Ayushman Bharat will not cover cataract ops, dialysis and normal deliveries

Note4students

Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level:  Ayushman Bharat Programme

Mains level: Everything about Ayushman Bharat Programme


News

  • The National Health Authority (NHA) is planning to remove procedures covered under existing national programmes from the list of packages approved for reimbursement under PMJAY (Ayushman Bharat).
  • Certain procedures like cataract surgeries, dialysis and normal deliveries will not be covered by the flagship health scheme.

Avoiding Duplication

  • Procedures or diseases for which there is already an existing national programme, do not need to be covered under AB packages.
  • Diseases for which there are existing national programmes and for which treatment is reimbursed under PMJAY for specified rates include tuberculosis, chronic kidney disease (dialysis), leprosy, malaria, HIV-AIDS and mental health disorders.
  • For many diseases like malaria, where surgeries are not established protocol for treatment, PMJAY approves a daily hospitalization cost of Rs 2,000.

I. Cataract

  • Cataract surgeries have topped the list of claims submitted under PMJAY.
  • In the first three months of PMJAY until Nov 2018 — 6,900 claims had been submitted for cataract surgeries.
  • However they are done for free under the National Blindness Control Programme (NBCP).

II. Normal Delivery

  • The NHA is planning to leave out normal deliveries from the ambit of PMJAY.
  • There are a host of national programmes for mother and child health, high-risk deliveries will continue to be covered.

III. Dialysis

  • The Pradhan Mantri National Dialysis Programme was rolled out in 2016 under which dialysis is already provided free of cost.

Bringing Implants under AB-NHPM

  • The NHA is also in talks with the National Pharmaceutical Pricing Authority (NPPA) to negotiate special rates for implants or other devices that are used under PMJAY to further bring down costs.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
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