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), which is India’s flagship national health protection scheme. ABHA is designed to facilitate cashless transactions and manage financial aspects related to healthcare services under the Ayushman Bharat scheme. Here’s an explainer on Ayushman Bharat Health Accounts:

1. Introduction:

Ayushman Bharat Health Account (ABHA) is an account/ number used to link all the health records of a person. ABHA intends to create a digital health ecosystem & aims to promote digitization of healthcare. Any individual can enroll in Ayushman Bharat Digital Mission (ABDM) to generate a Health ID or ABHA, free of cost.

2. Objective:

Ayushman Bharat Health Accounts aim to provide a seamless and efficient financial framework for implementing the Ayushman Bharat scheme. It ensures transparency, accountability, and accessibility of funds allocated for healthcare services.

3. Features:

Cashless Transactions: ABHA enables cashless transactions for eligible beneficiaries seeking treatment at empanelled healthcare facilities. This reduces the financial burden on beneficiaries during medical emergencies.

Electronic Health Records (EHR): ABHA integrates electronic health records, facilitating the storage and retrieval of patient information. This helps in maintaining medical histories and streamlining healthcare delivery.

Portability: The accounts are designed to be portable across various healthcare providers empanelled under the Ayushman Bharat scheme, allowing beneficiaries to access services seamlessly, regardless of their location.

Real-time Monitoring: ABHA incorporates real-time monitoring mechanisms to track the utilization of funds and ensure that resources are allocated efficiently. This helps in preventing misuse and optimizing the distribution of healthcare resources.

Transparency and Accountability: By promoting digital transactions and maintaining electronic records, ABHA enhances transparency and accountability in the healthcare system. This reduces the scope for corruption and ensures that funds are utilized for their intended purpose.

4. Components:

Beneficiary Identification: ABHA involves the identification and registration of eligible beneficiaries under the Ayushman Bharat scheme. Each beneficiary is assigned a unique health identification number (UHID) to facilitate tracking and management.

Funds Management: ABHA manages the allocation and disbursement of funds for healthcare services availed by beneficiaries. It ensures that funds are transferred to healthcare providers promptly and securely.

Claim Settlement: ABHA processes and settles claims submitted by healthcare providers for services rendered to beneficiaries. This involves verifying the authenticity of claims and disbursing payments accordingly.

Audit and Oversight: ABHA incorporates audit and oversight mechanisms to monitor the utilization of funds and detect any irregularities or discrepancies. This helps in ensuring compliance with regulations and maintaining the integrity of the healthcare system.

5. Benefits:

Financial Protection: ABHA provides financial protection to vulnerable sections of society by covering the costs of healthcare services under the Ayushman Bharat scheme. This reduces out-of-pocket expenses for beneficiaries and enhances access to quality healthcare.

Efficient Healthcare Delivery: By facilitating cashless transactions and electronic health records, AB-HA promotes efficiency in healthcare delivery. It minimizes administrative hassles and delays, allowing healthcare providers to focus on patient care.

Data-driven Decision Making: ABHA generates valuable data insights that can be used for evidence-based decision-making and policy formulation. This helps in addressing healthcare challenges effectively and improving the overall quality of care.

An ABHA user has the following identifiers and user app to access the benefits under ABDM:

ABHA number: Unique Health Identifier as a random 14-digit number: A unique identity of a person, across different health care providers across the country.

ABHA address: ABHA Address is an easy-to-remember username that enables a user to access their health records digitally and share their records with various healthcare providers. An ABHA address may look like ‘name@abdm’. It may also be required to sign up on ABHA mobile Application.

ABHA mobile application: The ABHA mobile application offers a convenient solution for individuals to effortlessly access and share their health records digitally. It empowers patients to seamlessly receive digital lab reports, prescriptions, and diagnoses from various healthcare providers, including doctors, labs, hospitals, and wellness centers. This approach ensures secure and consent-driven sharing of health data.

6. Benefits for CGHS Employees:

• ABHA shall integrate CGHS beneficiaries in the digital health ecosystem for the country.
• A CGHS beneficiary shall be able to view the generated and linked health records in any of his/her preferred Personal Health Record (PHR) app downloaded on the mobile device.
• A CGHS beneficiary shall be able to carry forward his/her health records from one hospital/Healthcare provider to another in a digitally secured way.
• e.g: Take the case of health records generated in a particular hospital for a particular patient by a particular doctor. The said patient may end up going to some other healthcare provider for subsequent treatment. It is desirable that his/her health records which are stored in the previous hospital are also available to the subsequent healthcare provider for comprehensive healthcare provision. This is made possible by unique entity (Health ID) which identifies the patient’s health records across all the healthcare providers. With the patient’s consent, these records are made available to the current healthcare provider.
• In future, a CGHS beneficiary shall directly be able take OPD appointment of a Doctor just by scanning a QR code through his/her mobile device present in front of the Doctor’s room/ Registration Desk in the Wellness Centre.

7. Steps to Create/Link ABHA number with the CGHS beneficiary ID:

Pre-Requisites:

Ensure that the mobile number is linked with the CGHS card.

