Concerns in covering alternative therapies in PM-JAY

Maitri Porecha New Delhi | Updated on October 18, 2019 Published on October 18, 2019

Last month, AYUSH Minister Shripad Yesso Naik had said that a total of 33 packages had been sent to the Health Authority for consideration to be included under PM-JAY   -  THE HINDU

Standardisation needed to include ayurveda, yoga, unani, siddha and homeopathy under Government’s cashless insurance scheme

Two pet ministries of Prime Minister Narendra Modi – Ministry of Ayurveda, Yoga, Unani, Siddha and Homeopathy (AYUSH) and Ministry of Health’s National Health Authority which runs Pradhan Mantri Jan Arogya Yojana (PM-JAY) are not on the same page, when it comes to practicing ‘integrative medicine.’

Currently, PM-JAY — cashless insurance up to ₹5 lakh for poor families — only offers hospitalisation based on allopathic medicine. However, the AYUSH Ministry is keen on pushing alternative treatments in the scheme.

A Health Authority official said that inclusion of AYUSH packages in PM-JAY is not feasible currently. “It will be too difficult to work our way around fraud control in AYUSH procedures, where we will not be able to ascertain if hospitalisation is for correct purposes,” said the official.

AYUSH Secretary Vaidya Rajesh Kotecha said that even though such an inclusion has not happened yet, the Ministry is trying hard to get the packages included. “We will help the NHA with adequate fraud control mechanisms,” Kotecha added.

Last month, AYUSH Minister Shripad Yesso Naik had said that a total of 33 packages had been sent to the Health Authority for consideration to be included under PM-JAY.

Proposed packages

The list of pacakges proposed by AYUSH, seen by BusinessLine, includes 19 Ayurveda, Unani and Siddha, eight Yoga and six Naturopathy treatments. These are treatment of respiratory disorders such as asthma, pneumonia, gastrointestinal problems like hepatitis, stomach ulcers, cardiac issues like high blood pressure, metabolic disorders like diabetes, thyroid, gynaecological issues like endometriosis, reproductive tract infections, infertility, skin problems like vitiligo, psoriasis, neurological disorders like mental retardation, Parkinson’s, Alzheimer’s, Dementia, eye problems like diabetic retinopathy and glaucoma.

It also proposes to include mental health issues such as clinical depression, anxiety, manic disorders, and other miscellaneous illnesses like varicose veins, diabetic foot in the in-patient hospitalisation packages. AYUSH Ministry has proposed a flat rate of ₹4,000 per day for hospitalisation in a routine ward, and has said that the average length of stay of a patient could be 14 days costing ₹56,000 and could extend up to 28 days costing ₹1.2 lakh. Similarly, cost for Yoga and Naturopathy related to above disorders has been pegged at ₹1,000 for each specialty per day of hospitalisation.

According to experts, while there is a need to include AYUSH treatments for access to poor, standardisation of procedures is a must. Naresh Trehan, Chairman of Gurgaon-based Medanta Medicity said, “There is no harm in including AYUSH packages in PM-JAY, however, standardisation must be done. The authority must ascertain if a hospital is certified to mete out alternative treatments, otherwise anybody can open a centre and claim to give those treatments.”

Partha Dey, Chief Operating Officer at Artemis Health Institute in Gurgaon said, “It is difficult to control fraud as of now in the scheme, even with allopathic treatments. As far as AYUSH packages are concerned equal standard setting is a must.” Dey also said that there is a resistance from patients on addition of alternative therapies apart from allopathy and it causes a confusion for them.

Kotecha said that while there is a popular perception that there are no standards as far as alternative treatments are concerned, this is not entirely true. “AYUSH is working with All India Institute of Medical Sciences to develop integrative model for treatment of breast cancer patients. Also, it has been seen that adding ayurvedic treatments to Tuberculosis regimen reduces liver damage. The ministry also showed evidence in Germany for treatment of Osteoarthritis through Ayurveda,” he said.

However, Kotecha too agreed that there is a need to have quality services. “For this we have proposed to National Accreditation Board of Hospitals that such hospitals which provide alternative therapies should receive Entry Level Certification,” he said.

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Published on October 18, 2019
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