Explainer: Ayushman scheme faces test of survival in Haryana

A flagship Central scheme that offers free treatment to poor patients even in private hospitals is facing an existential crisis in Haryana. The tussle between private hospitals empanelled under the Ayushman Bharat scheme and the state government is showing no signs of ending soon, leaving lakhs of patients in limbo.

Since August 7, private doctors in around 600 hospitals across the state, under the banner of the Indian Medical Association (IMA)-Haryana, have suspended treatment of patients having Ayushman cards. The doctors claim that at the time of the suspension of treatment, the state BJP government owed them nearly Rs 500 crore in unpaid dues, making it impossible for hospitals to continue offering services under the scheme.

The Ayushman Bharat scheme provides health insurance coverage of Rs 5 lakh per family per year. The scheme is designed to help poor and vulnerable families access quality healthcare in both government and empanelled private hospitals.

For the initial list of beneficiaries identified by the Union government, the state government contributes 60 per cent of the payment, while the Centre provides 40 per cent. For the rest of the beneficiaries, the entire cost is borne by the state government. Several Ayushman card holders have had to postpone their elective surgeries, while a large number of patients are now dependent on government hospitals across the state, which have limited beds and resources.

Cataract and orthopaedic surgeries are among the procedures being delayed, while emergency patients are thronging government facilities. Authorities in government hospitals say they are prioritising critical cases, but admit a strain on the system.

The national unit of the IMA has come out in support of its Haryana chapter, criticising the state government for failing to honour its financial commitments and endorsing the demand for fair payments and systemic reforms. Private doctors in the state are firm that services will not resume till their demands are fully met.

Doctors argue that with operating costs rising steadily, delayed payments and arbitrary deductions make it unsustainable to offer services under Ayushman Bharat. They maintain that unless there is a transparent and time-bound mechanism for fund disbursal, the scheme will collapse in private hospitals.

IMA-Haryana has not only demanded immediate clearance of all dues, but also a comprehensive overhaul of the system. “The entire process must be streamlined. The new portal launched in February 2024 has unresolved glitches, there are illogical deductions after patient discharge, and communication with the state authorities is poor. We also demand an annual budget allocation of at least Rs 2,500 crore to ensure smooth functioning,” said Dr Mahaveer P Jain, president of IMA-Haryana. He warned that the Ayushman services will remain suspended until their “genuine demands, made in the larger interest of patients as well as hospitals”, are met.

Private doctors allege that the crisis has been aggravated not only by the delay in clearing dues, but also due to “harassment from local authorities by conducting raids and issuing notices”.

Meanwhile, the state government has denied ignoring the concerns of private hospitals. Sangeeta Tetarwal, CEO of Ayushman Bharat Haryana, said the government has been disbursing funds regularly. “Out of the total Rs 434 crore pending, we have already disbursed around Rs 250 crore since August 5, two days before the strike began. On Friday itself, we received an additional Rs 291 crore, which will be disbursed soon,” she added.

Tetarwal admitted that notices were issued to five hospitals for refusing to treat patients, but insisted that there was no impact of the suspension.

“Private doctors are still treating patients, and the number of claims we are receiving has increased. So far, we have received 81,000 claim applications this month, compared to 80,000 during the entire last month,” she said.