New Delhi: Only a few insurance packages under Ayushman Bharat cover supportive care for terminally ill patients, an analysis by the government-run National Health Authority has revealed.
The analysis by NHA, which is the implementing agency of Ayushman Bharat — the Modi government’s health insurance scheme — noted that only eight of the 152 oncology insurance packages cover palliative care.
Palliative care refers to specialised care for people, of any age, suffering from life threatening, chronic, debilitating illnesses.
According to the World Health Organization, “Each year, an estimated 40 million people are in need of palliative care where 78% of people live in low- and middle-income countries.”
However, NHA’s working paper, titled ‘Palliative Care Under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY)’, highlighted that low- and middle-income countries have still not been able to make mainstream palliative care accessible across various levels of health care.
“Currently the palliative packages are related to few only in the oncology specialty,” the analysis, accessed by ThePrint, read.
It added: “Supportive care for terminally ill cancer patients for pain and other symptom relief related packages are not available.”
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Only 31% claims made for palliative care under Ayushman Bharat
In order to tackle this shortage, the NHA has suggested introducing “separate specialty for palliative care for effective designing of packages, implementation and monitoring their utilization”.
The paper also highlighted that under the Ayushman Bharat scheme the claims made under the palliative care category were also quite low, making up only 31 per cent of the total claims made under oncology packages. This implies that most of these terminally ill diseases were diagnosed later.
According to the government’s analysis, palliative claims accounted for 31 per cent (3.16 lakhs cases) of total oncology volume (Rs 10.1 lakhs) while amounting to only 16 per cent (Rs 27.2 Crore) of total oncology claim value (Rs 170 crore).
“Hence it is suggested that screening programs under the Non Communicable Diseases (NCDs) need to be strengthened,” the paper noted.
Furthermore, the NHA suggests that more hospitals focused on providing palliative care should be empanelled in the insurance scheme.
“As there are limited hospitals/centers providing palliative care currently in AB PMJAY network, efforts should be made to empanel more hospitals providing oncology services and standalone palliative care centers…” the report stated.
The Ayushman Bharat Pradhan Mantri Jan Aarogya Yojana (AB PM-JAY) is the largest government-funded health insurance in the world that provides a cover of Rs 5 lakh per family per annum, for a 10.76 crore population, for secondary and tertiary care hospitalisation.
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Ayushman Bharat can play bigger role in palliative care
According to the NHA, the insurance packages should take care of follow-ups and post-discharge medications to reduce out of pocket expenditure (OOPE) and for better outcomes along with primary packages.
“They must be extended to pain management, geriatric, mental health, pediatric, cancer, trauma, etc, preferably cross specialty for in-patient management. This could be initiated with support from professional associations in palliative medicine…” noted the NHA analysis.
It also suggested that the linkages should be established with the other arms of Ayushman Bharat, such as the health and wellness centres, for decentralised referral and follow-up services.
“Palliative Care Centers in hospitals should ensure post-discharge care and follow-ups and for better patient outcomes,” it said.
According to the analysis, one of the few good healthcare practices available within India are the palliative care models in Kerala, Maharashtra and Karnataka.
What is palliative care?
According to the WHO, palliative care improves the quality of life of patients and that of their families who are facing challenges associated with life-threatening illness, whether physical, psychological, social or spiritual. The quality of life of caregivers improves as well.
It offers a support system to help patients to live as actively as possible until death.
The global health agency also noted that early delivery of palliative care reduces unnecessary hospital admissions and the use of health services.
The NHA, in its analysis, has also recognised this fact: “Mainstreaming palliative care policies into the health system can result in reduced out of pocket expenses, better outcomes and improvement in the quality of life for the people suffering from chronic illnesses.”
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