J&K Private hospitals suspend Ayushman Bharat services over policy changes

The decision to revise the Health Benefits Packages (HBP) 2.2 was made during the 8th and 9th Governing Council meetings, with the changes officially coming into effect from March 15, 2025. As per the new regulations, appendectomy, cholecystectomy, hemorrhoidectomy, and fissure-in-ano surgeries will now be exclusively performed at public hospitals, preventing private healthcare facilities from offering these procedures under the AB-PMJAY SEHAT scheme.

Additionally, the 10% additional package price previously granted to private hospitals has been removed, meaning these facilities will now receive payments strictly at base rates under HBP 2.2. Revised reimbursement rates have also been introduced, with Sub-District Hospitals (SDHs) and Community Health Centres (CHCs) now receiving 65% of HBP 2.2 rates, while district hospitals, government medical colleges, and private hospitals will continue to be reimbursed at 100% of the set package rates.

The private hospital association has criticized the move, arguing that excluding certain procedures from private facilities could burden public hospitals and limit healthcare accessibility for patients. They have urged the government to reconsider the decision and ensure a balanced healthcare system where both public and private hospitals can function effectively under the scheme.

“This move not only makes it challenging for us to continue providing services but also goes against Prime Minister’s vision of universal health insurance, which aims to provide comprehensive healthcare coverage to all residents of J&K,” the association told Rising Kashmir. “This decision, coupled with the reservation of four surgical procedures exclusively for public hospitals, undermines our ability to provide quality care to our patients. The scheme is very beneficial for the public, but unfortunately, due to these decisions by SHA the quality of medical services will be compromised,” they further added.

The scheme is very beneficial for the public, but unfortunately, due to these decisions by SHA the quality of medical services will be compromised,” they further added. The private hospitals have also demanded the release of the pending amount under the scheme, as according to the Chief Secretary, all previous payment was supposed to be paid by the end of Dec 2024.

The order came as a surprise as previously the Jammu and Kashmir High Court directed the state government to consider the inclusion of four surgical procedures—Appendectomy, Cholecystectomy, Hemorrhoidectomy, and Fissure in ANO—under the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) scheme for empanelled private hospitals in the Union Territory.

Medical Dialogues had earlier reported that private hospitals and dialysis centres across Jammu and Kashmir announced their decision to withdraw from the AB-PMJAY-Sehat scheme in March. This move came in response to several contentious decisions made during the 9th Governing Council Meeting, which private healthcare providers believe could have severe repercussions for the sector.