JK AB-PMJAY SEHAT Scheme
A severe healthcare crisis is gripping Jammu and Kashmir, as payment delays and contract disputes threaten to cripple the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) SEHAT scheme.
The scheme, launched in 2020 to provide free health insurance to all residents, is struggling to pay hospitals on time.
Nearly 3 lakh patient cases are pending, with around 1000 cases processed daily as per reports from private hospital administrators.
Paramount Company, based in Goa, took over processing insurance claims under the PMJAY SEHAT Scheme Golden Card, but the backlog continues to grow.
Private hospitals, critical to the scheme’s success, are reluctant to continue providing services due to delayed payments. IFFCO TOKIO General Insurance Company Limited’s premature contract termination has further exacerbated the issue, leaving 137 private hospitals without payments since March 15, 2024.
Talking to Greater Kashmir, Minister of Health and Medical Education, Sakeena Masood (Itoo) said that she would soon take a detailed account of the scheme.
“I will see why there are issues, if any,” she said.
On November 5, Chief Secretary Atal Dulloo impressed upon the Health and Medical Education Department to expedite the payments, and clear all dues by the end of this year.
The hospitals have contended that cases of dialysis centres and nursing homes are being rejected without justifications and prior intimation.
“This is a gross violation of guidelines,” a hospital owner said.
He said that the High Court had categorically directed the insurance company not to deduct or reject cases based on “flimsy” grounds, but it was happening regularly.
“Now we fear that we will not get back the money we already spent. They will trim and cut our payments,” he said.
The situation is not drastically different in government hospitals.
Many hospital administrators that Greater Kashmir spoke to said that the vendors from whom they procured supplies had threatened to stop working with them since the hospitals were unable to pay on time.
Meanwhile, many private hospital owners feel the government needs to expedite the cases and payments.
“We are struggling to keep our hospitals running,” said an owner of a private hospital in Srinagar. “The government assured us of timely payments, but it has been months since we have received any funds.”
He said that the government has allocated Rs 473 crore to the insurance agency, but procedures worth Rs 420 crore had been carried out across hospitals, with premiums also getting overdue.
As the crisis deepens, patients are set to bear the brunt.
In the recent past, some hospitals stayed out of the empanelment process fearing payment issues by the government.
The Jammu and Kashmir State Health Agency (SHA) has assured private hospitals that their money was safe and secured, but experts say prompt government intervention was necessary to resolve the payment-related issues.
“The government should take immediate action to address the concerns of private hospitals,” a health administrator said. “Otherwise, poor patients will suffer with only government hospitals available for critical treatments and interventions.”
In August this year, the High Court of Jammu and Kashmir and Ladakh temporarily directed the IFFCO TOKIO General Insurance Company Limited to continue with the existing arrangement regarding the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana-SEHAT scheme
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