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Cataract to be out of Ayushman Bharat

The National Health Authority has decided to revamp cancer care, give choice of implants in major surgeries like knee replacement and remove cataract surgeries from the ambit of Ayushman Bharat.

, ET Bureau|
Aug 30, 2019, 08.07 AM IST
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It has been decided to remove free cataract surgeries from the ambit of Ayushman Bharat.
NEW DELHI: The government has moved to change the shape of treatment offered under Ayushman Bharat, the Centre’s health insurance scheme for poorest of the poor, which completes a year of its launch in September. The National Health Authority has decided to revamp cancer care, give choice of implants in major surgeries like knee replacement and remove cataract surgeries from the ambit of Ayushman Bharat.

An expert committee, headed by Niti Aayog member Prof Vinod K Paul, constituted to review the cost of 1,300 medical packages under Ayushman Bharat, wrapped up its groundwork and gave a final shape to the new version of Ayushman Bharat on Tuesday evening. The committee also included the secretaries of health and health research and Ayushman Bharat CEO. The biggest task before the committee was to revise 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 committee has decided to increase the rates of 200 packages and reduce the costs of 63 packages under Ayushman Bharat. A senior official involved in the process told ET, “There were many aberrations in the packages like the amount for left breast surgery and right breast surgery had a Rs 2,000 difference. A surgery under cardio-thoracic package was more expensive than the same surgery done under general surgery package. These anomalies have been removed.”

It has been decided to remove free cataract surgeries from the ambit of Ayushman Bharat. A source told ET, “Cataract surgeries will be dropped. We are unable to check fraud and abuse under this category. This has been a very popular surgery among Ayushman beneficiaries but we have realised it is impossible to check double dipping ––whether the government is financing the same individual’s surgery under Ayushman Bharat and other health schemes. Other schemes do not have a robust IT platform to check beneficiaries. At the same time, cataract can be funded under National Blindness Prevention programme.”

One of the biggest step has been the choice of implants that the beneficiaries would be able to make. So far, a private hospital was reimbursed a lumpsum package amount for any implant surgery – like knee replacement (a very popular surgery under Ayushman Bharat). Now, the package would specify separately the cost of procedure (surgery) and cost of implant. This would help the patient in getting good quality implants. “The tendency of hospitals was to put the cheapest possible implant. This differentiated cost structure would help in ensuring the quality of implants as the hospital would need to declare the cost of implant separately,”said the source.

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