PGI faces strain as Himachal delays payment for free treatment under HIMCARE scheme

Chandigarh: Himachal residents, particularly those with limited means, are finding it difficult to get free treatment in PGI as the Himachal government hasn't paid the hospital about Rs 14 crore for treatment of such patients under the HIMCARE scheme, a state-run health insurance initiative. Around 40% of the patients admitted in PGI are from Himachal Pradesh.
HIMCARE is a govt programme in Himachal Pradesh that helps families get cashless treatment worth up to Rs 5 lakh each year. It aims to help people who are not covered under other national health schemes.
PGI is facing delays in receipt of funds from the state government. Under the memorandum of understanding signed in Feb 2024, PGI began offering free medical services to impoverished patients through the HIMCARE initiative, starting in June, 2024. However, in a span of just eight months, over Rs 14 crore is pending, causing serious concern.
The ministry of health and family welfare has now instructed PGI to escalate the matter with the Himachal govt, as disbursal of funds is critical for smooth functioning of the scheme. Delays are being closely monitored after recent reports of financial misconduct in related schemes, including Ayushman and HIMCARE. There are allegations that money meant for the treatment of economically disadvantaged patients was siphoned off by some individuals with the help of some PGI staff members. The PGI vigilance department has already recommended a CBI probe into the matter.
The issue was formally raised during the Feb, 2025 meeting of the PGI governing body (GB), which was chaired by the Union minister of health and family welfare. The GB noted that, according to the MoU, the Himachal govt is obligated to disburse funds for cashless services provided under HIMCARE, within a month. However, in the latest report, PGI has raised claims worth Rs 14.3 crore for 1,478 beneficiaries, which remain unresolved.
The governing body expressed concern over the delay, describing it as a serious issue that could not only lead to excessive financial liability for PGI but also result in audit objections in the future. The GB has directed PGI to immediately take up the matter with Himachal authorities and ensure that payments are processed without delay.