J&K Pvt Hospitals Threaten To Stop Ayushman Services For Non-Payments

(MENAFN- Kashmir Observer) Srinagar- Private dialysis centers and hospitals empaneled under the Ayushman Bharat Scheme (AB-PMJAY) in Jammu and Kashmir are facing an unprecedented financial crisis, with payments pending since March 14, 2024.

The delay in releasing funds has left these healthcare facilities on the verge of bankruptcy, potentially jeopardizing medical services for thousands of patients across the Union Territory.

Despite repeated assurances from government officials, including the Chief Executive Officer (CEO) of the Ayushman Bharat Scheme, the hospitals said that payments have not been disbursed.

“An official meeting held in April 2024 saw the CEO promise a resolution by the first week of May 2024. However, when no funds were released, the private hospitals and dialysis centers submitted an urgent appeal to the Chief Secretary via the CEO on May 18, 2024, requesting the release of funds by May 31, 2024,” a spokesperson of the Jammu and Kashmir Empanelled Hospitals and Dialysis Centres said, adding that in response, the Secretary of Health convened an online meeting on May 31, 2024, assuring healthcare providers that the issue would be resolved soon, leading to a temporary suspension of the planned shutdown of services.

However, the situation has only worsened, with the hospitals and dialysis centers now unable to sustain operations due to severe financial constraints.

“The ongoing legal dispute between the government and the insurance company, IFFCO Tokio, over payments for wrongfully rejected and deducted claims has further exacerbated the crisis. Despite orders from the State Health Agency, IFFCO Tokio has yet to release approximately ₹300 crore in pending payments,” he said.

In a last-ditch effort to avoid a complete collapse, the private healthcare providers have submitted a letter to the District Commissioner (DC) Srinagar, seeking the release of emergency funds under the DC's jurisdiction. They have also issued a public appeal, informing citizens that they will no longer be able to provide services to Golden Card patients under the Ayushman Bharat Scheme after August 31, 2024, unless the funds are released.

The healthcare providers have expressed deep regret for the inconvenience this may cause to patients, emphasizing their commitment to the Ayushman Bharat Scheme. However, they have stated that, until the funds are released, they will only be able to offer services on a cash basis.

This financial crisis threatens to disrupt essential healthcare services in Jammu and Kashmir, with potentially severe consequences for public health in the region. The hospitals and dialysis centers are appealing to the authorities for an immediate resolution to the issue, urging the government to prioritize the release of funds to prevent a complete breakdown of healthcare services.

The health insurance scheme was started in J&K to provide healthcare coverage to all residents. The scheme was initially implemented through Bajaj Allianz General Insurance Company Limited, whose contract ended in 2022, after which IFFCO-TOKIO was roped in.

Last November, IFFCO-TOKIO General Insurance Company, the insurer for Ayushman Bharat in J&K, informed SHA authorities of their decision not to renew the contract after its expiry on March 14, 2025. Despite SHA's requests for them to continue in the interest of patient care, the company refused.

The SHA approached the High Court to stay the exit, but the petition was dismissed on February 2, complicating matters further for both SHA and beneficiaries across the union territory. The government has since approached the division bench to stay the single bench order, making the issue sub judice.

Sanjiv M Gadkar, Chief Executive Officer (CEO) of the State Health Agency, Jammu and Kashmir had earlier said that empanelled private hospitals have continued their services despite not receiving payment on time, and expressed gratitude for their commitment.“We are one of the stakeholders in the implementation of the scheme and all possible steps are being taken to resolve the issue on priority,” he told
a local news agency.

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