Pvt hospitals cut Ayushman services as payments drag
Some state governments have allocated insufficient funds for the health insurance scheme
New Delhi: The government is likely to soon finalize a framework for a state mining index which would serve as a tool for stakeholders and ensure ease of doing mining business, mines secretary V. L. Kantha Rao said on Wednesday. A state mining index would boost cooperative federalism as well as competition among states, Rao said at a daylong workshop on State Mining Index here.
Private sector hospitals in many states have scaled back services for beneficiaries of the Centre’s flagship health insurance scheme for the poor due to payment delays by state governments, leaving the vulnerable stranded in the middle of heatwaves.
The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), launched in 2018, is jointly funded by the Centre and states in the ratio of 60:40, with the Union government allocating ₹7,500 crore to it this year.
Officials from the Niti Aayog, health ministry and private hospitals who held a review meeting of the scheme on 1 May said they were concerned at the “inadequate release of funds” by states for the insurance scheme, persons aware of the matter said.
“The problem of [delays in] payments to the hospitals arose when states such as Telangana and Andhra Pradesh merged their state health scheme into the PMJAY,” said Girdhar Gyani, director general, Association of Healthcare Providers of India (AHPI), which represents most healthcare providers in India.
Delays in reimbursements have hampered cash flows at empanelled private hospitals and created “serious operational issues”, Gyani said. In turn, the scale-back in services at private hospitals could severely impact needy patients -- just when the brutal heatwave sweeping the nation triggers a surge in heat-related illnesses. “The government is positively reviewing the critical feedback of the scheme from the private sector,” one of the persons cited above said. “The National Health Authority has played its role. Now, the state governments must finance the scheme to make PMJAY sustainable for the private sector.”
“Right now, private hospitals are feeling exhausted because of PMJAY. Initially, the private sector thought they would be able to fill their vacant beds at subsidized rates, but now it is consuming their profits,” said the person, adding the Centre is trying to address the problem.
Queries sent to the health ministry and NHA spokesperson remained unanswered till press time.
“Pending bills of the hospitals are being reviewed by the finance department,” said Lakshmi Shah, CEO, State
Health Authority, Andhra Pradesh.
PMJAY currently has a network of 30,178 empanelled hospitals, of which 12,881 are private. They offer over 2,000 treatment procedures across 27 specialties.
“Hospitals can sustain low health package rates, but if the cash flow is affected, they will not accept the scheme and will start avoiding the beneficiaries citing unavailability of beds,” Gyani said, and added that a representation had been submitted to the government to resolve this matter as soon as possible.
“The Central government has been consistently telling the states that if they want to bring additional population under PMJAY, then the additional amount must be given by the state government only and the central government will not contribute to it,” said Gyani.
Ayushman Bharat aims to cover over 100 million poor and vulnerable families, or about 500 million individuals, providing coverage of up to ₹5 lakh per family per year for secondary and tertiary care hospitalization.
Around 68 million authorized hospital admissions have taken place and 400 million people have received their Ayushman cards so far.
Beneficiaries are selected on the basis of the Socio Economic and Caste Census (SECC) database of 2011.