A flagship scheme of public healthcare and concerning providing free treatment up to a limit of Rs.5 lakh on annual basis should not be caused to undergo procedural delays . As and when liabilities emerge , the same need to be cleared as early as possible in order to sustain the trust in such schemes both by the deserving persons seeking treatment in empanelled hospitals as well the hospitals which provide treatment without charging a penny only on the production of the Health Card issued under the scheme by the prospective beneficiary. On the other hand , when the provisions in the scheme itself enjoin upon the administration to clear the claims submitted by such empanelled hospitals within 15 days, why should , therefore, an inordinate delay take place in such reimbursement by the Government to the concerned hospitals is the moot question. UT of Jammu and Kashmir , as we already know , demonstrated its quite flexible approach in implementation of PM Ayushman Bharat, the largest Health Insurance Scheme of the world , in the UT by covering not only those otherwise eligible under the scheme but all citizens which really raised much hopes in the people . What should have followed , therefore, is a proper organised procedure in place to settle claims as and when submitted by the Government empanelled hospitals to keep the cycle of treatment of the ailing ones moving uninterruptedly .
There can , no doubt , be some difficulties encountered in the process looking to the number of beneficiaries and the claims thereto which could cause some delay in processing or getting certain queries clarified but that cannot obviously become a routine since that was ultimately going to bring discredit to such a noble scheme involving free treatment in hospitals. We learn that as against an outstanding liability under the reimbursement process of Rs.68 crore , an amount of Rs.31 crore is yet to be cleared . In other words , while the amount of half of the total claims submitted stand cleared by the Government , more than as much is still outstanding, which naturally upsets the applecart of those hospitals which do not have enough financial cushion to sustain blocking of or receipt on deferred basis the realisation of owing from their sundry debtors. It is despite the fact that these very hospitals , primarily small and medium sized Nursing Homes like in structure etc, by providing treatment to the satisfaction of the patients under the scheme are, making the Ayushman Bharat Scheme quite successful on the ground.
If such a situation – that of a mismatch between the claims submitted and the ones realised – continues without much improvement in Jammu and Kashmir as there are some structural problems in respect of renewal of Insurance Cover etc following the conclusion of the agreement of previous service provider Insurance Company as also receipt of funds from the Central Government and then releasing the same by the UT Government and other procedural humps , the affected empanelled Hospitals may refuse to entertain any new cases as they would not afford to keep their own money spent on medicines and other items of treatment of the patients blocked for unspecified period. In fact, we learn that many have already started doing so. On the one hand while the scope of the scheme keeps on widening in terms of diseases covered like treatment for COVID infections and even the quarantine at any private hospital, on the other unsettled claims bring a bad name to the scheme itself . The unique features of the scheme, needless to add, being providing cover to even from an urban beggar to a ragpicker to a street vendor to a domestic worker and the like with no pre- or post hospitalisation expenses is primarily to ensure healthcare of all those eligible , especially the most deserving and underprivileged ,hence it is incumbent upon the UT Government to speed up taking the matter with the previous service provider for the three to four months of the cover under the previous MoU by clearing the unpaid premium amount pertaining to that period.
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