The private healthcare sector in Jammu and Kashmir is on the brink of a significant crisis, as the Jammu and Kashmir Private Hospitals and Dialysis Centre Association has announced its decision to withdraw from the Ayushman Bharat SEHAT scheme, effective March 15, 2025. This move, prompted by unsustainable contract terms and prolonged financial distress, threatens to disrupt access to critical healthcare services for thousands of patients in the region.

Reasons Behind the Withdrawal

In a letter addressed to the CEO of the Ayushman Bharat and SEHAT scheme, the association cited several pressing concerns that have made continued participation in the scheme unviable:

1. Delayed Payments: The private hospitals claim they have been awaiting overdue payments for months, significantly impacting their financial stability. The association has called for the release of long-pending Bajaj payments along with 1% interest on delayed payments.
2. Unfair Deductions & Rejections: Since 2022, private hospitals allege they have been subjected to arbitrary deductions and payment rejections without a proper review mechanism, exacerbating financial losses.
3. Reduction in UT-Specific Incentives: The 9th Governing Council Meeting of the Ayushman Bharat Scheme, held on January 19, 2025, decided on a 10% reduction in UT-specific incentives. Private hospitals argue that this decision will push them further into financial distress.
4. Reservation of Procedures for Public Hospitals: The governing council has reserved four specific procedures exclusively for government hospitals. The association believes this restricts patient choice and undermines the viability of private hospitals.
5. Implementation of HBP 2.2 Instead of HBP 2022: The decision to implement HBP 2.2 instead of the previously approved HBP 2022 has raised concerns among private hospitals regarding fair reimbursement for medical procedures.
6. Escalating Costs & Unchanged Treatment Packages: Despite a 24% increase in the Union Government’s budget for the Ayushman Bharat scheme, treatment package rates have not been revised, making it difficult for private healthcare providers to sustain their operations.

Impact on Healthcare in Jammu & Kashmir

The withdrawal of private hospitals from the SEHAT scheme will have far-reaching consequences for patients and the overall healthcare ecosystem:

• Reduced Access to Quality Care: Thousands of patients, especially those requiring dialysis and specialized treatments, may struggle to access timely medical care if private hospitals cease their services under the scheme.
• Increased Burden on Public Hospitals: With key procedures reserved for public hospitals, an already overburdened government healthcare system may struggle to accommodate the increased patient load.
• Disruptions in Emergency and Specialized Treatments: Private hospitals play a crucial role in providing specialized treatments. Their exit could result in significant delays and increased mortality rates due to limited availability of advanced medical care.
• Financial Instability in Private Healthcare: The ongoing financial strain could lead to hospital closures, loss of jobs, and a decline in overall healthcare infrastructure development in the region.

The Association’s Demands & Call for Government Intervention

To prevent this impending crisis, the Jammu and Kashmir Private Hospitals and Dialysis Centre Association has urged the government to take immediate corrective actions:

1. Immediate Release of Pending Payments – Including Bajaj payments with interest, to provide financial relief to hospitals.
2. Adoption of HBP 2022 – Ensuring fair reimbursement rates for private hospitals.
3. Opposition to Reservation Policies – Allowing patients the right to choose between public and private hospitals.
4. Review of Unfair Deductions & Payment Rejections – Instituting a transparent review mechanism to address financial grievances.
5. Restoration of UT-Specific Incentives – Preventing further financial losses for private healthcare providers.

The Broader Implications for India’s Healthcare Sector

This standoff between private hospitals and the government highlights a larger issue within India’s healthcare system—the sustainability of public-private partnerships in delivering universal healthcare. If unresolved, this could set a precedent for other states where private healthcare providers may reconsider their participation in government health schemes due to similar financial concerns.

To ensure the success of Ayushman Bharat and its state-level variants, policymakers must address the economic realities of private hospitals and establish a fair and timely payment system. A collaborative approach between the government and private stakeholders is crucial to maintaining an efficient and accessible healthcare system for all.

As the March 15, 2025, deadline approaches, the urgency for intervention grows. The government must act swiftly to avert a healthcare crisis that could leave thousands without access to life-saving treatments.

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