VIKAS SHARMA
JAMMU, OCT 18: The Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), India’s flagship health insurance scheme that has been a lifeline for millions of economically weaker families, is facing a serious setback in Jammu and Kashmir. A sharp decline in hospital empanelments under the scheme this year has raised concerns that thousands of poor patients may be deprived of cashless treatment in the Union Territory.
According to official data presented in the Lok Sabha by the Union Ministry of Health and Family Welfare, only one private and four public hospitals have been empanelled under the scheme in J&K during the financial year 2024–25 — a steep fall from 37 private and three public hospitals in 2023–24.
Health experts warn that such a drastic reduction could directly affect the poor and vulnerable sections who depend on Ayushman Bharat for free medical care, particularly in areas where government hospitals are either overcrowded or lack specialist facilities.
From Expansion to Decline
The figures show that J&K had 111 public and 17 private hospitals empanelled in 2018–19 when the scheme was rolled out. The number of private hospitals rose gradually, peaking at 32 in 2021–22 and 37 in 2023–24, before plummeting to just one this year. Meanwhile, the number of public hospitals has dropped from 111 to only four over the same period.
Experts Sound Alarm
“The private sector plays a critical role in bridging healthcare gaps, especially in rural and semi-urban areas where government infrastructure remains inadequate. Such a steep fall in empanelments under PMJAY is alarming and suggests systemic challenges like delayed claim settlements and weak coordination between the State Health Agency and private hospital managements,” said health policy analyst Dr. Sanjay Raina.
Public health researcher Dr. Meenakshi Gupta added that the scheme’s potential remains underutilized in the UT.
“PMJAY has shown impressive results in states like Uttar Pradesh and Gujarat where private hospital participation is robust. In J&K, however, delays in reimbursements, cumbersome empanelment procedures, and lack of awareness about the revised Health Benefit Package have discouraged hospitals from staying on board,” she noted.
Financial and Technical Hurdles
Officials associated with the scheme acknowledge that many hospitals face long claim-settlement delays, often exceeding the defined turnaround time, which affects their cash flow. Smaller hospitals also struggle to comply with technical requirements such as online claim processing and audit documentation, discouraging continued participation.
Government Response
The Ministry of Health maintains that hospitals cannot deny treatment to eligible beneficiaries and has established a three-tier grievance redressal mechanism to ensure accountability. It has also introduced reforms like a paperless Hospital Empanelment Module (HEM 2.0), a Hospital Helpline (14413), and a revised Health Benefit Package (HBP 2023) covering 1,961 medical procedures.
However, experts believe that unless private hospitals are assured of timely reimbursements and reduced bureaucratic hurdles, participation will remain low.
“The government must build confidence through dialogue and faster payment mechanisms. Without the private sector, the poor will have limited options for specialized care,” said Dr. Rajesh Gupta, a Jammu-based health economist.
With over five lakh families in J&K depending on Ayushman Bharat for secondary and tertiary healthcare, the decline in empanelled hospitals threatens to push poor patients back into the cycle of debt and delayed treatment — undermining the core goal of universal health coverage in the region.
