J&K Private Hospitals threaten to exit Ayushman Bharat Scheme over surgery reservation proposal

Srinagar: Private hospitals and dialysis centres across Jammu and Kashmir have recently announced their decision to withdraw from the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)-Sehat scheme, starting next month. This move comes 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.

In a letter to the Chief Executive Officer (CEO) of AB-PMJAY-Sehat, the J&K Private Hospitals and Dialysis Centres Association expressed serious concerns over key decisions made during the meeting on January 19, 2025.

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As per the recent media report by Daily Excelsior, the letter reads,“…We want to share that we have come to know that the 9th Governing Council Meeting was held on January 19, 2025, in which some critical decisions were taken, including the reservation of four procedures for public hospitals, a 10% reduction in UT-specific incentives, and the implementation of Health Benefit Package (HBP) 2.2 instead of HBP 2022.”

Common procedures, particularly in the private sector, include laparoscopic cholecystectomy, hemorrhoidectomy, appendectomy, and fissure-in-any surgeries. Private healthcare providers are concerned that these procedures may be restricted to public hospitals in the future.

The association's concerns are not limited to the reservation of surgical procedures. Another major issue is the ongoing financial strain faced by private healthcare providers due to delayed payments.

The association stated that they believe all these decisions are not in their interest, are an anti-private sector, and will likely push them to the verge of bankruptcy, as they have already been suffering for the past ten months.

The private healthcare providers said that “unfortunately,” the meeting did not address the release of their long-pending payments from Bajaj-the insurer-nor did it discuss 1% interest on delayed payments, review and reimbursement of unjustified deductions, or rejections since 2022.

According to the news reports, private hospitals and dialysis centres, which play a crucial role in implementing the scheme in J&K, stated in a letter—referred to as an "exit notice"—that they have concluded their contract with the State Health Agency, set to complete its three-year term on March 15, 2025, "is no longer tenable."

The association emphasized that despite repeated efforts, the long-pending payments remain unresolved, and no official solution has been provided.

According to the Daily Excelsior, the letter added, “Neither has the package rates been revised, even after the Union Government enhanced the budget for the Ayushman Bharat scheme by 24% to Rs 9,406 crores.”

It also mentioned that HBP 2022, approved by the National Health Authority of India in 2022, should be implemented with a special rate revision for dialysis patients.

In the letter, the J&KPHDC emphasized the importance of the Right to Health, guaranteed under Article 21 of the Indian Constitution. The association firmly opposed the reservation of specific medical procedures exclusively for public hospitals, stressing that such a move would limit patient access to care. They urged that patients should not be restricted to receiving treatment only from public hospitals under the PMJAY scheme.

Additionally, they urged the National Health Authority of India to implement guidelines, including the reimbursement of 1% interest on delayed payments.

The association also made several demands to make the scheme more sustainable for private healthcare providers. The association demanded that no unjustified deductions or rejections be made. They also called for the establishment of a standardized rate for deductions, to be finalized in advance.

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