As the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) marks seven years since its launch, mounting unpaid bills to private hospitals—now exceeding ₹15,000 crore nationwide—are casting a shadow over its promise of free secondary and tertiary care for over 55 crore vulnerable Indians. A recent investigation highlights how these delays, averaging 90-120 days, are forcing providers to ration services or demand out-of-pocket payments, potentially derailing the scheme's role in averting healthcare-induced poverty for millions.
Launched on September 25, 2018, by Prime Minister Narendra Modi, AB-PMJAY provides up to ₹5 lakh annual coverage per family for 1,949 procedures across 27 specialties, integrated with the Ayushman Bharat Digital Mission that has issued 74 crore health IDs. By July 2025, the National Health Authority (NHA) reported 9.84 crore hospital admissions worth ₹1.4 lakh crore, with 70% utilization in rural areas. Beneficiaries like 60-year-old farmer Mahesh Kumar Sharma from Madhya Pradesh, who underwent cardiac repair at Delhi's National Heart Institute without upfront costs, exemplify its impact: pre-scheme, such treatments pushed 5.5 crore Indians into poverty annually.
Yet, the scheme's financial backbone is cracking under reimbursement bottlenecks. State-level verification delays and fraud probes have created a ₹5,000 crore quarterly backlog, per NHA data. In Haryana, over 650 private hospitals—half of the state's 1,300 empanelled facilities—suspended AB-PMJAY services from August 7, 2025, citing ₹490 crore in dues, though partial releases averted a full crisis. Manipur's Association of Healthcare Providers India (AHPI) chapter warned on October 18 of halting services from November 7 unless ₹200 crore-plus arrears are cleared, affecting dialysis patients reliant on cashless care. In Jammu & Kashmir, a shift to "trust mode" on April 17, 2025, left ₹200 crore pending, prompting threats of withdrawal by March 2025.
Dr. Girdhar J. Gyani, Director General of AHPI, which represents thousands of private providers handling 20% of claims, stated, "Hospitals joined out of national service, but delays up to six months are unsustainable. We demand 1% interest on bills unpaid beyond 30 days, as per original guidelines, to enforce accountability." Private chains like Apollo Hospitals, empanelled nationwide, have flagged reduced bed allocations, while smaller facilities in Chhattisgarh and Uttar Pradesh report 15% network exits.
NHA CEO R.S. Sharma acknowledged the strain, noting ₹1.2 lakh crore disbursed since inception and guidelines mandating 15-day intra-state payments. "We're enhancing digitization via e-Sanjeevani for faster claims, but state funding shares (40%) contribute to variances," Sharma said. Union Health Minister J.P. Nadda, addressing the Times Network India Health Summit on October 4, pledged ₹400 billion in private investments to add 34,000 beds by FY29, amid India's $372 billion healthcare market (projected $638 billion by 2025).
Critics, including the Indian Medical Association (IMA), point to low package rates—often below operational costs—and arbitrary deductions as exacerbating factors. A 2025 study in the Indian Journal of Community Medicine found only 15% rural awareness in Uttar Pradesh, compounding access gaps. With non-communicable diseases affecting 20 crore Indians, unresolved delays could lead to 2 million coverage losses, experts warn.
The government maintains all public hospitals are deemed empanelled, ensuring continuity, but private sector reliance—65% in states like Gujarat—makes reforms urgent. As AB-PMJAY eyes universal coverage under Viksit Bharat 2047, timely payments remain key to sustaining its transformative equity.
Sources for this news report:
- Medical Buyer (November 2, 2025) - medicalbuyer.co.in
- Medical Dialogues (October 18, 2025) - medicaldialogues.in
- The News Minute (August 29, 2025, with ongoing context into October) - thenewsminute.com
- India Today (August 1, 2025, updated impacts) - indiatoday.in
- New Indian Express (October 13, 2025) - newindianexpress.com
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