First low Rates, then No Payments! Hospitals decry Ayushman Bharat Yojana, point to Rs 1.21 LAKH crore dues

New Delhi: With a whopping Rs 1.21 lakh crore pending claims under Ayushman Bharat Yojana, the hospitals are now decrying the payments for the services already rendered. While the hospitals pointed out that even though rates were low they participated knowing that this was a government scheme, however, now non-payment is becoming a concern.

As per the Centre, over 29,000 hospitals including 12,625 private ones, are empanelled with the Ayushman Bharat scheme.

The Ayushman Bharat PM-JAY was launched in September 2018 by Prime Minister Narendra Modi, as part of the National Health Policy 2017. It is the largest health insurance scheme in the world. Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) is a health insurance scheme providing financial protection for secondary and tertiary healthcare to economically vulnerable families. Beneficiaries can access cashless treatment at empanelled hospitals, ensuring affordable healthcare services and reducing out-of-pocket medical expenses.

In 2019, the scheme was allocated Rs 2,400 crore. The budget was significantly increased by 166 per cent to Rs 6400 crore in 2020. After 2 years, the budget saw a meagre increase of Rs 12 crore. Last year in 2024, the budget was then increased to Rs 7200 crore with only a 100 crore increase approved this financial year for the scheme. for 2026, the budget of around Rs 9400 crore is estimated.

While the government has only around Rs 7300 crore in its budget for the Ayushman Bharat beneficiaries, the Government owes a total outstanding amount of around Rs 1.21 lakh crore to the empanelled hospitals under the Ayushman Bharat Scheme (AB-PMJAY) for more than 63 lakh pending claims.

The National Health Authority (NHA) revealed this data while responding to a query raised in this regard through a Right to Information (RTI) application. Filing the RTI, Mr Ajay Basudev Bose had sought the details regarding the statistical details of the total pending amount owed to the hospitals empanelled under the Ayushman Bharat Yojana scheme.

In response to this, the NHA disclosed that a total of Rs 63,89,517 claims remained uncleared, and these pending claims led to a staggering amount of Rs 1,21,61,45,63,617 remaining as outstanding dues to empanelled hospitals under the Ayushman Bharat Yojana.

Doctors from private hospitals have pointed out that the rates of treatment under the AB-PMJAY (Ayushman Bharat Pradhan Mantri Jan Arogya Yojana) scheme have not been revised properly and in most of the cases, the payment gets delayed by months, affecting the cash flow.

While big hospitals, having a huge number of patients, manage the situation, it becomes extremely difficult for smaller hospitals to exist amid this crisis. According to doctors, even though the

When asked how the doctors are facing the delay in payments, Dr. Alex Thomas, the founder and patron of the Association of Healthcare Providers India (AHPI) informed Medical Dialogues that the empanelled hospitals have to perform the procedures at a rate below the cost. Due to this, the hospitals have to face a huge loss.

In addition to that, the delayed payments from the Government's end make it very difficult for the hospitals as it impacts the cash flow, explained Dr. Thomas, adding, "The hospitals also have to pay their staffs."

"We have submitted many representations. However, the situation has not changed. We hope that the Government will respond and if they cooperate, this can be made into one of the best schemes across the world," he mentioned, further pointing out that because of low rates and delayed payments, the hospitals are finding it very difficult to survive.

Dr. Narin Sehgal, Director of SNH (Sehgal Neo Hospital), and Secretary Delhi State AHPI said, "Ayushman Bharat per se as such is a great scheme. If it is handled well, it can change how healthcare is delivered in India. But the point is there is so much gap between what is promised and what is delivered. There are a lot of issues which need to be handled and one of them is the rates and the second is the timely payments."

"If you do not get proper rates, it would affect the cash flow. Maybe very very big houses, who have deep pockets would be able to handle it and they have their own ways and they have large volumes of other kinds of patients also. But if you really want this scheme to be successful, to be implemented well and to be utilized well in tier-2 and tier-3 cities, then how will smaller cities handle this? The quality would get affected if there is no cash flow, without proper rates, there would be shortcuts. This is not a good thing. We are going in the wrong direction because of improper management of this scheme," he added.

Dr Sehgal mentioned that the Government had promised to revise the rates in a timely manner. However, the rates of only a minuscule number of package rates have been revised, not in everything.

Mentioning that the hospitals get Rs 9000 rupees per delivery and Rs 11,000 for C-section, he added that if the costing of even the smallest hospitals in Delhi is considered, then it would be clear that one cannot survive in Rs 9,000 or Rs 11,000. "Rates are impractical, not genuine and they are not thought of well," he added.

When asked about the RTI response revealing that the Government owes Rs 1.2 lakh crore under the scheme, he added, "Apart from revising rates, timely payment is also very important. Otherwise, there should be heavy penalty." He also highlighted that even though there are provisions for the Government to pay interest for delayed payments, it has never been honoured.

Commenting on the matter, Dr. Alex Thomas added, "They have to remember that for hospitals also this has to be an affordable execise. If the payment doesn't come in time, it becomes very difficult financially." He also opined that one solution could be that the Government pays interest if the payment gets delayed beyond 3 months.

Also Read: Rs 1.21 lakh Crore claims pending under Ayushman Bharat, reveals RTI