According to a report by Priyanka Sharma for Live Mint, private sector hospitals across several states are reducing services to AB-PMJAY (Ayushman Bharat) beneficiaries due to payment delays and inadequate fund allocations from state governments.

According to Sharma’s report, private hospitals in states like Telangana and Andhra Pradesh have faced significant delays in receiving payments, exacerbating operational challenges. These delays began when some states integrated their state health schemes with PMJAY, as noted by Girdhar Gyani, Director General of the Association of Healthcare Providers of India (AHPI). Gyani pointed out that untimely reimbursements have disrupted cash flows, causing serious operational issues for private hospitals.

On May 1, officials from NITI Aayog, the health ministry, and representatives from private hospitals convened to review the scheme. Concerns were raised about the inadequate release of funds by states, with a call for state governments to finance the scheme more robustly to ensure its sustainability for the private sector.

Gyani stated, “The central government has been consistently telling the states that if they want to bring additional population under PMJAY, then the additional amount must be given by the state government only and the central government will not contribute to it”.

ALSO READ: Eden Medical Centre suspends Ayushman Bharat Services amid payment issues

According to Gyani, the inordinate delay in receiving reimbursement has hampered the cash flow of these private hospitals and created serious operational issues.

As per the report, the government is positively reviewing the critical feedback of the scheme from the private sector.

“The National Health Authority has played its role. Now, the state government must finance the scheme to make PM-JAY sustainable for the private sector,” one of the persons said.

“Right now, private hospitals are feeling exhausted because of PM-JAY. Initially, the private sector thought that they would be able to fill their vacant beds at subsidized rates, but now it is consuming their profits,” said the person, adding the government is trying to address the concerns raised.

ALSO READ: NHAP ensures resumption of claims processing for PM-JAY and CMHIS

Launched in 2018, the scheme is jointly funded by the Centre and states in a 60:40 ratio, with the union government allocating Rs 7,500 crore to PMJAY this year. PMJAY currently has a network of 30,178 empaneled hospitals—both private and public—with 12,881 being private healthcare providers. They offer over 2,000 treatment procedures across 27 specialties.

Ayushman Bharat aims to cover over 100 million poor and vulnerable families, or around 500 million individuals, providing coverage of up to Rs 5 lakh per family per year for secondary and tertiary care hospitalization.

To date, approximately 68 million authorized hospital admissions have taken place, and 400 million people have received their Ayushman cards. Beneficiaries under PMJAY are selected based on the Socio-Economic and Caste Census (SECC) database from 2011.

MTNews Desk

10 thoughts on “Integration of state schemes with Ayushman Bharat leads to payment delays for private hospitals: Report”
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