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Government Commissions Study on Package Rates Under Modicare, Open to Revise Rates

The central government has commissioned a costing study on 1350 treatment packages under Ayushman Bharat – National Health Protection Mission — and said it is open to review the package rates based on the study. Policy think tank Niti Aayog and Indian Council for Medical Research (ICMR) are tasked to do undertake a detailed study that aims to examine the cost of each procedure and arrive at a suitable package rate. “Right now cost studies have not been done in India for most of the treatments. We also don’t have standard treatment protocols,” Indu Bhushan, Chief Executive Officer of Ayushman Bharat told. “So we will work on those and if we believe that rates need to be revised we will revise them.” The study is expected to take around three years for completion. Ayushman Bharat, also dubbed Modicare aims to provide ₹5 lakh health coverage to 10 crore poor families, covering 40 percent of India’s population. Though not officially decided, the Prime Minister’s pet scheme is widely expected to be launched on August 15.

According to Ayushman Bharat so far close to 3000 hospitals have been empaneled into the scheme. Twenty six states have enrolled to the scheme with West Bengal being the latest one to be on boarded after long drawn negotiations. Moneycontrol had first reported that the Mamata Banerjee-led state will sign an MoU with the Center on July 20. Two days later the West Bengal inked the pact for implementing the health insurance scheme in the state. Large private hospital chains have kept away from the scheme citing the proposed reimbursement package rates as unscientific, arbitrary and insufficient. Over 70 percent of healthcare in India is provided by private hospitals, making the participation of these hospitals critical to success of Ayushman Bharat. With launch date nearing government wants to make sure that large private hospital sign-up with the scheme. Bhushan asked private hospitals to consider large volumes that Ayushman Bharat generates and said he does not see any reason for private hospitals from sitting out of the path-breaking government initiative.

“This scheme is opening up (a market) of around 500 million beneficiaries. We are talking about large volumes. We haven’t had such scheme so far that provides this kind of volumes,” Bhushan said. “We want to make sure that rates are high enough so that we can attract the private sector, but at the same time they should not be so high that they make the scheme unsustainable,” he added. Bhushan said the empanelment process is still underway, and expects others hospitals to join. Though the prices were set at the national level, Bhushan said, the hospitals should not be worried as states were given the flexibility to states to increase or decrease prices, and some states have done that already. “The Cesarean section has been put at a package rate of ₹9000, Chhattisgarh has changed it to ₹18,000. States have flexibility to change that based on their requirement,” Bhushan said. There are also a few inbuilt incentives, over and above the package rates announced by the government to improve quality of treatment and expand healthcare infrastructure in backward districts. For hospitals with entry-level National Accreditation Board for Hospitals & Healthcare Providers (NABH) accreditation, the government provides 10 percent commission above the package rate and 15 percent for fully-accredited hospitals. – Money Control