Payment paralysis overshadows SEHAT scheme success

Srinagar, Aug 23: The ambitious free health insurance programme for all citizens of Jammu and Kashmir is facing a severe crisis.

Private hospitals and dialysis centres empanelled under the Ayushman Bharat Scheme have announced their decision to stop treating patients under this scheme starting September 1, citing non-payment of Rs 300 crore dues since March.

The decision comes as a significant blow to the healthcare system and potentially affects thousands of patients who rely on the scheme for their medical needs.

The outstanding dues, reportedly amounting to approximately Rs 300 crore have left these healthcare providers in a financial quandary.

A spokesman for the affected hospitals and dialysis centres said, “We are left with no option other than to stop our services under the free insurance scheme. We have exhausted all our resources as our payments have been pending since March. We have become defaulters of banks, our supplies, and employees, and it is not sustainable for us to continue.”

The root cause of this crisis stems from a legal dispute between the government and IFFCO Tokio, the insurance company responsible for the scheme.

“Despite orders from the State Health Agency to release payments for wrongfully rejected and deducted cases, IFFCO Tokio has reportedly not complied, exacerbating the financial strain on healthcare providers,” the spokesman said.

In a collective statement, the affected hospitals and dialysis centres expressed their regret saying: “We remain committed to the Ayushman Bharat Scheme and are dedicated to providing the best possible care to all our patients. However, until the funds are released and our suppliers and creditors resume their services, we will only be able to offer services on a cash basis.

“As a result, we regret to inform you that we will not be able to cater to Golden Card patients beyond August 31, 2024, till the payments are released. Our suppliers, who have supported us on credit until now, have categorically denied extending credit beyond this date. We remain committed to the Ayushman Bharat Scheme and are dedicated to providing the best possible care to all our patients. However, until the funds are released and our suppliers and creditors resume their services, we will only be able to offer services on a cash basis.

"We deeply regret any inconvenience this may cause and appeal to the authorities for an immediate resolution of this issue, as it directly impacts the lives and well-being of the people of Jammu and Kashmir.”

J&K administration’s free health insurance scheme, SEHAT (Social Endeavour for Health and Telemedicine), has saved residents of J&K a staggering Rs 2285 crore in medical expenses.

This universal health coverage initiative, providing each family with Rs 5 lakh annual insurance entirely free of cost, has emerged as a game-changer in J&K’s healthcare landscape.

Since its launch in August 2020, SEHAT has demonstrated remarkable reach and impact.

Over 85.49 lakh individuals have been issued Golden Cards, granting them access to the scheme’s benefits.

This widespread adoption represents a significant portion of the J&K’s population, indicating high acceptance and utilisation of the programme.

The scheme’s infrastructure is robust, with approximately 251 hospitals empanelled under the AB-PMJAY-SEHAT scheme.

This extensive network ensures beneficiaries have access to a wide range of quality healthcare services across the region.

The impact has been substantial, with about 12.90 lakh treatments facilitated, directly benefiting 3.60 lakh individuals since the scheme's inception.

“About 12.90 lakh treatments have been provided so far worth Rs 2285 crore which has provided services to 3.60 lakh beneficiaries since August 2020. The scheme has been a game changer for the public at large as it provided financial support to treatment seekers for 48 availing timely intervention required for leading a healthy life. Telemedicine services have also been introduced,” an official note of the government reads.