PM Modi's 'Revolutionary' Health Insurance Scheme in Jammu and Kashmir Faces Closure

The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (government health insurance scheme) in Jammu and Kashmir, is on the verge of closure due to delayed reimbursement to the empanelled hospitals and a legal dispute between the insurance company and the LG administration, writes ETV Bharat's Mir Farhat Maqbool.

Srinagar:The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (government health insurance scheme) in Jammu and Kashmir, which Prime Minister Narendra Modi, termed "revolutionary" in the country's healthcare, is on the verge of closure due to delayed reimbursement to the empanelled hospitals and legal dispute between the insurance company and the LG administration.

Facing a fund crunch due to no reimbursement since March, the owners of the empanelled hospitals have shot an alarming letter to the chief secretary of Jammu and Kashmir, Atal Dullo, pleading their inability to deliver their services to patients beyond May. In all, 239 government and private hospitals are empanelled under the scheme.

"The private hospitals and dialysis centres empanelled under the SEHAT scheme have not received any payment since March 15, 2024. We will be unable to continue with the said scheme beyond June 1, 2024," the letter warns the government.

The owners of the empanelled hospitals told ETV Bharat that they had dashed off the letter on May 17 to the Chief Secretary through the office of the Chief Executive Officer of the State Health Agency, Sanjiv M Gadkar. The letter states that the empanelled hospitals have exhausted their funds to run their health centres under the scheme.

The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), commonly known as the 'Golden Card' scheme, was launched by Prime Minister Narendra Modi in 2018 to provide health insurance coverage of Rs 5 lakhs to all residents of Jammu and Kashmir.

The scheme, a ray of hope for patients that enables them to avail healthcare at private hospitals for free, faced its first roadblock when IFFCO-TOKIO General Insurance Company Limited unilaterally terminated its three-year contract with the Jammu and Kashmir government in November 2023. The contract was executed for three years starting from March 10, 2022, and would have ended on March 14, 2025.

ETV Bharat had first reported about the termination of the contract in February this year.

Notwithstanding requests from the State Health Agency (SHA) to continue, IFFCO-TOKIO said it was not interested in renewing the contract. The SHA knocked the Jammu and Kashmir High Court for continuation of the contract, but the single bench of Justice Wasim Sadiq Nargal in February this year dismissed its petition compelling the government to approach the Division Bench for staying the single bench order. And the case got stuck in legal rigmarole with no relief as yet.

Nodal officer SHA said that the scheme is running smoothly as of today and due to a legal battle in the High Court between the SHA and the insurance company, they are not able to take any decision.

"As of today, no empanelled hospital has stopped its service to the patients despite delayed reimbursement to them. Patientcare is not hit as yet and hopefully, it won't have any impact in future," the officer said.

IFFCO-TOKIO Chief Manager Mukhtar Lone told ETV Bharat that they will not make any payment to the hospitals this year as they terminated their contract last year.

"We withdrew our contract as per the guidelines, so we will not pay from this year [March 2024 to March 2025]," Lone told ETV Bharat.

Worried about the lack of funds, the empanelled hospital owners have met CEO SHA and Nodal Officer SHA, but with no relief.

"We are not able to pay salary to our employees for March and April and our distributors are also not getting any payment for equipment and medicine," hospital owners said.

"Our money has been exhausted and we won't be able to accept the golden card and provide services to patients without payment," they said.

As per the SHA, more than 97,17,471 people have benefited from the scheme as it has issued 82,10,171 Ayushman cards and settled 10,468,53 claims since the launch of the scheme. The SHA says that more than 1,400 procedures like surgeries and dialysis take place every day in Jammu and Kashmir as patients avail this scheme.

Should the empanelled hospitals stop their service from June as they have warned the government, the patients will suffer as healthcare is getting costlier day by day.