Punjab’s Rs 10 lakh health-cover promise: A bold, optmistic bet...by KBS Sidhu

With a payments-first backbone and Deputy Commissioners leading district-level oversight, this scheme can become a genuine game-changer.

Punjab’s decision to roll out the ₹10 lakh Mukh Mantri Sehat Bima/Sehat Yojana is politically bold in the best sense of the term: it aims to make catastrophic hospitalisation less terrifying for ordinary families and to signal that healthcare security is not a privilege but a state-backed entitlement.

It also fits an optimistic governing narrative that AAP has been trying to build in Punjab—one where public health is made more affordable through stronger first-contact services, especially via Aam Aadmi Clinics and allied public provisioning.

If clinics are the base of the health pyramid—routine consultations, early detection, basic diagnostics, medicines—then this scheme is the apex: high-cost surgeries, ICU episodes, complex interventions, and tertiary care. That is precisely why it is ambitious, and also why it carries higher operational risk. Primary care is largely delivered within systems the state can control. Cashless hospitalisation—especially involving private hospitals—is delivered within systems the state must continuously earn through credibility.

A major operational step in this direction is that Punjab has formally tied up United India Insurance Company Ltd. as the insurer for the new universal ₹10 lakh rollout, after bids were opened in early December 2025. That adds seriousness and structure to implementation. But it also clarifies the real test: insurance is not a press release; it is a machine that must keep running—authorisations, claims, audits, grievance redress, and above all timely payments.

Why the scheme is inherently high-stakes

A ₹10 lakh ceiling is not merely a higher number on a card. It shifts the scheme into the territory of expensive packages where hospitals deploy large resources upfront—implants, consumables, specialist time, theatre slots, ICU beds—and then wait for reimbursement. In such an ecosystem, the state is not simply “providing cover”; it is effectively underwriting a high-value credit cycle.

That is where the scheme becomes a high-risk gamble: if payment discipline is strong, hospitals participate, access expands, and the promise becomes real. If payment discipline weakens, hospitals ration, restrict, or suspend cashless care, and the promise collapses at the point of need.

The representative warning sign: September 2024

Punjab does not need to assume this risk in theory—it has already seen a version of it in practice. In September 2024, private hospital bodies publicly claimed that around ₹600 crore was pending under Ayushman-linked arrangements and many private hospitals suspended cashless treatment. The Punjab government disputed the figure and publicly stated ₹364 crore pending in total, with ₹197 crore owed to private hospitals.

One need not adjudicate which headline number was “truer” in public debate to understand what that episode revealed: when hospitals lose confidence in payment timelines, cashless access becomes fragile. And a larger scheme multiplies the consequences of even small failures.

Why this is also a credibility battle for AAP

The scheme is branded in a way that brings the Chief Minister’s name into the centre of the promise. That can be a strength—personal ownership can drive administrative focus—but it also raises the reputational stakes. If the card works smoothly, it becomes a signature achievement. If it fails in private hospitals or tertiary centres, it will not be seen as a routine departmental lapse; it will be read as a broken guarantee.

This sensitivity is heightened because other big-ticket promises—especially the ₹1,000 per month support for women—remain part of the public discourse as commitments still awaiting fulfilment. In that context, the health card will be judged quickly and emotionally: does this government deliver guarantees as lived outcomes, or as aspirational entitlements?

How Punjab can pull this off: optimistic, practical governance

If Punjab treats this as a system-building exercise rather than a launch-event achievement, it can absolutely be pulled off. The design principles are straightforward and managerial:

1) Make payments the single dominant KPI

Everything else—publicity, enrolment counts, even empanelment numbers—should be treated as secondary to payment reliability. Hospitals will tolerate paperwork; they will not tolerate unpredictable cashflow. Punjab should publish simple, regular payment performance indicators: claims received, claims cleared, claims paid, average days-to-payment, and aged pendency.

2) Create district-level implementation discipline led by the Deputy Commissioner

A universal scheme succeeds district by district, not in Chandigarh press conferences. Punjab should formally involve the Deputy Commissioner and create district-level review committees that meet on a fixed cadence to track:

• hospital empanelment and capacity constraints,
• patient grievances and denial patterns,
• and most importantly, payment status to private hospitals (ageing, reasons for pendency, escalation).

A DC-led committee gives the scheme local authority, removes informational fog, and forces coordination between health administration, the insurer/TPA chain, and finance channels.

3) Tighten the Health–Finance handshake

The real scheme owners are not the slogans but the Health Department, Finance Department, and field formations who must keep the pipeline moving. If finance releases become episodic and reactive, arrears will reappear. The state should build a predictable release calendar, ring-fence the payments pool, and ensure that cashflow is treated as routine infrastructure, not emergency firefighting.

4) Use enlightened political supervision—focused on rules, not micromanagement

Political leadership can add tremendous value by insisting on dashboards, timelines, and accountability—without interfering in individual claim disputes. The goal should be to protect the integrity of process: quick approvals, predictable reimbursements, and transparent dispute resolution.

5) Institutionalise third-party audits

Third-party actuarial and financial audits, published periodically, are not merely optics. They are a stabiliser. They reassure hospitals that the system is being watched honestly, and they reassure the public that the scheme is not an unfunded promise. In a high-coverage scheme, transparency is not a luxury—it is a survival tool.

The optimistic bottom line

Punjab’s ₹10 lakh scheme is politically bold, socially attractive, and potentially transformative. It is also a high-risk gamble because it depends on a single fragile ingredient: payment credibility in a high-cost hospital ecosystem.

If Punjab brings disciplined bureaucratic ownership across Health and Finance, empowers field formations, involves Deputy Commissioners through district-level review committees, and backs it all with enlightened political supervision and third-party audits, it can convert ambition into a working institution. If not, the state risks repeating the familiar pattern of high-decibel entitlements that produce cards quickly and access unevenly.

The bet is real. But so is the opportunity.

December 26, 2025