HT Explainer: What’s ailing Ayushman Bharat scheme in Punjab

Private hospitals in Punjab suspended treatment to patients under the Ayushman Bharat PM-JAY Mukh Mantri Sehat Bima Yojana. This isn’t the first time it’s happening. Ever since its launch in 2019, the scheme has remained mired in controversies.

What is the scheme?

The Ayushman Bharat PM-JAY Mukh Mantri Sehat Bima Yojana provides health insurance cover of ₹5 lakh per family per year to almost 65% population in the state. Under this scheme, cashless and paperless treatment is available at government and empanelled private hospitals. Initially, it was the Narendra Modi-led central government’s flagship programme in which 16.65 lakh families were covered. But in 2022, the then Capt Amarinder Singh-led Congress government in state decided to extend the scheme to families of farmers and arhtiyas and those who are not covered under any health scheme, thereby adding 22.12 lakh more beneficiary families.

What are the core benefits of the scheme?

Health cover of ₹5 lakh per family per year and cashless treatment at secondary and tertiary care centres in public and empanelled private hospitals in all states of the country. Pre-existing diseases are also covered. Treatment package includes three days’ pre-hospitalisation and 15 days’ post hospitalisation expenditure.

Why is the scheme running into controversies?

Ever since its launch in Punjab, budget has always remained an issue. As per the agreement, it is mandatory to reimburse the treatment costs to hospitals within 14 days of submitting of bills. There is a provision of 1% per annum interest payments to hospitals in case of delay in payments. According to private hospitals, these payments have never been made on time. In 2021, private hospitals stopped treatment citing undue checking by the insurance company hired by the government to make payments on its behalf. In 2022, private hospitals denied treatment to patients under the scheme, citing pending payments of ₹130 crore.

Why have private hospitals stopped treatment now?

The state health agency itself disburses the claims through a ‘Trust’. Private hospitals now rue that the health agency has to give ₹600 crore as dues to them. However, state health minister Dr Balbir Singh says the figures are inflated and they owe only ₹197 crore. The Nursing House Cell (NHC), a body representing private hospitals, said: “Pendency has completely emptied our finances. The state government had come up with manipulative figures related to the pending dues. Till the time the government clears our all dues, we won’t return to treatment under this scheme.”

What does the health minister have to say?

Health minister Dr Balbir Singh said the total pending amount for both public and private hospitals is ₹364 crore. He said since April 1, 2024, the government has disbursed ₹101.66 crore to private hospitals and ₹112 crore to public hospitals, totalling ₹214.3 crore.

Why the blame game?

The state government has also been blaming the Centre for delaying paying ₹225 crore in the form of its share for the scheme. According to the health minister, the pendency is because of utilisation certificates sought by the Centre for the spendings during previous regimes.

What did JP Nadda say?

Union health minister JP Nadda urged Punjab chief minister Bhagwant Mann to clear the dues of hospitals under the Ayushman Bharat programme. Reacting over the announcement of the Private Hospital and Nursing Home Association (PHANA) to halt cashless treatments under the government’s health insurance scheme, Nadda wrote on X, “Ayushman Bharat was conceptualised to aid the economically backward families with ensured medical cover, and today, due to the mismanagement of the state government in Punjab, people have lost access to free healthcare”.

What Oppn has to say?

Leader of Opposition Partap Singh Bajwa said there is a stark difference between what the government has been claiming and what the ground reality is. “Health has been an area which this government has claimed to have improved to a world-class level. Reality is totally opposite. Insurance scheme started during Congress regime is in shambles thus depriving the poorest of the poor of free healthcare. What can be more shameful that even PGIMER, Chandigarh, had earlier stopped giving treatment to the patients under this scheme,” said Bajwa.