Rates of 270 packages hiked, 237 new packages added in PM-JAY

Maitri Porecha New Delhi | Updated on September 26, 2019 Published on September 26, 2019

Low rates can deter private hospitals from participating in the scheme, says NHA official

Procedure costs of the cashless insurance scheme for the poor — Pradhan Mantri Jan Arogya Yojana (PM-JAY) — have been finally revised as the scheme completes one year. While earlier there were 1,393 health packages in the scheme, this has been trimmed to a thousand-odd packages now.

Rates of 270 packages have seen an upward movement in the range of 10 to 60 per cent in 90 per cent of the packages. In the rest of the 10 per cent cases where rates have been revised it is up to 250 per cent. For example, while a procedure to implant a temporary heart pacemaker was priced at ₹5,000, it has now been revised to ₹17,500. Other procedures which have seen an upward revision in price are gall bladder stone removal and open heart bypass surgeries, which are commonly done.

“We do not want private hospitals to not participate because of low rates,” said a senior official at National Health Authority (NHA).

Some packages that have been dropped include vasectomy or male sterilisation and cochlear implant surgeries in children. “There are well-defined government programmes to deal with male sterilisation and cochlear implants in cases of congenital deafness in children, so we have accepted NITI Aayog’s recommendation of dropping them, as there is an overlap,” said the official.

There is no change in the rate of 469 packages. Especially those packages which are abuse-prone, for example hysterectomy which involves removal of a woman’s uterus, have not seen any increase in price, because NHA wants to keep fraud in check.

Also, 237 new packages have been added, keeping in mind modern advancements in medicine and also 43 stratified packages have been adopted.

An example of stratified package is ‘Balloon Pulmonary Valvatomy.’ “Earlier both paediatric and adult cases of this surgery were priced at ₹27,000. However, costs of balloon in paediatric cases are higher. So we have kept a base price for the surgery and depending on whether an adult is being operated or a child we have added variable top-up cost of the balloon,” said the official.

Officials said that dropping of packages does not mean that crucial packages have been removed or that the patients’ treatment will be hampered.

“What this means is that there were replications of certain packages across specialities, as also there were some packages which have now become obsolete, procedures that were being done in 1960s to 1980s. There were over 550 such packages. We have done away with those,” the official said.

For example, a package — ‘Coiling of Pseudo-Aneurysm of Abdomen,’ which involved inserting a metal wire to resolve a clot has been done away with. “It was a dangerous procedure which could involve risk of clotting to the brain,” the official said.

“Another package, ‘Liver Abscess Drainage’ has been dropped because now there are drugs to deal with abscess in liver and we do not want any unscrupulous doctors to take advantage of obsolete packages like these.”

In yet another example, cryosurgery which involves use of liquid nitrogen to make a tissue dead has been dropped. “We have modern methods to do that now,” said the official.

The NHA has revised the packages and has left it to States to adopt the revised rates as and when they are ready.

“Different States have different contractual timelines with insurance companies. They can only adopt revised package rates while renewing their contract with insurance companies for the next year,” the official said.

Published on September 26, 2019
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