Modicare rejigged to flush out frauds, enhance benefits

The rates of procedures identified as abuse-prone, such as correction of club foot per cast, have been reduced by up to 80%.

Published: 27th September 2019 03:42 AM  |   Last Updated: 27th September 2019 09:30 AM   |  A+A-

medicine, medical field, doctors

For representational purposes

By Express News Service

NEW DELHI: As part of the lessons it learnt while running the Centre’s flagship health insurance scheme for a year, the National Health Authority (NHA) on Thursday rejigged the treatment packages on offer to plug fund leakage and make it more effective.

Of the 1,393 packages currently available, the NHA dropped 554 as they were assessed as having been duplicated or no longer practised. On the flip side, it added 237 packages to the Pradhan Mantri Jan Aarogya Yojana, also called Modicare, as they were seen as necessary for beneficiaries.

For example, incisional hernia repair and intestinal perforation have been dropped and new ones like neuroblastoma excision and tracheostomy added.

The rates of procedures identified as abuse-prone, such as correction of club foot per cast, have been reduced by up to 80%. Hospitals will now be paid lesser for 57 such packages that includes arthrodesis of the shoulder and diaphragmatic repair.

Also, rates of 270 packages have jumped by up to four times for procedures such as temporary pacemaker implantation and appendicectomy.

Oncology packages have also been split to include multiple regimens of surgical and medical oncology complemented by radiotherapy regimens.

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