Gujarat: Private Hospitals, doctors exit AB-PMJAY over payment delays

Despite over 4.77 crore citizens registered under the Ayushman Bharat Health Account (ABHA), many doctors are backing out of the Pradhan Mantri Jan Arogya Yojana (PM-JAY), citing irregular and delayed payments by third-party administrators (TPAs) that have left healthcare providers cash-strapped.

Several private practitioners and small hospitals reported that operating under the scheme has become financially unsustainable. One such case is that of Dr. Ramesh Patel, an orthopedic surgeon who ran a 15-bed facility in Palanpur. After facing a loss of nearly Rs. 4 lakhs while treating patients covered by PM-JAY, Dr. Patel has decided not to renew his hospital’s participation in the scheme, reports Ahmedabad Mirror. “I was to recover Rs 12 lakh under the PM-JAY scheme, but I was paid only Rs 8 lakh. In spite of multiple representations to the TPA and government, I am still waiting for the remaining payment,” said Dr Patel.

According to the Daily, healthcare professionals in Ahmedabad echo similar concerns. Many have voiced opposition to existing regulations, such as the stipulation that 30% of cases must be trauma-related before Total Knee Replacement (TKR) procedures can be approved. This has significantly hindered their ability to offer effective treatment. The Ahmedabad Hospitals and Nursing Homes Association (AHNA) has submitted a formal appeal to the Gujarat government, urging a review of policies to reflect clinical realities and improve operational sustainability.

All over the country, many ABHA-empanelled hospitals are denying patients due to a hefty number of unpaid dues. Medical Dialogues had earlier reported that a total outstanding amount of Rs 1,21,61,45,63,617 (₹1.21 lakh crore) remains unpaid to empanelled hospitals under the Ayushman Bharat scheme (AB-PMJAY), with more than 63 lakh pending claims yet to be cleared, revealed the data shared by the National Health Authority (NHA) in response to a RTI application.