IMA Flags ₹1.21 Lakh Crore Ayushman Bharat Dues
Over ₹1.21 Lakh Crore in Ayushman Bharat Claims Remain Unpaid: IMA
India’s largest medical association has raised alarms over growing financial stress in the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY). According to a white paper submitted by the Indian Medical Association (IMA), more than ₹1.21 lakh crore in claims under the scheme remain unpaid.
The IMA warned that if not resolved urgently, these delays could collapse trust in the government’s flagship healthcare scheme, which promises free hospitalisation up to ₹5 lakh per family for around 55 crore low-income individuals—almost 40% of India’s population.
64 Lakh Hospital Claims Still Await Clearance
According to data shared in Parliament and through an RTI filed by health activist Ajay Basudev Bose, more than 64 lakh claims across India are still pending.
While the government has approved 9.84 crore admissions since the scheme’s inception and paid over ₹1.40 lakh crore, hospitals say much more remains due.
- In Gujarat, claims worth ₹300 crore from 2021 to 2023 remain unsettled.
- In Kerala, unpaid dues exceed ₹400 crore.
- Nationwide, only 5% of claims are cleared within the mandatory 15-day window.
The IMA says this creates cash flow challenges for private hospitals, especially smaller ones, and discourages participation in the scheme.
IMA Criticises Low Reimbursement, Red Tape
Dr. Dilip Bhanushali, IMA’s National President, said the biggest issues hospitals face are delayed payments, low package rates, and complex claim processes.
“IMA should be consulted while fixing rates. We need simplified procedures, real-time tracking, and timely payments,” he told NDTV.
Currently, reimbursement rates often fall below the actual cost of treatment, making it unsustainable for many hospitals, especially tertiary private hospitals, to participate.
This is especially visible in Delhi, where only 67 of over 1,000 private hospitals are empanelled under Ayushman Bharat. Uniform pricing and claim rejections due to minor technical issues further add to losses.
IMA Recommendations to Fix the Crisis
To restore trust and sustainability, the IMA has recommended the following:
- Automated payments and real-time claim tracking systems
- Revised package rates based on updated treatment costs
- 24/7 digital support platforms like WhatsApp and SMS
- Simplified documentation to reduce claim rejections
- Tiered incentives for rural and accredited hospitals
- Direct benefit transfers to reduce delays caused by intermediaries
- Policy reforms to reduce payor bias and oligopsony practices
These changes, they argue, would make the system more transparent, efficient, and equitable.
Government Acknowledges Challenges, Promises Reform
Speaking in the Rajya Sabha, Union Health Minister Prataprao Jadhav admitted there were “implementation challenges” and called on states to adjust their models to improve delivery.
The Ayushman Bharat scheme operates under Trust, Insurance, and Hybrid models, allowing states to choose their framework. There are currently 31,466 empanelled hospitals, including over 14,000 private facilities.
More than 41 crore Ayushman Cards have been issued so far, with Uttar Pradesh leading at 5.33 crore cards, followed by Madhya Pradesh, Bihar, and Odisha.
However, without timely reforms, doctors warn that the scheme’s long-term credibility is at stake.
Conclusion: Will Ayushman Bharat Deliver Its Promise?
The Ayushman Bharat unpaid claims crisis has spotlighted serious gaps in the execution of India’s largest healthcare scheme.
While the intent is noble—universal health coverage for the poor—the reality on the ground is far more complex. Without addressing issues of payment delays, outdated rates, and administrative burdens, the system risks alienating the very hospitals that keep it running.
The National Health Authority (NHA) is yet to officially respond to the IMA’s white paper. But the pressure is mounting for urgent, structural reform before the cracks widen further.