Ayushman Bharat and Mahatma Jyotirao Phule health schemes: State owes Rs204cr to hospitals

Kolhapur: As of today, the state govt owes Rs204.4 crore to hospitals empanelled under the Ayushman Bharat and Mahatma Jyotirao Phule health schemes since July 1, 2024.
Data from the state health assurance society reveals the government has disbursed Rs1,768.88 crore for over 8.84 lakh secondary and tertiary treatments since then. These schemes provide cashless treatment up to Rs5 lakh per family annually to eligible poor patients in private hospitals, with costs reimbursed by the state
Private hospitals have treated around 5 lakh beneficiaries under these integrated schemes. Additionally, Rs409 crore worth of treatments lack valid documentation from hospitals.
A senior state health official, while talking to TOI, assured that Rs60.5 crore of the outstanding Rs204.4 crore will be cleared immediately, emphasizing that claim processing is ongoing and all dues will eventually be paid.
On Sunday, a delegation of Shiv Sena (UBT) led by party's Kolhapur city president Sunil Modi met state health minister Prakash Abitkar, claiming that hospitals are not accepting patients under the schemes owing to a large number of dues.
"We sought information under RTI Act. The state health assurance society provided us with the details of the dues district-wise. We receive repeated complaints that patients are not admitted by private hospitals as the govt has not cleared the dues. We have been told that the finance department is delaying the release of funds to clear the dues due to a shortage of funds because of the Ladki Bahin and other schemes," Modi said.
Abitkar, however, told the delegation that he would call for a meeting in a day or two to get clearance for the release of funds from the finance department.
"We suspect that the govt will close the health schemes in the near future. The health minister has assured us that none of the schemes will be closed," Modi said.
The health official, however, said that the amount of dues right now is not abnormal and is not due to any financial crunch on the part of the govt.
A heart surgeon based in Miraj, while speaking to TOI on the condition of anonymity, said, "The treatment packages have not been revised for a long time, and the last time they were revised, it was not in sync with inflation — the actual cost of the treatment. For instance, we have to use a balloon catheter which costs Rs62,000, but the govt wants us to operate the procedure at a low cost. We have around Rs3 crore dues with the govt, and we have to wait for months to just get partial payments cleared."