Ayushman Bharat-NHPS: Are package rates giving preference to affordability over quality healthcare?

Published: October 18, 2018 2:40 AM

With Ayushman Bharat-National Health Protection Scheme, the healthcare sector is expected to witness a makeover.

ayushman bharat, nhpsThe Indian Medical Association (IMA) appreciated the government’s promulgation of empanelling hospitals from 10 beds onwards for endorsing the revised rates.

With Ayushman Bharat-National Health Protection Scheme, the healthcare sector is expected to witness a makeover. It aims to target poor, deprived rural families and has identified an occupational category of urban workers’ families, 8.03 crore in rural and 2.33 crore in urban areas, as per latest SECC data. The total expenditure on health is below 4% of GDP, and the government expenditure is below 1.3% of GDP. The new National Health Policy promises to increase this to 2.5% by 2025.

Under the world’s most anticipated and largest healthcare framework, the government has capped procedural treatment costs for over 1,350 treatment packages, ranging from Rs 1,000 to over Rs 1.5 lakh. While defining these rates, I urge decision-makers to understand that any healthcare scheme should strike a balance between patient-ask for affordability on one hand, and quality and safety on the other, making it truly ‘healthcare’ for all.

Patients who seek these treatments require more than just affordability—they also need quality healthcare. In the long-term, quality and effective treatment will improve patient outcomes and reduce the long-term costs of healthcare. It cannot be one for the other—quality cannot be completely replaced on the premise of affordable healthcare.
So, what do these poorly-defined package rates leave in store for the stakeholders?

The Indian Medical Association (IMA) appreciated the government’s promulgation of empanelling hospitals from 10 beds onwards for endorsing the revised rates. The IMA, however, raised concerns over possible decline in quality due to rationalising prices of essential and high-quality medical devices. The revised package rates for the entire procedure, including price of the devices, are: knee and hip replacements at Rs 9,000 each, stenting at Rs 40,000, coronary artery bypass grafting at Rs 1.1 lakh, caesarean delivery at Rs 9,000, vertebral angioplasty with a single stent at Rs 50,000, and hysterectomy for cancer at Rs 50,000. Sure, affordability will lead to a near equi-distribution of patients in private and public hospitals, but wouldn’t it limit the efficacy of private hospitals? Fixing a treatment in a certain price bracket could lead the hospital or doctor to employ a cheaper alternative, which could be ineffective or, in some cases, be harmful. Ultimately, substandard replacements in the long run could put a patient’s life at risk.

In fact, highlighting a loophole in the price-capping schemes, a recent IQVIA study on “Medical Devices in India-An Agenda to Effective Healthcare Delivery” states: “There is minimal post-treatment coverage in these reimbursement schemes, whereas most of these procedures involve post-treatment cost, e.g. in the case of knee implants, physiotherapy treatment is mandatory. In the absence of post-surgery coverage, patients tend to avoid these costs leading to increased mortality, affecting the quality of life.”

A large percentage of the population in rural and urban India is still not reporting health expenditure. So, when the government advocates for health sector reforms to minimise out-of-pocket expenditure, it leaves us with many questions. One of the major questions that the recent initiative brought forth is the impact on the stakeholders—medical device manufacturers, distributors and hospitals.
Has price-capping benefited patients?

Though the intent was right but, in my opinion, price-capping was not a realistic approach. Similarly, while fixing the package rates of treatment for this scheme, it should have been tier-marked because of the difference in services between tertiary and primary healthcare centres.

While the world awaits Ayushman Bharat to unfold, what we are looking for is not just affordable and accessible healthcare, but also budgeted quality reforms. The road ahead invites a strategic PPP model that encourages investment in medical device innovation and supports the objectives of Ayushman Bharat. The future of medical care in India should not focus on numbers but promise healthcare initiatives that people can trust. We expect the future of the medical devices sector to be a harmonious relationship between the stakeholders and patient—a relationship that’s a win-win for both. Once this groundwork is laid, the synergy will bring out the full potential of Ayushman Bharat to the fore.

By Ashok Kumar Vaid. The author is Chairman, Medical and Haemato Oncology, Cancer Institute, Medanta-The Medicity.

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