NITI Aayog to relook at costs under Ayushman Bharat plan

National Health Protection Mission - Ayushman Bharat (NHPM-AB) aims to provide ₹5 lakh annual insurance cover to more than 10 crore poor families.

Federal think tank NITI Aayog is stepping in to resolve a standoff between the government and private sector hospitals over the package rates for various medical procedures under the Prime Minister’s flagship health insurance scheme, Ayushman Bharat.

The IMA has termed the package rates for certain treatment under the National Health Protection Mission as “unacceptable”.(Mint File)

The think tank will undertake costing studies to decide which rates will be revised next year, two officials familiar with the development said on Tuesday.

NITI member (health) Dr Vinod Paul said, “We will be creating subgroups for the exercise.” He did not elaborate but said work on it will begin soon.

Earlier this week, the Indian Medical Association had termed the package rates as “unacceptable” as these put patients “at risk” by “compromising on the quality of service”. A draft tender document shared with the states last month said procedures under the scheme are priced nearly one-fifth lower than the rates offered under the Central scheme. Knee and hip replacements were priced at ₹9,000 each, stenting ₹40,000 and coronary artery bypass grafting ₹1,10,000.

“…our objections about package rates, fund allocation, and insurance model stand unchanged. The IMA had also raised the need for scientific costing before fixing the rates. The cardinal objections raised by IMA remain to be addressed.” said Dr Ravi Wankhedkar.

“We don’t have an actual study for what should be the costs. Their objections have to be based on real costs, not on the different prices charged by the private sector,” an official involved with the project said on the condition of anonymity.

The official added that the programme will require support of the private healthcare sector to achieve the targeted coverage.