Punjab patients pained as Ayushman payments to GMCH-32 stop

The delay has forced the hospital authorities to suspend treatment under the scheme, leaving thousands of needy patients in the lurch

Healthcare services under the Ayushman Bharat Mukh Mantri Sehat Bima Yojana have come to a grinding halt at Chandigarh’s Government Medical College and Hospital (GMCH), Sector-32, for patients from Punjab due to the state government’s failure to release pending payments of around ₹4.9 crore since August 2024.

The Ayushman Bharat scheme aims to provide cashless health insurance of ₹5 lakh per family per year to approximately 65% of Punjab’s population, covering around 40 lakh families. (HT file photo)

The delay has forced the hospital authorities to suspend treatment under the scheme, leaving thousands of needy patients in the lurch.

“This is a dire situation. We want to continue helping patients, but without the funds, it’s impossible to sustain the scheme,” said GMCH-32 medical superintendent Dr Sudhir Garg.

“Despite repeated requests, the Punjab government has neither released the payments nor given any assurance about future reimbursements,” he added.

Launched in August 2019, the Ayushman Bharat scheme aims to provide cashless health insurance of ₹5 lakh per family per year to approximately 65% of Punjab’s population, covering around 40 lakh families. Yet, mounting dues are jeopardising the programme’s implementation at key tertiary care centres.

Dr Garg said, “While we continue to provide general care to poor patients, treatments covered under the scheme have been put on hold. The amount due has reached unsustainable levels.”

Punjab government claims that the scheme covers 44.99 lakh families, empaneling 772 hospitals - 210 public, 556 private, and six central government hospitals. The growing financial gap now threatens to undermine the scheme’s credibility and disrupt healthcare access for the state’s underprivileged population.

Patients, many of whom rely on the scheme for critical treatments, are left in uncertainty, with no clarity on when or if at all will the dues be cleared. Hospital authorities have emphasised that the suspension will continue until the Punjab government addresses the payment crisis.

This isn’t the first time it’s happening. Ever since its launch in 2019, the scheme has remained mired in controversies. The budget has always remained an issue with Punjab. As per the agreement, it is mandatory to reimburse the treatment costs to hospitals within 14 days of submitting of bills. There is a provision of 1% per annum interest payments to hospitals in case of delay in payments.

Know the scheme

The Ayushman Bharat PM-JAY Mukh Mantri Sehat Bima Yojana provides health insurance cover of ₹5 lakh per family per year to almost 65% population in the state. Under this scheme, cashless and paperless treatment is available at government and empanelled private hospitals.

Initially, it was the Narendra Modi-led central government’s flagship programme in which 16.65 lakh families were covered. But in 2022, the then Captain Amarinder Singh-led Congress government in Punjab decided to extend the scheme to families of farmers and arhtiyas, and those who are not covered under any health scheme, thereby adding more beneficiary families.

As it was the flagship programme of the central government, some portion of the scheme is paid by Centre and rest by the state government. The scheme also extends to PGIMER and GMCH-32 in Chandigarh. But while the state is clearing the dues for PGIMER, it hasn’t paid GMCH-32 in August.

How does it work

After a patient’s eligibility is confirmed under the scheme, a file is created containing their details, including the proposed treatment plan and estimated cost

This information is then sent for approval with codes of treatment and estimated budget

The approval takes a few hours and once the budget is passed, the patient can get cashless treatment under the scheme

At GMCH-32, approximately 400-450 patients benefit from this process each month, availing treatments ranging from minor procedures to critical care services.

How is the crisis impacting patients

With the scheme currently suspended at GMCH-32 due to pending payments, patients who once relied on it are now left scrambling for alternatives. Many are forced to delay their treatments indefinitely, waiting for the scheme to resume.

Others are left with two difficult choices: paying out-of-pocket for their medical care, often an unmanageable expense for those from low-income backgrounds, or seeking treatment at an already overburdened PGIMER, leading to significant delays in treatment.

The situation has created a ripple effect, burdening other healthcare facilities in the region while leaving thousands of patients without timely and affordable treatment options.