Ayushman Bharat Scheme: Ayushman Bharat scheme is in financial crisis, 64 lakh claims are stuck..

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) is in crisis. Under this scheme, about 55 crore economically weaker people of the country are provided with a cashless hospital treatment facility of up to Rs 5 lakh every year. But the biggest health scheme to provide free treatment to the poorest section of the country is facing a serious financial crisis. The Indian Medical Association (IMA) has said that more than Rs 1.21 lakh crore is still outstanding for the treatment done by private hospitals under the Ayushman Bharat scheme. Due to non-receipt of money on time, the hospital is unable to treat Ayushman cardholders. The IMA has given a white paper to the National Health Authority (NHA) regarding the scheme.

On Friday, the government told Parliament that so far, 9.84 crore hospitalizations have been approved under the Ayushman scheme, and more than Rs 1.40 lakh crore has been paid. Under this scheme, which provides free treatment to about 40 percent of the country's population, more than 41 crore Ayushman cards have been made so far. Uttar Pradesh is at the forefront with 5.33 crore cards, followed by Madhya Pradesh, Bihar, and Odisha. Lakshadweep has the least number of cards made at 36,000. There are 31,466 hospitals included in the Ayushman scheme, including more than 14,000 private hospitals.

Private hospitals are not getting money on time.
IMA says that delay in payment, low package rates, and complicated claim process have broken the back of private hospitals. According to the data given by IMA, claims of Rs 300 crore between 2021 and 2023 are still pending in Gujarat. Liabilities of more than Rs 400 crore are pending in Kerala. According to an RTI, claims worth Rs 1.21 lakh crore are still pending in 64 lakh cases across the country. Only 5% of these cases have been settled within the stipulated time (15 days).

Low package rates

IMA said that the package rates fixed under the scheme are very low, which do not cover the cost of complex surgery and critical treatment, especially in private hospitals. There are more than 1,000 private hospitals in cities like Delhi, but only 67 hospitals are associated with the scheme because the rest of the hospitals have to bear losses in operation. IMA has demanded that the government include it in the process of deciding the package.

Suggestions given by IMA
IMA has suggested automating the payment process and implementing a real-time tracking system to maintain transparency. Apart from this, the government has been suggested to revise the package rates according to the actual cost and update it from time to time, simplify the documentation of claims, start a 24×7 digital help desk (WhatsApp, SMS, etc.) facility, and establish a complaint redressal system at the district, state, and national level.

The government also admitted the shortcomings.

Health Minister Prataprao Jadhav also admitted in the Rajya Sabha that there are challenges in the implementation of the scheme and he has asked the states to improve their model so that the scheme can be more effective. The white paper presented by the IMA has been submitted to the Standing Committee on Health of the Rajya Sabha. Now the response of the NHA is awaited. The IMA has warned that if improvements are not made, this ambitious scheme, which was started with the aim of providing free and quality treatment to the poor of India, may itself become sick.

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