Ayushman Bharat in J&K: Private hospitals must wait for the High Court decision

As Jammu and Kashmir’s empanelled private hospitals have warned of  halting services under the Ayushman Bharat scheme due to delay in the payment of their due funds, it would be prudent for the hospitals to wait for the J&K High Court order on the matter. While the private hospitals’ association has  said that the member hospitals have not received payments amounting to Rs 300 crore since March this year, government’s estimation of the dues seems different. While the exit of Bajaj Allianz as the insurance provider for the scheme, followed by the latest action of the new insurer – IFFCO-Tokio – have complicated the scheme implementation, any extreme step at this stage could jeopardise patients’ access to critical life-saving services under the scheme in J&K, and must be avoided. While the  court of law, in its  best wisdom, would make the final decision on the matter, it is worthwhile to highlight another crucial aspect of this issue that merits attention—the integrity of the claims made by hospitals and their billing practices.

The Ayushman Bharat scheme is designed to provide affordable healthcare to millions of people across India, and especially in states like Jammu & Kashmir, where access to quality healthcare can be challenging. However, for this scheme to function effectively, hospitals must uphold the highest standards of transparency and fairness in their dealings with both the government and patients. Most of the private hospitals have been rendering healthcare services under the scheme with professional commitment and integrity, and they need to be recognized for that. However, certain private hospitals have, on occasions, fallen short of fulfilling the standards and patient expectations as enshrined in the scheme. To make the scheme work without hiccups, all hospitals must ensure that all claims submitted to the government under the Ayushman Bharat scheme are accurate, justified, and in compliance with the rules. At the same time, they should provide patients with clear, detailed, and legally binding invoices that fully disclose the services rendered and the costs incurred. This transparency is essential not only for the integrity of the scheme but also for maintaining the trust of the public.

Consider the case at Shifa Hospital, Srinagar, on June 23, 2023, where a woman (MRD No SS/1988) was charged an additional Rs 50,000 in cash for a simple laparoscopic surgery and removal of a dermoid cyst. The payment was demanded to be made in cash, despite the patient insisting for a bank transfer or a cheque payment. Even if the questionable payment was ‘due’, the bill she received was not a legal invoice; instead, it was a generic receipt devoid of specific details, such as the breakdown of services charged or the precise nature of the surgery performed. When the patient insisted on a proper bill, a stamp was belatedly added to the invoice, but still without the necessary details about what the Rs 50,000 had been charged for.

This incident is not an isolated one. Such practices create confusion, mistrust, and a sense of exploitation among patients, who rely on hospitals to provide clear and honest billing for the services rendered. For the Ayushman Bharat scheme, which is a lifeline for many, such practices can undermine public confidence and compromise the scheme’s objectives.

While the current impasse between the government, the insurance company, and the hospitals is unfortunate, it also presents an opportunity for introspection and reform. As hospitals demand timely payments from the government, they must also commit that all member hospitals, without exception, improve their own practices. This includes ensuring that their claims are legitimate and that their billing processes are transparent and fair. The decision by the J&K High Court on the matter needs to be respected by all the parties.

The Ayushman Bharat scheme is too important to be derailed by issues of mismanagement, whether on the part of the government or the hospitals. For the sake of the millions who depend on this scheme, it is imperative that all stakeholders—government, hospitals, and insurance companies—work together to ensure its smooth and transparent operation. This includes not only timely payments but also a commitment to fairness and integrity in all aspects of its implementation.

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