Ayushman Bharat Health Benefit packages: National Health Authority (NHA), the nodal agency for implementation of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) said on Thursday that Health Benefit Packages (HBP) of the scheme have been revised. There has been an increase in the rate of 270 packages, addition of 237 new packages, adoption of 43 stratified packages; and there is no change to the rate of 469 packages. In an official statement, NHA also said that revision of packages will not affect the range of treatment offered under the scheme. “Without compromising the range of treatment covered under PM-JAY, 554 packages will be discontinued, and there is a reduction in the rate of 57 packages,” NHA said.
It is expected that the revision would reduce the abuse of packages by fraudsters at different levels and motivate more private players to join the scheme.
“A conscious attempt has been made to keep the price of abuse-prone packages at the minimum level to minimize incentives for abuse,” said NHA.
Commenting on the revision of packages, Dr. Harsh Vardhan, Union Minister of Health and Family Welfare, said, “We are confident that with the revision in the Health Benefit Packages of Ayushman Bharat PMJAY, 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”.
Packages under Ayushman Bharat
PMJAY offers 1,393 treatment packages, out of which 1,083 are surgical, 309 medical and one unspecified package. The package includes the cost of diagnostics up-to 3 days before hospitalization, and medicines up to 15 days post-hospitalization. Since the launch of the scheme, NHA said it had been receiving feedback on various aspects of the scheme including existing HBP and their rates.
Dr. Indu Bhushan, CEO NHA said, “In the spirit of cooperative federalism, before finalizing the changes, feedback was also taken from the States and Union Territories. Their feedback was examined by the review committee”.
“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,” he added.
Cancer care revamp
- The revised oncology packages will revamp cancer care for the beneficiaries and are aligned to reflect the current best practices in the country, NHA said. Dr. Harsh Vardhan said, “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.”
- NHA further said that 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 HBP 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.
Ayushman Bharat: Addressing price movement
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.