Ensure that the Aadhar card is linked with the aforementioned phone number.

Step 01: Open CGHS website www.cghs.nic.in and Log-in via Beneficiary Log-in

Step 02: Move to the ‘Update’ Tab and Click  ‘Create/Link ABHA ID’

Step 03: In front of the “Beneficiary Name” An option shall be visible ‘Create/Link ABHA   ID’. Click on that option.

Step 04: In case a beneficiary does not have an ABHA number, click on ‘I don’t have an ABHA number’

Enter Aadhar number

Accept the Consent Message

Click on Get Aadhar OTP

Enter Aadhar OTP

Click on ‘Verify OTP’

If the data is successfully matched, the ABHA number is created and successfully linked with the CGHS beneficiary ID.

*In case a beneficiary already has an ABHA number, In step 04, instead of clicking on ‘I don’t have an ABHA number’, enter the 14 digit ABHA number and proceed by verifying OTP.

For more information, visit: https://abha.abdm.gov.in/abha/v3/

A detailed video on the step-by-step procedure to Create/Link ABHA number is also available on the ‘@cghsindia’ YouTube channel at the following link:

https://www.youtube.com/watch?v=ZVytyQv2ngo&t=90s

8. Future Directions:

Expansion and Enhancement: ABHA is expected to evolve and expand over time, incorporating new features and functionalities to meet the evolving needs of the healthcare sector.

Integration with other Schemes: There is potential to integrate ABHA with other healthcare schemes and initiatives to create a unified and comprehensive healthcare ecosystem.

Research and Innovation: Continued research and innovation in healthcare financing and delivery models can further strengthen the effectiveness and impact of ABHA.

In conclusion, Ayushman Bharat Health Accounts play a pivotal role in facilitating cashless transactions, managing funds, and enhancing transparency in the implementation of the Ayushman Bharat scheme. By leveraging technology and data-driven approaches, ABHA aims to improve access to quality healthcare and alleviate the financial burden on vulnerable sections of society.

MYTH VERSUS REALITY:

Myth 1: Does getting ABHA Number mean enrolment in Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)?

Reality: No, ABHA is just an account/ number used to link all the health records of a person.

Myth 2: What is not entailed under Ayushman Bharat Health Account?

Reality: Ayushman Bharat Health Account does not mean the eligibility of a person for the particular scheme including AB-PMJAY. Ayushman Bharat Health Account is not a replacement of current CGHS services or a replacement of current CGHS HMIS. Rather it is an addition/add-on to the current services offered by CGHS.

Myth 3: I am afraid that by linking all my health records to my ABHA other doctors may be in a position to see all my medical History which I don’t want to show. How can this be prevented?

Reality: The consent provided digitally need not be for all the health records linked to ABHA at a time. It can be provided for sharing only selected health records as per the choice of the patient. Therefore, by linking all your health records to your ABHA you will not end up sharing all your health records when providing consent. The consent is granular “which can be provided separately for each of the health records as per the wish of the patient”. However, it is recommended that you provide consent to share all health records with your doctor so that he can make correct clinical decisions.

Myth 4: Is it possible for the government or any other entity to do surveillance of the health status of an individual through ABDM?

Reality: No. The health records are created and stored at the place of their creation by respective healthcare providers (which is the case even now). ABDM is creating interoperable platforms for linking these data repositories/fiduciaries. This is known as federated architecture. This means that the health records will continue to be processed and stored at the same place where they are created, which has been happening prior to ABDM as well. The government will not have access to such data. No additional means of accessing such data is being created or envisaged in the current ecosystem.

Myth 5 : Will my Digital health Records be shared with other doctors or health facility without my permission?

Reality: No. Only you can share your own records with other doctors/hospitals using different digital health systems after giving your consent.

Myth 6: How will my data be used by the government?

Reality: Protocols for anonymization and aggregation of data and use of such data will be defined after extensive stakeholder consultations. After that, anonymous records can be used by the government to make policies and other relevant interventions in the interests of the public. Till this is done, health records will not be used by the government.

Myth 7: Are my health records safe and Secure on ABDM System?

Reality: ABDM does not store any medical records. These are always created and stored by healthcare providers as per their retention policies and this will continue. ABDM only facilitates secure data exchange between the intended stakeholders on ABDM network after the patient’s consent. Hence, through ABDM compliant applications, patients will also be able to choose which health records they want to link with their Health IDs, securely store their digital health records on their devices, securely access their records online, and securely share their health records with healthcare providers after the patient’s consent. Only the data collected for registries such as Health ID registry, Healthcare Professional Registry and Healthcare Facility Registry is stored centrally. It is necessary for these datasets to be stored centrally because they are essential to provide interoperability, trust, and identification and single source of truth across different digital health systems. This data is stored and processed in secure and safe manner.

Myth 8: Can ABHA be used outside the government hospital/CGHS?

Reality: Yes, ABHA can be used outside the government hospital/ program. However, it is up to the private players to decide whether they want to use it or not. For example, a private hospital may decide to use ABHA for creation and linking of health record. If the patient is not willing to use ABHA, the hospital/ program may provide an alternate number which they are using as part of their existing system.