New Delhi: The Narendra Modi government has for the first time since the launch of Ayushman Bharat last year revised the list of medical packages offered under the flagship health insurance scheme.
Headed by NITI Aayog member Vinod K. Paul, an expert committee constituted to review the cost of 1,300 medical packages has increased the rates of 270 health packages. As many as 237 new packages have been added and 554 “discontinued”, which sources said have been accommodated under other packages.
The 237 new packages added to the list will cover various cancer treatments, advanced orthopaedic and heart surgeries. Those that have been “discontinued” are renal angioplasty, skull base surgery, incisional hernia repair, close fixation of hand bone, among several others.
The decision on whether to remove one of the “top-selling” treatments — cataract surgery — from the ambit of the scheme has been put on hold as of now. There was speculation that the government may remove cataract surgeries as it was difficult to check fraud in this category.
The government had earlier proposed to bring cataract treatment under National Blindness Prevention Programme (NBPP), a centrally-sponsored scheme that aims to reduce blindness in India. However, the NBPP had cited “huge burden of patients” for not including cataract under its scheme.
“NITI Aayog is still in discussions. We sent the proposal (to NBPP) to include PM-JAY beneficiaries into their fold, but it wasn’t accepted. They are citing huge burden of patients. The discussions are still going on,” said a senior official from the Ministry of Health and Family Welfare, who did not wish to be named.
Ayushman Bharat or Pradhan Mantri Jan Arogya Yojana (PM-JAY), which was launched last year, is a cashless scheme that provides an annual health cover of Rs 5 lakh per family to more than 10.74 crore poor families — about 50 crore people.
Within a year, around 46.5 lakh patients have been treated under the scheme, costing the government Rs 7,490 crore.
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Govt now expects more private players to join scheme
The government, in a press release issued late Thursday, said 554 packages will be discontinued “without compromising the range of treatment covered under PM-JAY”. Overall, the statement said, a “conscious attempt has been made to keep the price of abuse prone packages at the minimum level to minimise incentives for abuse”.
Last year, more than 2,000 super-specialty hospitals, including Sir Ganga Ram Hospital, Medanta, Fortis Healthcare, Apollo Hospitals, Narayana Health and BLK Super Speciality Hospital, refused to be a part of the scheme because the government reimbursement rates are as low as 11-15 per cent of the actual costs of surgeries or procedures.
Now, with revised rates and packages, the government expects to increase participation of private players.
“We are confident that with the revision in the health benefit packages, many new private hospitals will get empanelled with the scheme,” Health Minister Dr Harsh Vardhan said in the statement.
According to government data, 53 per cent of the treatments under the scheme are provided in private hospitals.
Packages added and discontinued
The government did not release the list of revised packages, but ThePrint has accessed a partial list.
The list includes expensive electrophysiological study of the heart in the package. The test is performed to assess the heart’s electrical system or activity. Heart catheterisation — a procedure to insert thin device in artery or veins to diagnose heart related ailments — is also included in the package now.
For cancer treatment, the list has added procedure called “hemiglossectomy” under which the tumor located on the tongue is removed by cutting some portion of the organ. The list now also includes, Neuroblastoma, the most common abdominal tumour diagnosed in children.
“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,” said Dr Indu Bhushan, CEO, Ayushman Bharat.
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