Rs 1500 core pending for hospitals under Ayushman Bharat, IMA Raipur raises concern

Hospitals are still awaiting payment for claims under the Ayushman Bharat health insurance scheme, one of the flagship initiatives of Prime Minister Narendra Modi's government. Despite efforts by the Union government to address the issue, hospitals have not received crores worth of screening payments for up to 10 months.

Officially known as the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY), it is dubbed the largest publicly funded health insurance scheme and it currently covers secondary and tertiary care healthcare facilities for beneficiaries up to Rs 5 lakh per family a year at both public and private empanelled hospitals. The IMA's correspondence with the government points to issues over the sustainability of continuing the scheme for patients if the claims reimbursement process is delayed, reports News18. 

The letter cautioned that failure to pay dues could force hospitals to start protests including the possibility of doctors going on fasting. The IMA also demands a strong policy to pay the money on time. Additionally, the association suggests that a 1 percent interest charge should be applied to amounts pending post-July, along with a review of health benefits packages to prevent unnecessary deductions in pricing.

“As you are aware, all government and private hospitals in the state under the Ayushman Bharat Swasthya Yojana are yet to receive the payment of Rs 1,500 crore for the last several months," said the letter written by state representatives of the Indian Medical Association, Raipur. “The association has been requesting the same to you from time to time. But there is no decision-making and no concrete policy on this subject," the letter further added.

The letter was written by Dr Rakesh Gupta (president, IMA Raipur), Dr Anil Jain (president, hospital board, Raipur) and Dr Digvijay Singh (secretary, IMA Raipur) on November 30. According to the Association of Healthcare Providers of India (AHPI) the issue of delay in initiating reimbursement has been a burning issue in many states, not only in Chhattisgarh.

“Data shows that there are 29,000 hospitals which have up to 50 beds empanelled under the scheme followed by 3,750 hospitals with a capacity of 50-100 beds and 1,600 hospitals with a capacity of 100-200 beds," Girdhar J Gyani, director-general, AHPI, told News18. Evidence suggests that the system disproportionately affects smaller healthcare facilities. “These small hospitals won’t be able to sustain without timely reimbursement as they do not have deep pockets. Eventually, they will stop providing the services under the scheme which will be very unfortunate for Ayushman Bharat, a scheme of world-class stature," Gyani said.

When it comes to the issue of overspending that causes payment delays, AHPI often points the finger at state governments as well. The benefit of the initiative has been extended by numerous state governments to beneficiaries beyond the database of the Union government. The federal government foots 60% of the bill, while the individual states chip in the remaining 30%. Therefore, states should be careful with their spending as they bring more people into the program.