Healthcare Funding Crisis – Private Hospitals in J&K Warn of Exit From SEHAT Scheme

Healthcare Funding Crisis – Thousands of patients across Jammu and Kashmir could face difficulties in accessing treatment under the Ayushman Bharat-SEHAT Scheme after private hospitals and dialysis centres signaled their intention to withdraw from the government-backed health programme beginning July 1, 2026. Healthcare providers have attributed the proposed move to long-pending claim settlements and increasing financial challenges that they say are threatening the continuity of medical services.

Hospitals Cite Growing Financial Burden

The Jammu and Kashmir Private Hospitals and Dialysis Centres Association (JKPHDA) stated that repeated requests to concerned authorities have not resulted in the release of outstanding payments for claims that have already been approved under the scheme. According to the association, the delay has created significant financial pressure on healthcare institutions that continue to provide treatment to beneficiaries.

Representatives of the association noted that running critical healthcare services requires a steady supply of medicines, medical consumables, trained healthcare workers, and properly functioning equipment. They said that maintaining services such as dialysis, intensive care, cancer treatment, emergency care, trauma management, cardiac procedures, and surgeries has become increasingly difficult under the current circumstances.

Delayed Payments Affect Operations

The association further alleged that reimbursement delays are being compounded by deductions and claim rejections, often without a clear and transparent mechanism for review. Hospital operators argue that these issues have affected their ability to manage operational expenses and maintain healthcare standards.

Officials associated with the group also highlighted the impact of rising healthcare costs and international supply chain disruptions. They claimed that the availability and pricing of several essential medicines, particularly drugs used in cancer treatment, have been affected in recent months. As a result, some medical facilities are reportedly struggling to maintain adequate stock levels.

Concerns Over Patient Care

According to the association, continued delays in receiving payments have limited the ability of private hospitals to procure critical medical supplies and life-saving products. Healthcare providers fear that prolonged financial constraints could eventually affect patient care and treatment availability.

The group also claimed that more than Rs 180 crore allocated under the Ayushman Bharat programme remains unutilized within public healthcare institutions, while private hospitals and dialysis centres continue to wait for reimbursement of approved claims.

Waiting Time Issues Raised

Another concern highlighted by the association relates to patient waiting periods for certain medical procedures. It alleged that treatments such as gallbladder surgeries and haemorrhoidectomy procedures are increasingly being handled by public hospitals, where patients are reportedly experiencing extended waiting times that can stretch for several months.

The association argued that the delay in processing and settling claims does not align with the timelines outlined under National Health Authority (NHA) guidelines and contractual obligations governing the scheme.

Demand for Immediate Intervention

Referring to the Memorandum of Understanding signed under the programme, the association stated that empanelled hospitals are entitled to compensation in the form of interest on delayed payments. It claimed that this provision has not been implemented despite significant delays.

The JKPHDA has called on authorities to take urgent corrective action. Among its key demands are the immediate release of all pending payments, settlement of applicable interest, establishment of a transparent review process for rejected claims, compliance with NHA payment timelines, separate payment systems for public and private hospitals, and restoration of patient choice within the scheme.

Potential Impact on Beneficiaries

Healthcare providers have warned that maintaining quality medical services becomes increasingly challenging when reimbursements are delayed for long periods. They believe that sustainable healthcare delivery depends on timely financial support under the scheme.

If private hospitals and dialysis centres proceed with their proposed de-empanelment, a substantial number of beneficiaries across Jammu and Kashmir could face reduced access to healthcare services. Many residents currently depend on the Ayushman Bharat-SEHAT Scheme for specialized treatment, emergency care, and routine medical procedures, making the outcome of discussions between healthcare providers and authorities crucial in the coming weeks.