7 days ago
Mint Explainer: Why are private hospitals resisting the government's health insurance scheme Ayushman Bharat
Seven years after its launch, Ayushman Bharat, the government's health insurance scheme for the poor, has run into trouble. More than 600 private hospitals in Haryana suspended services for patients under the scheme this month, citing pending dues.
Private and public hospitals across the country have been struggling to recover dues from the government for Ayushman Bharat patients they treat. What's going wrong? Mint explains.
What is Ayushman Bharat?
Also called the Ayushman Bharat Pradhan Mantri Jan Arogya Yojna (PMJAY), this health insurance scheme was launched in 2018 for India's poorest and most vulnerable people. Each family covered under the scheme gets up to ₹5 lakh cashless health insurance coverage every year.
This covers secondary and tertiary care in both public and private hospitals empanelled under the scheme. Since its launch, Ayushman Bharat has issued over 41 crore cards for beneficiaries and authorised hospital admissions worth nearly ₹1.2 trillion in more than 32,000 empanelled hospitals, per latest data from the National Health Authority.
How does the scheme work?
Families identified at the bottom of the ranks based on deprivation occupational criteria of the Socio-Economic Caste Census 2011 qualify for the scheme, with different qualifiers for rural and urban families.
Families covered under previous health insurance schemes run by the Centre and various state governments were also included in Ayushman Bharat when it launched in 2018. Patients with an Ayushman Bharat card can be treated at an empanelled hospital for free. These hospitals claim the cost of treatment from the state or central health authorities per a rate list fixed by the government under the scheme.
What is the problem now?
Earlier this month, over 600 private hospitals in Haryana stopped accepting patients covered by the Ayushman Bharat Scheme after more than six months of threatening to do so. These hospitals, represented by the Haryana chapter of the Indian Medical Association, said they had not been paid for the free treatments provided to government-insured patients.
In a post on X (formerly Twitter), the IMA Haryana said that the Haryana government had cleared only ₹245 crore of the total pending dues worth nearly ₹500 crore as of 7 August.
So, is this a Haryana-only problem?
No. Private and public hospitals around the country have struggled to recover dues from the government for Ayushman Bharat patients they treat. Three years ago, Chandigarh's prestigious government-run PGI Hospital stopped treatment under Ayushman Bharat after the Punjab government failed to clear dues worth ₹16 crore.
Last year, the Nursing House Cell under the IMA suspended cashless treatment for Ayushman Bharat patients in the private hospitals and nursing homes it represents, citing pending dues.
Private hospitals in several other states, including Andhra Pradesh and Telangana, have been reluctant to join Ayushman Bharat; last November, a Karnataka MP even suggested 'taking action' against private hospitals that refuse to be enrolled in the scheme.
How much are hospitals across India owed under the Ayushman Bharat scheme?
The National Health Authority has not officially disclosed this figure on its dashboard for the scheme. However, in a reply to a Right to Information query by activist Ajay Basudev Bose, it said that empanelled hospitals were owed over ₹1.21 trillion in unpaid dues as of February this year.
The health ministry did not respond to a Mint query regarding pending dues. In 2023, the minister of state in the health ministry said in a Lok Sabha reply that 77% of all claims were settled under the Ayushman Bharat scheme overall, and 86% of all claims made in private hospitals, as of February that year.
What happens now?
The Centre and various state governments must settle pending dues or issue a formal rejection of claims for cases pending with empanelled hospitals. Bose's RTI query cited above said nearly 64 lakh cases are yet to be settled under the Ayushman Bharat scheme.
Besides, the IMA and other representative bodies say the prices of various procedures and medical packages under the scheme are too low to be viable; they want these prices to be hiked.
