Removes 10% extra; stakeholders aghast
Irfan Tramboo
SRINAGAR, Mar 15: As anticipated, the State Health Agency (SHA), J&K, has ordered the restructuring of the AB-PMJAY-Sehat scheme, making four commonly sought surgical procedures exclusive to public hospitals and removing the additional package price for private hospitals.
The changes include the removal of the 10% additional package price previously applied to private hospitals under HBP 2.2, which will no longer be applicable-prompting the empaneled private hospitals to stop the services under the scheme from today.
The SHA stated that the direction follows decisions made during the 8th and 9th Governing Council meetings.
According to the order, it was decided in these meetings that significant changes would be implemented in the Health Benefit Packages (HBP) 2.2 across all empanelled public and private hospitals in the Union Territory of J&K.
Additionally, the SHA has revised the package rates for hospitals under the scheme.
While private hospitals will no longer receive an additional 10% over the base rates, their packages will now be standardized at HBP 2.2 base rates, whereas public hospitals will continue to follow standardized rates under the same guidelines.
The SHA has also directed revisions to package rates across different hospital categories.
Under the new structure, Sub-District Hospitals (SDHs) and Community Health Centres (CHCs) will have package rates set at 65% of HBP 2.2 rates, while District Hospitals, Government Medical Colleges (GMCs), and private hospitals will retain package rates at 100% of HBP 2.2 rates.
Regarding the exclusive reservation of certain procedures for public hospitals, the SHA stated that appendectomy, cholecystectomy, hemorrhoidectomy, and fissure-in-ano will now be exclusively performed in public hospitals.
“All hospital administrators are mandated to comply with these changes and ensure their effective execution from March 15, 2025, taking necessary steps for immediate implementation and seamless transition,” the SHA stated.
Earlier, the owners and operators of private hospitals had voiced concerns about the proposed changes, particularly the decision to reserve certain procedures for public hospitals.
The stakeholders also approached the court seeking relief. However, while responding to their plea, the court urged the authorities to consider the request of empanelled private hospitals to include these procedures in the scheme.
Despite this, the authorities proceeded with their planned changes.
In response to the SHA’s restructuring decision, the J&K Private Hospitals and Dialysis Centres Association announced that they would be forced to stop providing services under the scheme, effective March 15, 2025.
“The SHA’s decision to reduce package rates for procedures by 10% has put private hospitals in a difficult position. This move not only makes it challenging for us to continue providing services but also goes against the Prime Minister’s vision of universal health insurance,” the association stated.
Beyond the rate reduction, the association said that reserving four surgical procedures exclusively for public hospitals, along with the non-release of pending payments, has worsened the situation.
“The scheme is highly beneficial for the public, but unfortunately, these decisions by the SHA will compromise the quality of medical services.”
The private empanelled hospitals further stated that Government payments have not been fully released, despite assurances from the Chief Secretary that all pending dues would be cleared by the end of December 2024.
“As a result, private hospitals are being forced to stop providing services under the Ayushman Bharat/SEHAT Scheme from March 15, 2025. This will undoubtedly affect the community unless the government reconsiders its decision,” the association warned.
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