A boon for Ayurveda and patients

by Ayurveda Admin

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In a country like India where a large part of the society still depends on Ayurveda for various ailments, the central government decision to include the ancient treatment system under insurance coverage is a great boon for the patients as well as the industry. Dr. D. Induchoodan– who is trying for insurance coverage to Ayurvedic treatments for several years and was part of its official deliberations- Convener, Treatment Standardisation Committee, AHMA, looks at the major features of the insurance guidelines

The Ayurveda community at large and the citizens of India have been demanding for the inclusion of Ayurvedic treatments under Health Insurance coverage for a long time. Large to small Ayurveda hospitals have also been demanding and trying for this approval for several years through their organisation – Ayurveda Hospital Management Association (AHMA). However, the personalised treatment approach of Ayurveda was the main barrier for inclusion of its treatments under insurance coverage. Because of that approach, treatments for the same disease in different individuals are variable and thus also the cost. Hence, the difficulties in standardising treatment costs in such individualised but highly effective treatment discouraged and prevented insurance firms from calculating total expense, developing insurance premiums and designing policies. Unhelpful skepticism about the curative aspects and misbranding of Ayurvedic therapies under wellness treatments in the society also added to these problems.

There were some efforts in this direction few years before itself. Under the initiative of Department of AYUSH with active involvement of Ayurveda Hospital Management Association (AHMA), I, as its Treatment Standardisation committee convener had prepared a treatment protocol and costing method for Ayurvedic treatments for its inclusion under Insurance coverage. It was unanimously approved by the meeting of Ayurveda Hospitals convened by AHMA followed by its submission to Department of AYUSH by AHMA General Secretary Dr. Babykrishnan and its presentation in General Insurance Council in the same year. Even though IRDA suggested for the inclusion of Ayurvedic treatments under insurance coverage in 2013, since different insurance firms insisted various conditions, Ayurvedic community was not able to obtain the required benefits.

AHMA continued its struggle through all possible ways to avail the benefit to patients taking treatments in all Ayurveda hospitals. When existing Central Govt. under the leadership of Prime Minister Narendra Modi formed a separate AYUSH Ministry to focus on the development and promotion of AYUSH systems, AHMA channelised the follow- up through that. AHMA officials met AYUSH Minister Shripad Yasso Naik, explained the details and submitted the request. The Minister assured them to take necessary action.

Realising the significance of inclusion of AYUSH systems under insurance coverage, Ministry of AYUSH contacted various stakeholders and convened a meeting on 12th July 2016 under the Chairmanship of AYUSH Secretary Ajit M.Sharan to discuss and consolidate AYUSH information document for the same. This author was also invited for the meeting considering AHMA’s & his personal activities for this purpose earlier. The modified treatment protocol with updated treatment rates (considering expenses in 2016) submitted by the author to AYUSH was accepted by the stakeholders in this meeting.

Ministry of AYUSH on 30th September 2016 released the ‘Guidelines for reimbursement/settlement of Ayurvedic treatment expenditure claims under insurance coverage’ which includes criteria of eligible hospitals for insurance coverage, tentative list of diseases/disease conditions needing hospitalisation of the patients, indicative therapies and likely duration of hospitalisation and benchmark costing of Ayurvedic therapies/interventions. etc.

Major features of the guideline:

Eligible Hospitals:

Central or state Govt. Hospitals
NABH Accredited Ayurvedic Hospitals

Teaching hospitals attached to Ayurvedic colleges recognised by Central Government/ Central Council of Indian Medicine

Ayurvedic hospitals having registration with a Government Authority under appropriate Act in a State/UT, minimum fifteen beds, minimum five qualified and registered Ayurvedic Doctors, adequate number of qualified paramedical staff, dedicated Ayurveda therapy sections and daily maintenance of medical records.

Tentative list of diseases/disease conditions needing Hospitalisation

Twenty well recognised and properly described disease categories in Ayurveda and known to respond well to Ayurvedic treatment are included in this proposed protocol and costing. Diseases like Greeva Sthambha (Cervical spondylosis, Cervical disc prolapse etc.), Kateegraha (Low Back Ache..etc) and Gridhrasi (Sciatica etc), Apabahuka & Viswachi (Frozen Shoulder, Brachial Neuralgia etc), Pakshaghata (Paralysis, Hemiplegia etc), Kampavata (Neuro-spastic conditions etc), Ardita (Facial Paralysis..etc), Vataraktha & Kroshtukasheersha (Rheumatiod Arthritis..etc) Amavata (Rheumatic fever etc.), Sarvanga vata & Supthi (Motor-Neuron diseases, Fibromyalgia etc.), Sandhigatavata & Vathakandakam (Degenerative Joint disorders, Tennis elbow, Calcaneal spur), Twak Vikara (Skin diseases, Psoriasis, Eczema..etc), Visarpa (Cellulitis, Erisepelus..etc), Grandhi & Arbuda (Benign & Malignant Growths..etc), Arsha, Bhagandara & Parikarthika (Hemorrhoid, Fistula in Ano, Fissure in Ano..etc), Nadeevrana (Pilonoidal Sinus etc.), Moothraghata, Moothrakruchra & Asmari (Renal dysfunction, Renal/ Urinary calculi etc.), Arthava dushti, Kashtarthava, Kruchrarthava, Yonee roga & Rakthapradara (Amenorrhoea, Dysmenorrhoea, DUB, PCOD/PCOS..etc), Mamsagata Vikara & Mamsakshaya (Muscular dystrophy..etc), Drishti Dosha (Refractive errors, Chronic allergic & inflammatory diseases, Chronic conjunctivitis, Dry eye syndrome, Retinitis pigmentosa, Night blindness, Retinopathy etc.), Sirasoola, Sooryavartham & Ardhavabhedakam (Headache, Migraine..etc), Swasa roga & Kasaroga (C.O.P.D, Bronchial Asthma..etc), Abhighataja Vikara (Restricted movements due to fracture/dislocation etc) are included. This provides clarity for hospitals, patients and insurance firms about the extent of insurance coverage for Ayurvedic treatments.

