The National Health Authority (NHA), nodal agency for implementation of PM-JAY, said it will configure the costs at the backend of its information technology system in preparation for the future. This will prove useful whenever there is a movement in the prices of these significant components of a package cost, the NHA said.
“Separate rates for implant/devices and procedures will ensure that we clearly define the quality of implant/devices and whenever the prices of these inputs go down, as they will with collective bargaining, the overall rates will also automatically come down," Indu Bhushan, CEO NHA, told Mint.
The NHA on also Thursday revised the Health Benefit Packages (HBP) of the scheme. There has been an increase in the rate of 270 packages, addition of 237 new packages, adoption of 43 stratified packages, with no changes in the rates of 469 packages.
NHA said without compromising the range of treatment covered under PM-JAY, 554 packages will be discontinued, and there rates of 57 packages will be reduced. Overall, a conscious attempt has been made to keep the price of abuse prone packages at the minimum to minimize 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," said Harsh Vardhan, union minister of health and family welfare.
Currently, PM-JAY has 1,393 treatment packages of which 1,083 are surgical, 309 medical, and 1 unspecified package. NHA said since the launch of the scheme, there has constant feedback on various aspects of the scheme, including existing packages and their rates. The governing board of NHA took a serious note of the various feedback received and decided to undertake an exercise to remove aberrations and anomalies in the packages.
Following a scientific procedure, the NHA along with the Department of Health Research (DHR), Indian Council of Medical Research (ICMR) and Tata Memorial Hospital, consulted specialist committees which helped remove inconsistencies in the nomenclature and pricing of respective specialties.
The specialist committees examined the relevant sections of the health benefit packages 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.
“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," said Bhushan.
The government has also revised oncology packages, claiming that it will revamp cancer care for beneficiaries and will be aligned to reflect the current best practices in the country.
“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," said Vardhan.
NHA said a conscious attempt has been made to standardize the nomenclature and definitions of the packages. NHA, in collaboration with World Health Organization (WHO), has initiated the process of aligning the health packages with International Classification of Health Interventions (ICHI) and International Classification of Diseases (ICD) coding of the WHO. When completed, India may become the first country to use ICHI in its HBP list.
The treatment packages cover treatment for nearly 24 specialities that include super-specialty care like oncology, neurosurgery and cardio-thoracic and vascular surgery, etc.
AB-PMJAY, India’s flagship healthcare scheme provides a cover of Rs. 5 Lakh per family per year to around 50 crore poor and vulnerable individuals. Within a year of implementation of the scheme, 46.5 lakh hospital treatments were provided, amounting to claims worth ₹7,490 crores. Of that 53% of the treatments were provided in private hospitals, and 60% were for tertiary care.