Modicare Overhaul Sees 554 Packages Nixed, 237 Added

NEW DELHI: In a major overhaul of the Ayushman Bharat health insurance scheme on its first anniversary, the National Health Authority has discontinued 554 packages, added 237 new ones, increased the rate of 270 packages, while also bringing down prices for 57.

The discontinued packages include renal angioplasty with single stent (medicated) and eversion of hydrocele sac — unilateral. The list of procedures, which will now be part of the scheme, include right/left heart catheterisation and DJ stent removal. Packages have also been redesigned to provide better care to cancer patients.

TOI was the first to report that government is planning an overhaul of the scheme on September 18. The authority-responsible for implementation of the government’s health insurance scheme- said it has made a “conscious attempt ” to keep the price of “abuse prone packages at the minimum level to minimise incentives for abuse”.

“We are confident that with the revision in the Health Benefit Packages of Ayushman Bharat PM-JAY, many new private hospitals will get empanelled with the scheme. This will help improve the access to good quality healthcare, and lakhs of vulnerable families will receive free treatment, health minister Harsh Vardhan said.

The revised oncology packages will revamp cancer care for the beneficiaries and are aligned to reflect the current best practices in the country. Vardhan explained “These revised rates are expected to further augment cancer care in the country, along with drastic reduction in the catastrophic expenses associated with it. Oncology packages have been split, to include multiple regimens of surgical and medical oncology, complemented by radiotherapy regimens.”

The government was under pressure from hospitals to revise package prices as healthcare providers contended the prices fixed for high-end procedures were mostly unviable. This had also restricted many big chain tertiary hospitals from signing up for the scheme.

Several innovative concepts were used by NHA while revising the packages such as cross speciality packages, stratified packages and add-on packages which will enhance the ease of selecting the right package for the empanelled hospital.

Dr. Indu Bhushan, CEO NHA said “In the spirit of cooperative federalism, before finalising the changes, feedback was also taken from the states and Union Territories. Their feedback was examined by the review committee”. He added “States/UTs which are using insurance model or a combination of Trust and insurance model shall have autonomy to either continue using existing package master till their current contract period ends or shift to the new version after making suitable amendments in their contract”.

NHA said that in preparation for the future, it is planning to configure the cost of implants, high-end consumables in its IT system separately at the back end. This will be useful whenever there is a movement in the price of these significant components of a package cost.

Currently, the scheme has 1,393 treatment packages out of which 1,083 are surgical, 309 medical and one unspecified package.

The agency said it followed a vigorous and scientific procedure along with the Department of Health Research (DHR), Indian Council of Medical Research (ICMR) and Tata Memorial Hospital, which helped remove the inconsistencies in the nomenclature and pricing for their respective specialities.

The specialist committees examined the relevant sections of the scheme and made suggestions, the review committee examined the suggestions made by the specialist committees and moderated them, and finally the recommendations of the review committee were put up to the governing Board for approval – which took the final decision. – TOI

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