In Short:
Private hospitals in various states are providing reduced services to beneficiaries of the Ayushman Bharat health insurance scheme due to payment delays and insufficient fund allocations from state governments. This is causing serious operational issues for hospitals, impacting patient care. The government is working to address these concerns and ensure the sustainability of the scheme for private healthcare providers.
Private Hospitals Reduce Services for AB-PMJAY Beneficiaries
In a concerning development, private sector hospitals in various states have scaled back their services for beneficiaries of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). The reason? Payment delays and insufficient fund allocations from state governments towards this vital health insurance scheme. This has left many patients, especially those from economically disadvantaged backgrounds, with limited access to essential healthcare services. Without the support of private hospitals, beneficiaries of AB-PMJAY are facing significant challenges in receiving timely and quality medical care. Unless the issue of payment delays and insufficient fund allocations is resolved soon, there could be a negative impact on the overall health outcomes of the population. Additionally, there is concern that these limitations on healthcare services could lead to increased intercity travel by yearend as patients seek alternative options for their medical needs.
Government Concerns Over Fund Release
The AB-PMJAY scheme, launched in 2018, is funded jointly by the Centre and states in a 60:40 ratio, with the central government allocating ₹7,500 crore this year. However, officials from NITI Aayog, the health ministry, and private hospitals recently raised alarms over the inadequate release of funds by states for this crucial insurance scheme.
The Impact on Private Hospitals
Girdhar Gyani, director general of the Association of Healthcare Providers of India (AHPI), pointed out that the problem of untimely payments to hospitals surfaced when states like Telangana and Andhra Pradesh merged their health schemes into PMJAY. This delay in reimbursement has severely affected the cash flow of private hospitals, leading to significant operational challenges.
Challenges for Patients
The reduced participation of private hospitals in the Ayushman Bharat scheme could have serious consequences for patients, especially with the ongoing heatwave causing a surge in heat-related illnesses across many states.
Addressing the Issues
While the government is actively reviewing feedback from the private sector, it is crucial for state governments to finance the scheme adequately to ensure its sustainability for private healthcare providers.
Inadequate Cash Flow
PMJAY presently has a network of over 30,000 empaneled hospitals, including both private and public facilities. However, without a steady cash flow, these hospitals may start avoiding beneficiaries, citing bed unavailability. Urgent action is needed to resolve the payment delays to maintain the success of the scheme.
Progress of Ayushman Bharat
Ayushman Bharat aims to provide coverage of up to ₹5 lakh per family per year for secondary and tertiary care hospitalization to over 100 million disadvantaged families. With millions already benefiting from this scheme, ensuring timely payments to hospitals remains a top priority.
