National Health Authority (NHA) is planning to remove procedures covered under existing national programmes from the list of packages approved for reimbursement under PMJAY. This means procedures like cataract surgeries; dialysis and normal deliveries will not be covered by the health scheme.
Cataract surgeries have topped the list of claims submitted under PMJAY. In the first three months of PMJAY — until November 24, 2018 — 6,900 claims had been submitted for cataract surgeries even though they are done for free under the National Blindness Control Programme (NBCP). In 2017-18 alone, 15,91,977 surgeries were performed under NBCP, which dates back to 1976.
While the NHA is planning to leave out normal deliveries from the ambit of PMJAY because there are a host of national programmes for mother and child health, high-risk deliveries will continue to be covered. The Pradhan Mantri National Dialysis Programme was rolled out in 2016 under which dialysis is already provided free of cost.
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.
