The government on Thursday announced it has revised treatment packages under its flagship health insurance scheme, Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY), under which Rs 5 lakh annual health insurance cover per family is provided to 100.7 million poor and vulnerable families for hospitalisation.
Of the 1,393 treatment packages that were initially included in the scheme, there has been an increase in the rates of 270 packages, addition of 237 new packages and adoption of 43 stratified packages.
There is no change in the rates of 469 packages. However, 554 packages have been discontinued, and there is a reduction in the rates of 57 packages, according to the National Health Authority (NHA), the nodal agency for implementation of PM-JAY.
“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 health care, and lakhs of vulnerable families will receive free treatment,” said Union health minister Harsh Vardhan.
Within one year of the scheme, 46.5 lakh hospital treatments were provided, amounting to claims worth Rs 7,490 crore. As many as 53% of the treatments were provided in private hospitals, and 60% were for tertiary care.
{{/usCountry}}Within one year of the scheme, 46.5 lakh hospital treatments were provided, amounting to claims worth Rs 7,490 crore. As many as 53% of the treatments were provided in private hospitals, and 60% were for tertiary care.
{{/usCountry}}“We are constantly striving to make improvements in the scheme to make it better for the beneficiaries as well as hospitals offering the facilities. In the past one year, we constituted 24 expert committees to look into the packages and recommend changes wherever necessary,” said Indu Bhushan, CEO, Ayushman Bharat.
The NHA, along with experts from the Department of Health Research, Indian Council of Medical Research and Tata Memorial Hospital were involved in the process to remove the inconsistencies in the nomenclature and pricing for their respective specialties.
To ensure that the hospitals do not overcharge, and rates do not vary across hospitals, empanelled health care providers are paid based on specified package rates. A package consists of all the costs associated with the treatment, including pre and post hospitalisation expenses.