Cancer cover based on drug regimen & not on type of cancer; better implants in cardiology & orthopaedics.
Sep 12, 2019, 07.09 AM IST
NEW DELHI: In a major overhaul, Ayushman Bharat would provide health cover for cancer based on the drug regimen and not on the type of cancer. The new health insurance scheme for the poorest of the poor would add over 200 packages and offer a larger variety of better quality implants in cardiology and orthopaedics.
The governing board of the National Health Authority (NHA), the nodal agency for implementation of the flagship programme, approved Ayushman Bharat 2.0 on Wednesday. Taking a giant leap in cancer care, Ayushman Bharat has aligned its cancer care with the National Cancer Grid of Tata Memorial Hospital. So far, the cancer care provided by hospitals was dependent on the location of cancer (like lung or pancreas). However, now cancer care would depend on the type of drug regimen being prescribed. The protocols used by the premier Tata Memorial hospital would be available across healthcare institutions to the poor. A source told ET, “Cancer care packages were not being used as much as we would have liked. They just offered very limited choices. Now it will be changed.” After the approval of the governing board, the packages would be further tweaked and then sent for upload on the IT platform. Ayushman Bharat 2.0 is slated for rollout on October 1.
Improved implants would now be available under Ayushman Bharat. So far, a private hospital was reimbursed a lumpsum package amount for any implant surgery ––like knee replacement or stents. Now, the package would specify separately the cost of procedure (surgery) and the cost of implant. This would help the patient get good quality implants. “This would help in checking the tendency of hospitals to use any cheap implant and claim the entire package cost.”
The entire revamp exercise was carried out by an expert committee, headed by Niti Aayog member Prof Vinod K Paul, formed to review the cost of 1,300 medical packages under Ayushman Bharat. The committee reviewed the medical packages which decided the amount the Centre reimbursed the hospitals for treating patients and Ayushman Bharat beneficiaries. This had been a long-standing demand of hospitals and medical practitioners since the scheme was launched in September 2018.
The most important step in revamp would be rationalisation of the mission cost. About 200 new packages offering better treatment will be added under Ayushman Bharat. A senior official told ET, “There were packages not available under Ayushman Bharat. So these would be offered as unspecified packages and the hospitals were free to ask whopping amounts as reimbursements. In the review exercise we identified the most used packages and put them under Ayushman Bharat specifying their costs. This would help in pruning the mission cost.” Another cost cutting measure has been reducing the cost of dialysis. Now the government would reimburse less amount to hospitals for offering this service. “Through this exercise we have tried to correct some aberrations. There is a Pradhan Mantri Dialysis Yojana where the rates reimbursed to hospitals were less than what Ayushman Bharat was offering. So, we have brought our rates on par with those,” said the official.
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