PMJAY: Ayushman Bharat hospital packages recast to curb misuse

In an attempt to minimize misuse, there has been a restructuring of packages offered under Ayushman Bharat for availing hospitalization benefits under the scheme. Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY), India`s flagship healthcare scheme, provides a cover of Rs 5 Lakh per family per year to around 50 crore poor individuals. As part of a revamp exercise for packages that was underway, the National Health Authority (NHA), the nodal agency for implementation of PM-JAY announced on Thursday that the 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. The NHA also mentioned that 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.

"Overall, a conscious attempt has been made to keep the price of abuse-prone packages at the minimum level to minimize incentives for abuse", NHA said. Currently, PM-JAY has 1,393 treatment packages out of which 1,083 are surgical, 309 medical and 1 unspecified package.

NHA said that since the launch, it had been receiving feedback on various aspects of the scheme including existing HBP and their rates. The Governing Board of NHA took a serious note of that and decided to undertake an exercise to remove the aberrations and anomalies in the HBP.

The move is also geared to empanel more hospitals in the private network. 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 PM-JAY, many new private hospitals will get empanelled with the scheme."

The revised oncology packages will revamp cancer care for the beneficiaries are 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 regimen of surgical and medical oncology, complemented by radiotherapy regimen," Harsh Vardhan said.

NHA added 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.

Indu Bhushan, CEO NHA, said that 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.

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.

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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.