Modicare: Government proposes rates for 1,354 treatments under Ayushman Bharat scheme

Rates of treatment under the government-sponsored National Health Protection Scheme (NHPS), is around 15-20 per cent lower than that of Central Government Health Scheme. The ministry has prepared 1,354  packages covering 23 different types of diseases. But doctors have raised questions about the rates, as they have opined that it won’t be possible to provide treatment under these rates

Modicare: Government proposes rates for 1,354 treatments under Ayushman Bharat scheme

  • The Union Health Ministry has prepared a preliminary discussion document, to finalise rates of the treatment under the Pradhan Mantri Swasth Suraksha Yojana, popularly called Modicare.
  • The ministry has prepared 1,354 a packages covering 23 different types of diseases, including heart ailments, common disease, knee and hip implants, brain tumour, epilepsy surgery, etc.
  • The rate chart has been prepared after the consultation with the Niti Aayog and Indian Council of Medical Research (ICMR).

As the Modi led NDA government is all set to roll out India’s biggest health insurance scheme, Ayushman Bharat. The health ministry has prepared a draft of the rates at which the treatment would be provided to 50 crore people in the country.

The preliminary discussion document prepared by the health ministry revealed that under Ayushman Bharat, medical facilities will be available at the rates much lower than the rates under Central Government Health Scheme.

The C-section delivery rate under Ayushman Bharat has been fixed at Rs 9,000, while the knee and hip replacement would cost around Rs 80,000 and Rs 75,000 respectively. And the Vertebral Angioplasty with single stent will cost Rs 50,000.

While when compared with the private hospitals in the country, for a C-section delivery the rate is around 1 lakh rupees, and the knee replacement would cost somewhere around 2.5 to 3 lakhs rupees.

While Speaking to My Medical Mantra, Dr Prakash Marathe, Immediate past President of the Indian Medical Association said, “It is not possible for the private hospitals to provide the treatment at the rates which the health ministry has finalised under Ayushman Bharat. The hospital will not even recover their equipment and the machinery cost in these rates.”

While speaking to Economic Times, Indu Bhushan, CEO of Ayushman Bharat National Health Protection Mission, said, “Hospitals accredited by the National Accreditation Board for Hospitals and Healthcare Providers (NABH) will be allowed to charge 10-15% more than the rates set in this document.”

While Dr Parthiv Sanghvi, Secretary of the Maharashtra chapter of the Indian Medical Association said, “We agree that the people who belong to the economically weaker section of the society must get the treatment at affordable cost. But, treatment at the rates which have been finalised it not possible. No one knows why the government has fixed these rates.  But, it looks a populist announcement considering the 2019 elections.”

Dr Sanghvi further said, “Hip replacement in Rs 75,000 is not possible at all. As it attracts the import duty. The scheme is for those who are working in the central government sector, not for the private person. And if the scheme fails to kick off, then the blame would be squarely put on the private doctors.”

Rates of common procedures under Modicare

Vertebral Angioplasty with single stent (medicated)          50,000

Vertebral Angioplasty with double stent(medicated)          65,000

Coronary artery bypass grafting (CABG)                            90,000

Aortic Valve Repair                                                               80,000

Cataracts                                                                     5,000- 10,500

Hip replacement                                                                    75,000

Knee replacement                                                                  90,000

C-section delivery                                                                    9,000

Diarrhoea, Pneumonia, dog bite and other common diseases   Rs 1,000 per day

Dengue, Rs 2000 per day (Admission beyond 1 day requires pre-authorization)

Chikungunya, TB and Kala Azar Rs 2,000 per day

(Pre-authorisation needs to be sought to continue package beyond 2 and 5 day intervals – up to a limit of 10 days).

Brain tumour    1,35,000 (Total Treatment)

Brain biopsy         15,000

Epilepsy surgery      50,000