Ayushman Bharat Crisis: Bihar-UP Medical Fee Dispute Halts Cashless Care for Thousands
A severe financial impasse between the Bihar government and premier medical institutions in Uttar Pradesh has plunged thousands of Ayushman Bharat beneficiaries from Bihar into a healthcare emergency. For more than thirty days, the critical BHU Trauma Centre in Varanasi—a vital medical hub for Western Bihar—has suspended all cashless treatment services for residents of Bihar. This drastic measure stems from an unsettled debt amounting to Rs8 crore owed by the Bihar administration.
Healthcare Crisis Grips Border Districts
The suspension has triggered an acute healthcare crisis across border districts, including Kaimur, Rohtas, and Buxar. Patients arriving for emergency surgeries and specialised medical care are being systematically turned away at registration counters, leaving many without access to life-saving interventions. For the rural poor in Bihar, the Varanasi Trauma Centre often represents the only accessible facility for advanced medical treatment, making this disruption particularly devastating.
Political and Administrative Response
The issue has now escalated to the Bihar legislative assembly, where MLA Satish Kumar Singh has demanded the immediate release of funds. He has sharply criticised the administrative apathy that has effectively stalled the flagship central healthcare scheme. Additionally, Buxar MP Sudhakar Singh has escalated the matter directly to the Chief Minister's office, urging swift clearance of the outstanding Rs8 crore payment.
A senior officer from the Bihar Health Society, speaking on condition of anonymity, revealed that Rs24 crore had already been paid, and the process for settling the remaining amount is being initiated. However, this assurance offers little solace to those currently denied treatment.
Geographical and Logistical Realities
For residents of Kaimur, Rohtas, and Buxar, choosing Varanasi over the state capital, Patna, is not a matter of convenience but one of survival. Kaimur is situated a mere 60 kilometres from Varanasi, while Rohtas is approximately 120 kilometres away. In stark contrast, Patna lies between 170 to 200 kilometres from these districts.
The six-lane stretch of National Highway-2 allows ambulances to reach BHU in Varanasi within 90 to 150 minutes. Conversely, the journey to Patna can exceed five hours—a critical difference in medical emergencies. "Every minute is critical for a trauma patient. The time saved by travelling to Varanasi often represents the difference between life and death," emphasised Dr S N Mishra, former chief medical officer.
Records from the State Health Society indicate that 90% of attendants for critically ill patients referred from sadar hospitals and Primary Health Centres in these districts opt for Varanasi over Patna Medical College and Hospital. This preference is driven by superior facilities and crucial proximity.
Compounding Policy Challenges
The current crisis is further exacerbated by a controversial 2023 directive from the State Health Society, which prohibits government ambulances from transporting referred patients to healthcare institutions outside Bihar. This policy delivers a double blow to impoverished families already struggling with healthcare access.
An observer noted poignantly, "The Ayushman card has become a piece of plastic for the poor as they are not entertained in UP in absence of dues clearance." This statement underscores the human cost of bureaucratic and financial delays, transforming a promise of healthcare security into a source of despair for vulnerable populations.
