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The National Health Authority (NHA) released a consultation paper on the Provider Payments and Price Setting under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY).
The consultation paper provides a global overview of the different provider payment systems which are used in various insurance schemes. The paper also presents a detailed description of how the providers are reimbursed. Secondly, the paper discusses the use of cost evidence for price-setting under PMJAY. It presents an analysis of the heterogeneity in the cost of providing healthcare according to various hospital characteristics and discusses a framework for determining differential case-based payments to hospitals. Thirdly, the paper describes the proposed simulation pilot of diagnosis-related groups (DRG) which the NHA aims to implement in 5 States to determine cost weights as per patient characteristics based on level of severity and comorbidity. Fourth, the paper describes a framework for use of Health Technology Assessment (HTA) for decisions on the inclusion of new interventions in the health benefits packages and its pricing. Finally, the paper describes an approach to continually updating the prices on an annual basis for inflation.
Through this consultation paper, NHA seeks feedback of stakeholders on the different issues related to provider payment methods, approach towards pricing, the methodology for determining price weights, the proposed approach for assessing cost weights to determine DRG based provider payments, the proposed HTA-informed value-based pricing system, and the calculation of annual price revisions for inflation adjustment.
Giving his views on the consultation paper, Dr. R. S. Sharma, CEO of, the National Health Authority, remarked, “We are evolving a standardized methodology of determining prices for different procedures under the health benefits package. This document will help develop a standardized and transparent pricing policy that will ensure efficiency, acceptability, quality, and sustainability within the Indian health care ecosystem for PMJAY. Therefore, I urge all stakeholders to go through this paper and provide us with their valuable feedback.”
NHA will also organise a public webinar on the price consultation paper to provide a forum for a live discussion with NHA leadership. Links will be shared on the PMJAY website.
The full text of the consultation paper is available for download on PMJAY’s website under the Publications section (Hyperlink: https://pmjay.gov.in/sites/default/files/2022-03/AB%20PM-JAY%20Price%20Consultation%20Paper_25.03.2022.pdf). Comments and feedback can be emailed to [email protected]. Further consultation papers will be released on related issues in the coming months.
