SRINAGAR: In a development that could severely disrupt healthcare access for thousands of patients across Jammu and Kashmir, private hospitals and dialysis centres in the Union Territory have announced proposed de-empanelment from the flagship Ayushman Bharat–SEHAT Scheme from July 1, 2026, citing prolonged delays in reimbursement of claims and mounting financial pressures.
According to Jammu and Kashmir Private Hospitals and Dialysis Centres Association (JKPHDA), despite repeated representations before the concerned authorities, payments for approved claims under the Ayushman Bharat–SEHAT Scheme have remained pending for extended periods, placing severe operational and financial strain on empanelled healthcare institutions.
“Delivering essential healthcare services such as dialysis, intensive care, surgeries, emergency treatment, oncology care, cardiac interventions and trauma services requires uninterrupted availability of medicines, consumables, skilled healthcare professionals and properly maintained medical equipment,” a spokesperson of the Association said.
The Association maintained that delayed reimbursements coupled with deductions and rejection of claims without an effective review mechanism, have made it “increasingly difficult” for private.
Referring to the ongoing conflict in the Middle East, the Association said the disruptions in global supply chains and rising healthcare costs have worsened the situation.
“The availability and pricing of critical cancer drugs, including Cisplatin and Carboplatin, have been adversely affected, making it difficult for oncology centres to maintain adequate inventories due to blocked reimbursements.”
According to a spokesman, the continued delay in the release of payments has constrained the private hospitals from procuring life-saving medical products, potentially affecting patient care.
“More than Rs 180 crores of Ayushman Bharat funds are reportedly lying unutilized with public hospitals, while private hospitals and dialysis centres continue to await payments for approved claims,” the Association claimed.
Expressing concern over increasing waiting periods for certain procedures, including gallbladder surgeries and haemorrhoidectomies, the Association alleged that these services have increasingly been restricted to public hospitals where patients are reportedly facing delays extending beyond ten months.
The JKPHDA argued that the prolonged delay in settlement of claims is inconsistent with the timelines prescribed under NHA guidelines and contractual provisions governing the scheme.
“Under Section 6 of the Memorandum of Understanding (MoU), empanelled institutions are entitled to one per cent interest per week on delayed payments, which has not been provided.”
The spokesman said that in view of the prevailing situation, the Association announced that private hospitals and dialysis centres across J&K have decided to initiate de-empanelment from the Ayushman Bharat–SEHAT Scheme from July 1, 2026, unless immediate corrective measures are undertaken by the authorities.
The Association demanded immediate clearance of all pending claims along with applicable interest, establishment of a transparent mechanism for review of rejected claims, strict adherence to NHA guidelines on claim processing and payment timelines, segregation of payment systems for public and private hospitals, restoration of patient choice under the scheme, and urgent engagement with representatives of private healthcare institutions.
The Association cautioned that quality healthcare services cannot be sustained indefinitely without timely reimbursement.
If the Association goes ahead with its threat and exits from the flagship scheme, it would significantly impact healthcare access to the scheme for thousands of beneficiaries across Jammu and Kashmir, who rely on the Ayushman Bharat–SEHAT scheme for treatment.
