Ayushman Bharat Scheme Faces Financial Challenges

The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) has been a cornerstone of India’s universal health coverage initiative, providing up to Rs 5 lakh annually in cashless hospitalization to nearly 55 crore economically weaker individuals. This scheme aims to cover the bottom 40% of India’s population, ensuring access to essential healthcare services. As of now, over 9.84 crore hospital admissions have been approved, with payments surpassing Rs 1.40 lakh crore, as reported by the government in parliament.

Widespread Issuance of Ayushman Cards

A significant aspect of the scheme’s implementation is the issuance of Ayushman Cards, which facilitate access to healthcare services. More than 41 crore cards have been distributed across the country, with Uttar Pradesh leading at 5.33 crore cards issued. Other states like Madhya Pradesh, Bihar, and Odisha follow closely, while Lakshadweep has issued the fewest at 36,000 cards.

Operational Model and Hospital Participation

The scheme operates through a network of 31,466 hospitals, including over 14,000 private facilities. These hospitals function under Trust, Insurance, or Hybrid models, allowing for state-specific flexibility in implementation. However, participation from high-quality hospitals remains limited due to financial and operational challenges.

IMA’s Concerns Over Unpaid Claims

The Indian Medical Association (IMA) has expressed serious concerns regarding unpaid claims under the scheme. In a white paper submitted to the National Health Authority (NHA), the IMA highlighted issues such as delayed payments, low reimbursement rates, and complex claim processes that threaten hospital finances. In Gujarat alone, Rs 300 crore in claims from 2021 to 2023 remain unpaid. Similarly, Kerala faces Rs 400 crore in pending dues. Nationwide, over Rs 1.21 lakh crore in claims are still outstanding.

Recommendations for Improvement

To address these challenges, the IMA has proposed several recommendations: – Automate payments and implement real-time tracking for transparency.
– Revise reimbursement rates to reflect actual costs and update them regularly.
– Simplify claim documentation and provide 24/7 digital support.
– Establish grievance redressal mechanisms at district, state, and national levels.
– Incentivize accredited and rural hospitals with higher payments and faster approvals.
– Transition to direct benefit transfers using fintech solutions to improve efficiency.

Government Response and Future Outlook

Minister Prataprao Jadhav acknowledged these implementation challenges in the Rajya Sabha and urged states to adjust their models for better efficiency. The IMA’s white paper is currently awaiting a response from the NHA. Without necessary reforms, doctors warn that the scheme’s goal of providing free, quality healthcare for India’s poorest could be jeopardized.