Punjab patients grieved as Ayushman payments to GMCH-32 stop

The delay 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 funds, it is impossible to sustain the scheme,” said Dr. Sudhir Garg, Medical Superintendent GMCH-32.

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

Launched in August 2019, the Ayushman Bharat scheme aims to provide cashless health insurance for ₹5 lakh per family per annum to about 65% of Punjab’s population, covering about 40 lakh families. However, rising fees are jeopardizing the implementation of the program in key tertiary care centers.

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

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

Patients, many of whom rely on the scheme for critical treatments, are left in limbo with no clarity on when or if the charges will be scrapped. Hospital authorities stressed that the suspension will continue until the Punjab government addresses the payment crisis.

It’s not the first time it’s happened. Ever since its launch in 2019, the scheme has remained mired in controversy. Budget has always remained an issue with Punjab. According to the agreement, reimbursement of treatment costs to hospitals within 14 days of submission of invoices is mandatory. There is a provision for interest payments of 1% per annum to hospitals in case of late payments.

Know the scheme

Ayushman Bharat PM-JAY Mukh Mantri Sehat Bima Yojana provides health insurance for ₹5 lakh per family per annum to nearly 65% ​​of the state’s population. Under this scheme, cashless and paperless treatment is available at government and private hospitals.

Initially, it was the flagship program of the Narendra Modi-led central government 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 the families of farmers and arhtiyas and those not covered by any health scheme, thereby adding more beneficiary families.

As it was the flagship program of the central government, part of the scheme is paid for by the Center and the rest by the state government. The scheme also extends to PGIMER and GMCH-32 in Chandigarh. But while the state is releasing fees for PGIMER, it has not paid GMCH-32 in August.

How it works

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

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

Approval takes a few hours and once the budget is passed, the patient can receive cashless treatment under the scheme

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

How the crisis affects patients

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

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

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