New Delhi: After months of saying that it would not give any more money to hospitals for doing procedures under the Ayushman Bharat health insurance scheme, the government has reportedly increased the rates of at least 270 packages. About 237 new packages have also been added to the scheme.
The private sector has constantly demanded a hike in the prices, saying it would not be able to take part in the scheme because the rates were too low. Health activists, however, cautioned the government against transferring vast public funds to private players and instead suggested that it focus on developing public health infrastructure.
This is a sudden development, as just last week, health minister Harsh Vardhan told a press conference that there were no plans to change the rates. He said the government will only correct aberrations or anomalies in prices. In June, the government said in parliament it would not revise these rates either: “At present, there is no proposal to review the prices of packages being offered under the AB-PMJAY,” said the government in response to a question.
However, just a few days after the health minister’s statement, the Times of India reported that the government has decided to hike the rates.
The rates have apparently gone up by about 10% to 60% in 90% of the packages. In 10% of the cases, the rates have gone up by up by 250%.
For example, the cost of implanting a temporary pacemaker in the heart has reportedly been increased from Rs 5,000 to Rs 17,500.
The government has decided against increasing the cost of hysterectomies because officials are aware that this medical procedure has often been used fraudulently and the government doesn’t want to incentivise it.
Out of the 550 packages which have been removed from the scheme are those considered obsolete or were duplicated. For example, the Ayushman Bharat used to cover the procedure of “liver abscess drainage”, which has been dropped because there are now many drugs that do the same job.
The scheme currently has 1,393 treatment packages. Of these, 1,083 are surgical and 309 are medical. Hospital lobby groups such as the Association of Healthcare Providers India (AHPI) and doctor’s lobby groups like Indian Medical Association have been pressuring the government for the past year to hike prices of medical procedures. The AHPI termed the government’s pricing “unscientific”.
The government in January announced further sops for the private sector, such as giving land and funding to make to incentivise the process of establishing private hospitals or make it more “viable”.
The government also says that in the past year, Rs 1.1 crore has already been recovered in “frauds” found in the scheme and lakhs more are due from various hospitals.