Clinical conditions for hospitalisation

The clinical symptom of each disease category which necessitates In-patient admission is clearly defined. This helps to ensure the truly essential clinical conditions for I.P.D admission and to avoid unnecessary I.P.D admission & fraudulent insurance claims.

Indicated therapies required as per condition of the patient.

List of therapies for each disease category is specified which helps the physicians, patients and insurance firms to avoid disputes regarding the significance of particular therapy for a specific disease.

Duration of hospitalisation

Normal duration of hospitalisation for each category of disease is also mentioned which helps the patients to get insurance claims for their total treatments days satisfying this criteria. At the same time, it helps the insurance firms to avoid false/exaggerated claims.

Benchmark costing of Ayurvedic therapies/interventions

Cost of 97 therapy procedures/interventions (per session) is specified. The rate includes cost of materials, medicines, accessories, equipments maintenance and manpower (medical, paramedical and nursing) used in imparting therapies except room rent of the hospitalisation. Room rent shall be chargeable as per insurance company/insurance policy norms. Pre & post procedure cost will be chargeable @ Rs 75 per day. Twenty five percentage hike of the benchmark rates shall be applicable for the treatment taken in NABH accredited hospital or if the hospital is located in metropolitan city. The benchmark rates shall be considered for revision in every three years if required.

National and global impact

Inclusion of Ayurveda under insurance coverage is the victory of a team work. AYUSH Minister. Shripad Yasso Naik, Government officials, especially- A.M.Sharan (Secretary-AYUSH), A.K.Ganeriwala (Joint Secretary-AYUSH), P.N.Ranjith Kumar (Joint Secretary –AYUSH), Dr.D.C.Katoch (Advisor Ay.–AYUSH), Dr.Pradeep Kumar Dua Research officer (Ay) – AYUSH, Dr.Janardan Pandey (Former Joint Advisor –AYUSH), Dr.S.K.Sharma (Former Advisor –AYUSH) ..etc, Ayurveda Hospital Management Association, industrial leaders like Dr.P.M.Varier (Kottakkal Arya Vaidyasala), eminent physicians like Dr.S.G.Ramesh Varier (Kottakkal Arya Vaidya Sala)..etc had taken great efforts at different stages to obtain this great achievement. Dr.Muhammed Bappu, Dr.Sanal Kurinjikkattil, Dr.Rahmathulla, Dr.Anwar, Dr.B.G.Gokulan, Dr.C.S.Krishnakumar (Nagarjuna), Dr.I.Unnikrishnan Namboothiri, …etc from industrial side supported this activity well. From this it is clear that if Ayurvedic experts, concerned associations and officials stand together, great victories are possible even in future.

In a country like India where a large part of the society still depends on Ayurveda for various ailments, this is a high-impact decision. Since the costs of Ayurvedic treatments for specific diseases are comparatively less, it may be financially helpful for insurance firms in this “era of insurance for all”. Additionally, since several Ayurvedic treatments offer preventive benefits (through cleansing of the system through panchakarma…etc) along with its intended curative results, chances of other diseases decreases while being treated for one disease and hence the chances of further insurance claims also decreases.

If the possibility of this important decision is correctly utilised, it can contribute much to the Medical Value Travel (Medical Tourism) sector in India. As far as global scenario is concerned, a perfect insurance Protocol – satisfying Ayurvedic science & insurance norms- can be considered as inevitable for extending and promoting Ayurveda in those countries where insurance coverage is essential for a Medical system to survive.

Suggestions:

Total costs of individual diseases to be covered are essential for insurance firms to introduce new policies since they need that cost to fix premium and to design the policy. Considering this necessity of insurance sector, protocol submitted by AHMA had included that also which is missing in the published Guideline. Hence, to get more insurance policies from insurance sector to Ayurveda, that part also to be included.
Maybe unknowingly, some discrepancies occurred in the eligibility criteria of Hospitals. That is- since the number of Doctors, criteria of qualified paramedical staff, number of beds..etc in private hospitals (mentioned in section ‘d’ under Eligible hospitals) is more complex than criteria for NABH accreditation (which is considered as the standard of quality) and since NABH accredited hospitals are made eligible without these terms, conditions for NABH accreditation regd. this points to be made applicable to other hospitals also.

Dr.D.Induchoodan, B.A.M.S, M.B.A (Marketing), P.G. Diploma in Hospital Management, P.G. Diploma in Quality Assurance & International Regulatory Affairs, P.G. Diploma in Ethno pharmacology, PGDVTMS.

NABH (AYUSH) Assessor, Convener- Treatment Standardisation Committee, AHMA, Dist. Vice President- Laghu Udyog Bharati, dr.induchoodan@gmail.com