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    Panels to review Ayushman Bharat price caps

    Synopsis

    The 24 specialist committees, with 13-14 from each speciality, have doctors from AIIMS, PGIs in Chandigarh and Lucknow and major private hospitals.

    Many package rates under Ayushman Bharat were even lesser than the CGHS rates, raising the question if hospitals will be able to offer quality care to recover costs
    NEW DELHI: The government has set up committees of over 300 leading doctors from across the country to review the cost of nearly 1,300 medical packages under the Ayushman Bharat scheme. Hospitals and the Indian Medical Association have long complained of low package ceilings set under the insurance scheme.

    For instance, most cardiology surgeries are capped at about Rs 1-1.5 lakh while ceiling for caesarean, or high-risk deliveries, is just Rs 9,000. The 24 specialist committees, with 13-14 from each speciality, have doctors from AIIMS, PGIs in Chandigarh and Lucknow and major private hospitals.

    “Advice on appropriate cost of Health Benefit Packages (HBA) based on the results of costing study being undertaken,” is cited as one of the Terms of Reference of the committees, as per an order issued by the National Health Authority (NHA), a copy of which is with ET.

    The Department of Health Research (DHR) has already done the ‘costing study’ and a presentation was made on Wednesday at the first meeting of the committees. The medical industry was expecting movement on this issue after the Lok Sabha elections.

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    The IMA had earlier demanded a “reasonable and fair package rate” under Ayushman Bharat while consultants such as PricewaterhouseCoopers had said the rates of Ayushman Bharat were not sustainable for quality healthcare.

    “The committees would recommend which packages can be revised downward or upward. There are some packages which are priced on the lower side; some are on the higher side,” a senior government official told ET.

    Many package rates under Ayushman Bharat were even lesser than the CGHS rates, raising the question if hospitals will be able to offer quality care to recover costs. Like, package for a knee replacement was just Rs 80,000 and Rs 90,000 for a hip replacement surgery.

    Other points in Terms of Reference for the committees are to “recommend regarding to remove aberrations/anomalies/inconsistencies/duplicates and unnecessary laterisation, if any, existing in the HBP, recommend what to include and what to exclude in the HBP, advise on mandatory documentation for admission and discharge for each of the package, enable preparation of disease specific questionnaire for medical audit purpose and explore whether India can adopt WHO’s International Classification of Health Interventions (ICHI) or some other standard classification for coding its HBPs”.
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    2 Comments on this Story

    Kaliyan Pillai413 days ago
    The medical professionals should first realize that they were in the medical profession qualified with the cost and mercy of the government''s contribution. They were obliged to the society to render a dedicated service with a service moto but not with a business mindset. If they have the service mentality they will never put demands like this.
    Subodh Khanna413 days ago
    time to revise the price caps to rope in private hospitals ,who till now shying away from ayushman schema
    The Economic Times