TLI Staff
New Delhi: A year into Modicare, the National Health Authority (NHA) has increased the rate of 270 health benefit packages (HBP) including cancer care to provide the best available treatment to crores of vulnerable families across a network of government and private hospitals.
Benefit package includes secondary and tertiary levels of identified surgical, medical and day care procedures. It also includes most of the lifesaving and emergency procedures. The package includes the cost of diagnostics up-to 3 days before hospitalization, and medicines up to 15 days post hospitalization.
Based on the recommendations of specialist and review committees, the NHA has added 237 new packages in the list and adopted 43 stratified packages. The move would ensure empanelment of more private hospitals under the flagship Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) scheme popularly called as Modicare.
As per a health ministry official, rates of 270 packages including temporary pacemaker implantation, bypass surgery, knee replacement, breast cancer treatment, kidney stone removal have been increased while prices of around 60 packages including dialysis and cataract surgeries have been reduced.
The healthcare scheme provides a cover of Rs 5 lakh per family per year to around 50 crore poor and vulnerable individuals. Within one year of the scheme, 46.5 lakh hospital treatments were provided, amounting to claims worth Rs 7,490 crores. More than half of the treatment were provided in private hospitals and 60 per cent of them were tertiary care.
“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,” said Dr Harsh Vardhan, Union Minister of Health and Family Welfare.
Currently, PM-JAY has 1,393 treatment packages out of which 1,083 are surgical, 309 medical and 1 unspecified package. The NHA has said that since the launch of the scheme, it had been receiving feedback on various aspects of the scheme including existing HBP and their rates. The HBP has been recast to also minimize incentives for abuse.
The revised oncology packages are aimed at improving cancer care for the beneficiaries and are aligned to reflect the current best practices in the country.
Dr. Harsh 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.”
Several innovative concepts were used by NHA while revising the packages such as cross specialty packages, stratified packages and add-on packages which will enhance the ease of selecting the right package for the empanelled hospital.
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 backend. This will be useful whenever there is a movement in the price of these significant components of a package cost.
In an official statement, the NHA said that it is confident that with the restructuring and rationalization of the HBP of PM-JAY, the concerns of various stakeholders will be addressed, more private hospital will get empanelled, and more poor beneficiaries will be able to avail of their entitlements.
“This will take India one step closer towards its goal of Universal Health Coverage,” it said.
The PM-JAY, launched in September last year, provides cashless and paperless access to services for the beneficiary at the point of service. It has so far been implemented in 32 states and union territories (UTs).
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