Why Haryana's Public Health System Is Crumbling With Pending Dues From Ayushman Bharat

News18

2 days ago

Haryana's public healthcare system is collapsing under the weight of over-promising, financial mismanagement, and a lack of strategy
In an attempt to manage shrinking healthcare funds, the Haryana government in June dropped several high-demand treatment packages—including cataract, hysterectomy, laparoscopic cholecystectomy, gastroenteritis, and Chronic Obstructive Pulmonary Disease (COPD)—from both the Ayushman Bharat and Chirayu Yojana health insurance schemes for private hospitals.
While that decision is still rippling across hospitals and patients alike, another storm is brewing: over 650 private hospitals are preparing to halt Ayushman Bharat services starting August 7, citing unpaid dues of over Rs 500 crore. But this isn't just a payment delay issue. Haryana's public healthcare system is collapsing under the weight of over-promising, financial mismanagement, and a lack of strategy.
How Did We Get Here?
Haryana's health insurance net has grown rapidly in recent years. Under the Centre's Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), the state covered about 70–80 lakh beneficiaries. But in a bid to widen the safety net, the state launched Chirayu Yojana, expanding total coverage to a staggering 1.8 crore people—over 70 per cent of the state's 2.5 crore population.
This expansion was not backed by a scalable financial roadmap.
'In trying to serve too many, the government is now unable to serve anyone properly," said Dr Ajay Mahajan, former president of the Indian Medical Association (IMA), Haryana. 'They over-promised but didn't have the budget to sustain it."
Mahajan was IMA Haryana's president when the dialogues with the state government started for expanding the funding.
'In 2023–24, the total budget for these health schemes was Rs 1,300 crore, which increased to Rs 1,800 crore in 2024–25. During multiple meetings with the chief minister and his office, private hospital representatives were assured that the allocation would rise to Rs 2,000–2,500 crore. Instead, it was slashed to Rs 700 crore—causing a severe funding crisis."
'That entire amount of Rs 175 crore, from the first quarterly release, officials confirm, has already been used to clear old unpaid dues from previous years, leaving this year's reimbursements pending. Rs 175 crore has been used to clear old dues. There is no money left to clear the latest dues."
Why Top-Selling Packages Were Removed
In a notice titled 'Regarding Reservation of Medical & Surgical Packages for Government Hospitals", issued on 23 June 2025, seen by News18, the Ayushman Bharat Haryana announced that five high-demand procedures would now be reserved exclusively for public (government) hospitals. They labelled the move as part of efforts 'to streamline package utilization under Ayushman Bharat HHPA and to avoid over-utilization by private empanelled hospitals."
The five procedures—Phacoemulsification with foldable hydrophobic acrylic IOL, Abdominal Hysterectomy, Acute Exacerbation of COPD, Acute Gastroenteritis with Severe Dehydration, and Laparoscopic Cholecystectomy (Without CBD Exploration)—are in addition to 114 packages already reserved for government facilities. The notice further directed officials to 'update the TMS portal accordingly, so that booking of these packages is restricted to Government Hospitals only," adding that the step will 'enhance service delivery at public health institutions and ensure judicious use of scheme funds."
However, IMA Haryana and other private hospitals believe that the move is to cut budget under the scheme as these packages, especially cataract surgery, had very high demand. 'The more the packages sold in private hospitals, higher the bills for reimbursement become pending," Mahajan said.
About 700 private hospitals in Haryana are empanelled under the scheme—many of them mid-sized nursing homes and speciality centres that serve 90 per cent of Ayushman patients. The public sector, though nearly equal in number of hospitals, attracts only 10 per cent of patients.
'Most tertiary care and super-speciality beds—about 80–85 per cent—are with private hospitals," said Dr Girdhar Gyani, director general of the Association of Healthcare Providers India (AHPI). 'These hospitals cannot survive long payment delays. The government's intent may be genuine, but without a strategy and cash flow, the system is breaking down."
Hospitals say they are facing operational stress, rising costs, and zero liquidity. Payments have been delayed by up to five months in some cases. Arbitrary deductions and administrative apathy have only added to the strain. 'The only solution is to charge 1 per cent interest as a penalty for the amount due. This penalty was part of the original Ayushman Bharat scheme when launched in 2018. However, states have removed that clause due to their own convenience."
Quiet Cuts, Loud Consequences
To deal with the mounting costs, the government has begun cutting down packages. Mahajan confirmed to News18 that several high-volume, commonly claimed procedures were quietly removed from the Ayushman and Chirayu lists months ago. These include cataract surgeries, hysterectomies, gallbladder removals, and even procedures related to gastrointestinal and COPD conditions. 'Cataract was the top-selling procedure, and they have removed that as well."
'These five were core treatments, especially for the poor," he said. 'Removing them doesn't just balance the books—it leaves lakhs of people with no option but to pay out of pocket or skip care altogether."
The cost of running both schemes simultaneously, Mahajan said, has created an unsustainable financial burden, with the state now facing the consequences of overpromising.
Last-Ditch Talks, With Conditions
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Talks between the government and hospital associations are ongoing. A meeting scheduled on Monday was postponed, but fresh dates have been proposed. Hospital leaders say they're still open to negotiation.
'We were planning to meet the state government officials today, but the meeting was cancelled," Gyani said, adding, 'If we get a firm assurance and timelines, we might give them a week's extension. But if the funds are not released soon, we will have no choice but to stop services. We simply don't have the money to treat patients under Ayushman."
About the Author
Himani Chandna
Himani Chandna, Associate Editor at CNN News18, specialises in healthcare and pharmaceuticals. With firsthand insights into India's COVID-19 battle, she brings a seasoned perspective. She is particularly pass...Read More
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First Published:
August 05, 2025, 12:20 IST
News india Why Haryana's Public Health System Is Crumbling With Pending Dues From Ayushman Bharat
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