Why in news
- Private empaneled hospitals raised concerns over prolonged reimbursement delays and arbitrary claim deductions under Ayushman Bharat PM-JAY.
What is Ayushman Bharat PM-JAY?
- Centrally Sponsored Scheme launched in 2018 providing secondary and tertiary hospitalization coverage up to 5 lakh rupees per family per year.
- Fully funded by Central and State governments in a 60:40 ratio for most States, administered at national level by the National Health Authority.
Operational Bottlenecks and Impact
- Delayed claim settlements by State Health Agencies lead to liquidity crunches for empaneled private hospitals.
- Unresolved payment backlogs risk driving private healthcare providers to suspend cashless services, disrupting healthcare access for vulnerable beneficiaries.
Key terms
Empaneled Health Care Provider
Public or private hospital network authorized to deliver cashless treatment under PM-JAY.
National Health Authority
Apex body responsible for implementing Ayushman Bharat PM-JAY at the national level.
Prelims facts
- AB PM-JAY is fully funded by the government without any premium contribution from beneficiaries.
Mains discussion
- Structural challenges in public-private partnership models for universal health coverage in India.
Source: Hindu Business Line
Same topic · past papers
UPSC has asked this before
These previous-year questions sit on the same topic. Open one to practise the earlier ask.
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2022 · Q13 · GS III · 15 marks
What are the main bottlenecks in upstream and downstream process of marketing of agricultural products in India ? -
2022 · Q19 · General Studies · 2 marks
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2025 · Q20 · General Studies · 2 marks
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2024 · Q51 · General Studies · 2 marks
Consider the following statements : Statement-I : If the United States of America (USA) were to default on its debt, holders of US Treasury Bonds will not be able to exercise their claims to receive payment. Statement-II : The USA Government debt is not backed by any hard assets, but only by the faith of the Government. Which one of the following is correct in respect of the above statements ?