Industry body asks govt to strike balance between quality and cost while framing 'Ayushman Bharat' health insurance package

twitter-logo Joe C Mathew   New Delhi     Last Updated: May 17, 2018  | 22:00 IST
Industry body asks govt to strike balance between quality and cost while framing 'Ayushman Bharat' health insurance package
The picture for representational purpose.

Even as the government is working on its new 'Ayushman Bharat' health insurance policy, Medical Technology Association of India (MTaI), the lobby group of leading research-based medical technology companies has asked the government to be aware of the dangers of subsuming the cost of implants, prosthesis, hardware, etc. in the health package without any quality benchmarking.

MTaI wanted 'Ayushman Bharat' to be developed as a value-based healthcare programme giving priority to quality of treatment while keeping the cost component within the defined limit. The government announced its plan to launch Ayushman Bharat or National Health Protection Scheme (NHPS) in February 2018 to bring over 10 crore poor and vulnerable families under cashless health insurance cover of upto 5 lakh rupees per family per year for secondary and tertiary care hospitalisation. The government is currently in the process of drawing up package rates for treatments under the programme.

"Ayushman Bharat has the potential to be the most comprehensive health financing and reimbursement initiative, the success of which is very important to Indian people. It can metamorphose Indian healthcare ecosystem depending on the approach we take. The government is working out package rates to contain cost of treatment. These package rates are expected to subsume the cost of medical devices. Among all the good things, this is one element of the programme which can have a vitiating impact on the entire initiative in the medium to long term," says Kaustav Banerjee, Director, MTaI.

"Subsuming cost of implants, prosthesis, hardware and high risk consumables without any quality benchmarking or outcome measurement will make way for the cheapest products which may lead to sub-optimal therapies,"he adds.

Banerjee cautions that if the government opts otherwise, the episodic cost may be lower, but the total cost of disease management will increase. "Manufacturers will have no incentive to improve device longevity. Instead, the focus will be to reduce cost by significantly sacrificing outcome. The increase in redo, revision, repeat procedures due to increased adoption of cheaper products will have a direct impact on the payer and the patient both," he says.

MTaI proposes that the ideal solution that addresses such concerns will be to migrate to a value based healthcare system in the long run which will focus on health outcome for every rupee spent. As a short term measure, MTaI wants the government to consider a mechanism to separate the prices of medical devices from its package rates and rationalise trade margin of devices.

The implementation strategy of the government includes the setting up of an Ayushman Bharat National Health Protection Mission Agency (AB-NHPMA)  to monitor the programme at a national level. It also says that states and Union Territories would be advised to implement the scheme by a dedicated entity called State Health Agency (SHA). The scheme provides the flexibility to either use an existing Trust/ Society/ Not for Profit Company/ State Nodal Agency (SNA) or set up a new entity to implement the scheme.


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