Expert Committee to discuss package rate revisions, expansion of insurance coverage under Ayushman Bharat

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The Expert Committee headed by Dr VK Paul, Member (Health), Niti Aayog, will discuss recommendations for revisingAyushman Bharat package rates and also explore a possible increase in insurance coverage beyond the ₹500,000 limit, senior Health Ministry officials said.

There are nearly 1,949 medical procedures that are covered in the scheme and rates of these are fixed for treatment at empanelled hospitals that include both State-owned and private ones.

India’s flagship universal health assurance scheme, Ayushman Bharat provides coverage to 12.5 crore families, each with a floating insurance coverage of ₹500,000. In case the family has geriatric members, then an additional ₹500,000 is added to it.

About 33 States, excluding West Bengal and Delhi, are part of the scheme. The Odisha State government has begun discussions to come on board and be part of the scheme and technicalities like software integration are currently under discussion, sources said

Incidentally, several State governments and hospitals have requested a revision of laid down packager costs and medical procedure charges, considering inflation and other factors. This prompted the Union Health Ministry in March this year to set up a 16-member expert committee, led by Dr Paul.

The 16-member committee will monitor the progress of Ayushman Bharat-PMJAY, focussing on beneficiary identification, hospitalisation, and modes of implementation. A key task of the committee is to suggest measures to prevent fraud or misuse of the scheme. Additionally, the committee will explore ways to provide linkages with Ayushman Bharat Digital Mission (ABDM) and Ayushman Arogya Mandirs (AAMs).

“The committee recommendations will also address whether package rate revisions are necessary, what sort of revision are acceptable and so on. Also under discussion or scope of work of the committee is to see if the medical coverage needs to go up beyond ₹500,000 or not. So we are awaiting the recommendation of the Dr Paul Committee report on these issues,” the official told businessline.

The Ayushman Bharat scheme, which completed six years on Monday, includes the health benefit package (HBP) defines the scope of healthcare services and the financial risk protection for beneficiaries. The HBP is designed to cover diseases that are prevalent or contribute to the highest out-of-pocket expenditure.

MORE GERIATRIC PACKAGES

Officials said the Health Ministry is already working to increase the number of geriatric care packages available under the scheme. Geriatric care is a medical speciality that focuses on the unique health needs of older adults.

According to the official, the Ministry has formed an expert committee and suggestions have been sought for increasing the number of geriatric care packages under the health insurance scheme. At present, there are 25-odd such packages included in Ayushman Bharat.

“Work is on to increase the number of care packages, specially targeting the geriatric population,” the official said adding the recommendations on new package additions could happen in “another month or two.”

The pilot project to onboard the septuagenarian population under the revised guidelines of the scheme is underway, and registering these new beneficiaries is likely over the next few weeks. The scheme to include those aged above 70 years and above will be formally launched soon.