Ayushman Bharat: A Vision of Universal Healthcare
Launched in 2018, the Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is India’s flagship health insurance scheme, aimed at providing financial protection for secondary and tertiary healthcare to the poorest sections of society. With an annual health coverage of ₹5 lakh per family, the scheme supports over 12 crore vulnerable families nationwide. In Haryana alone, 1.36 crore citizens are eligible beneficiaries.
However, the scheme has run into serious trouble in Haryana. As of early August 2025, around 650 private hospitals across the state have discontinued AB-PMJAY services, citing non-payment of dues amounting to ₹500 crore from the government. The move threatens to disrupt healthcare access for millions dependent on this scheme.
Why Hospitals Have Walked Out
The Indian Medical Association (IMA), Haryana chapter, has taken a firm stand against the delayed reimbursements. According to IMA officials, private hospitals haven’t received payment for the current quarter, with some claims pending for over a year. Despite an emergency meeting with the state’s chief secretary on August 6, where ₹145 crore from Haryana and ₹70 crore from the Centre were reportedly released, a whopping ₹490 crore remains unpaid.
“The root cause is a budgetary shortfall,” explained Dr. Suresh Arora, a senior consultant at Faridabad’s Surya Ortho & Trauma Centre. “The state allocates ₹700 crore annually, but actual expenses cross ₹1,400 crore. This mismatch has persisted for three years.” His own facility has dues worth ₹20 lakh still unpaid.
High-profile institutions like the 2,600-bed Amrita Hospital in Faridabad, inaugurated by PM Modi in 2022, are owed as much as ₹18 crore.
Breaking Trust: Violation of Payment Terms
Hospitals further allege the violation of key clauses in the Memorandum of Understanding (MoU), particularly the one ensuring interest payments on delayed reimbursements. The clause, meant to enforce financial accountability, has either been ignored or removed, especially by states like Haryana.
Dr Arora noted several operational issues:
· Claims rejected on flimsy technical grounds
· No incentive for hospitals accredited by NABH (National Accreditation Board for Hospitals)
· Reimbursements as low as ₹4,000–₹5,000 for procedures billed at ₹18,000
“This not only discourages participation but also endangers the quality of care,” he said.
Recurring Pattern, No Permanent Fix
IMA Secretary Dr. Dhirendar K. Soni revealed a cycle of administrative inertia. “Every three months, we’re forced to threaten withdrawal. Only then do we see partial payments. It’s unsustainable,” he said. Even after a meeting with Chief Minister Nayab Singh Saini in February, no long-term resolution has emerged.
Wider Impact Across India
Haryana’s crisis isn’t unique. Delhi, Chhattisgarh, and other newly participating states are also struggling with delayed reimbursements. According to RTI data obtained by activist Dr. Ajay Basudev Bose, ₹1.21 lakh crore is pending under the scheme nationwide.
Dr. Girdhar J. Gyani, Director-General of the Association of Healthcare Providers of India (AHPI), representing over 15,000 private hospitals, highlighted systemic issues. “If states go beyond the nationally defined list of beneficiaries, they must fund the extra burden themselves. Most don’t have the capacity to do so.”
States like Tamil Nadu, Telangana, Maharashtra, and Gujarat have extended AB-PMJAY coverage beyond the initial eligibility pool. But without adequate treasury support, the extra load has turned into debt.
Dr. Gyani also pointed to the Central Government Health Scheme (CGHS), another healthcare initiative for government employees, suffering from outdated rates last revised in 2014. “If hospitals are forced to operate under new, tighter CGHS rules without updated payments, mass withdrawals from that scheme are likely too,” he warned.
The Stakes: 1.4 Crore Lives at Risk in Haryana
With over 1.36 crore beneficiaries in Haryana relying on AB-PMJAY, the suspension of services by 650 hospitals is a massive blow to public health. Patients requiring surgeries, cancer treatments, dialysis, or emergency procedures could face delays, denial of care, or high out-of-pocket expenses.
Smaller hospitals, particularly in tier-2 and rural towns, are struggling with cash flow issues, making it harder for them to treat patients without the certainty of timely reimbursements.
Time for Structural Overhaul
The current impasse reflects deeper structural flaws in public-private healthcare collaboration. Delayed payments, budget mismatches, and lack of enforcement of contractual terms are disincentivizing participation from private hospitals—the very backbone of AB-PMJAY’s implementation.
Way forward:
· Establish automatic reimbursement mechanisms with real-time claim processing and tracking.
· Reinstate and enforce interest payment clauses on delayed disbursals to ensure accountability.
· Ensure Centre-State coordination with realistic budgeting and regular audits.
· Update reimbursement packages and provide differential rates for NABH-accredited hospitals.
· Create grievance redressal mechanisms for hospitals and streamline dispute resolution.
AB-PMJAY was envisioned as a beacon of healthcare equity, but its promise can only be fulfilled with transparent, timely, and accountable execution. Without that, India’s dream of universal health coverage risks falling into chronic crisis.
(With agency inputs)
