Exclusive: Govt’s flagship health cover programme planning biggest price hikes since inception to woo more private hospitals

Modi government’s flagship health insurance scheme is set to undertake the biggest price hikes for almost all treatment procedures ever since it started more than three years ago, sources said, as part of a mega overhaul aimed at wooing and enrolling more private hospitals.   

Under the scheme called Ayushman Bharat- Pradhan Mantri Jan Aarogya Yojana, nearly 50 crore Indians or about 10 crore families categorised as the most impoverished are offered secondary and tertiary care cashless benefit of up to Rs 5 lakh per person on a yearly basis.

There are nearly 25,000 hospitals under the scheme: 10,500 public and 14,500 private.

Presently, nearly 1,669 treatment procedures are offered under the scheme of which 1,080 are surgical, 588 medical and one unspecified package. And, in the budget for 2022-23 the Centre had made a provision for Rs 6,400 crore for the scheme.

Previously, in 2019, rates of 270 packages were raised by up to four times for procedures such as temporary pacemaker implantation and appendicectomy.

Last year, the National Health Authority – the government agency responsible for operationalising the scheme – had come up with Health Benefit Package, increasing the rates of about 400 procedures from 20 percent to 400 per cent in some cases.

NHA chief executive R S Sharma could not be reached for comments despite multiple attempts but officials in the agency said that the latest revision, to be finalised by this month end, will be the biggest so far.

“There will also be some additions in the list of procedures offered and some existing treatments are being dropped or repackaged,” said one of the officials.

Another added that there are higher chances of many corporate hospitals now joining the scheme once the revised rates come into effect.

Since the scheme was implemented, more than 2.36 crore patients have benefitted so far, as per NHA data.

Sources in the private hospitals said that they have recently carried out an extensive exercise to prepare a list of average rates of procedures—outside the scheme--and submitted the same to NHA.

“We are hoping that even if the same rates are not adopted at least the prices would be reasonable so that it is beneficial for hospitals to partner with NHA for this scheme,” said Girdhar J Gyani, director general of the Association of Healthcare Providers of India.

On private hospitals arguing that rates for most procedures under the scheme are low, in some cases lower even than the rates under the central government health scheme, NHA officials have responded by saying that the scheme ensures very good volumes to hospitals, thus making up for the low rates.