On the night of March 28, 16-year-old VL Remsangpuii was in severe distress. She had been suffering from intense stomach pain and was referred to the capital, Aizawl, from her hometown of Serchhip, a gruelling four-hour journey. Each minute seemed to drag as the journey wore on. Upon arrival in Aizawl, she was rushed to LRM Hospital in Ramhlun. After further examination and an MRI scan, it was determined that she would need surgery.
While she was in the hospital, on April 1, the government rolled out the Mizoram Universal Healthcare Scheme. The cashless scheme was introduced under much controversy as it has been rejected by 99% of private hospitals in the state.
When Chief Minister Lalduhoma launched the scheme, he said in his speech, “The Mizoram Universal Healthcare Scheme aims to replace the previous healthcare schemes to ensure that empanelled hospitals no longer face difficulties and to provide comprehensive coverage and protection. The scheme was introduced following a thorough evaluation of the state’s progress over the past five years. Despite financial challenges, the government has prioritized this scheme, and banks have assured their full cooperation, making the scheme viable.”
The scheme covers all government employees, civil pensioners, the general public, and all those possessing Golden Cards under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY).
Citizens can enrol in the scheme during the designated registration period, with three annual fee options for family coverage: Rs. 2,500 for Rs. 5,00,000 coverage with a general ward stay, Rs. 5,000 for Rs. 5,00,000 coverage with a semi-private ward stay, and Rs. 10,000 for Rs. 5,00,000 coverage with a private ward stay. Government employees and civil pensioners will contribute to the scheme through deductions from their monthly income.
Surprisingly, the scheme does not cover regular or assisted vaginal deliveries during childbirth. It only provides coverage for complicated vaginal deliveries, such as breech, shoulder dystocia, big baby, caput 3rd degree, moulding, and caesarean sections.
This is unlike the previous healthcare scheme where the majority of private hospitals were empanelled by the government. In the Universal healthcare scheme, there are only six empanelled private hospitals in Mizoram. Out of these six, two are located in Aizawl, Nazareth Hospital and JC Eye Hospital while the other four are in Lawngtlai, Lunglei, Siaha and Champhai.
This creates a significant disadvantage for the majority of Mizoram’s population, as government hospitals are often overcrowded and severely understaffed, lacking the necessary equipment to effectively care for the growing number of patients.
Even the family of 16-year-old Remsangpuii was in distress. After learning that the new healthcare scheme was launched on April 1 and that all private hospitals, including LRM Hospital where she was admitted, were no longer included in the empanelled list, they urgently sought a referral to Zoram Medical College (ZMC) in Falkawn for the necessary surgery.
Her caretaker told EastMojo, “We have requested the hospital to provide a referral letter, and we are currently waiting for it. As soon as we get it, we will transfer her to ZMC.” For patients like VL Remsangpuii, there is a chance of securing an appointment at ZMC due to her aunt working as a nurse there. However, for those without connections in government hospitals, the process becomes an even more difficult and uncertain challenge.
EastMojo spoke to the directors of the biggest private hospitals in the state to understand why they were in disagreement with the new scheme.
Explaining their stance, Dr Vanlalsiama Chhangte, Medical Director of Ebenezer Medical Center, told EastMojo, “Private sector hospitals in Mizoram have a bad experience with the Government Health Care Scheme whenever the cashless system is attempted. Hospitals have lost money earlier which was not paid to date. So, all private sector hospitals including our hospital are hesitant to implement the cashless facility.”
He also explained how the rates are set by the healthcare scheme, saying, “Though rates of Private hospitals in Mizoram are very reasonable compared to other hospitals in another part of the country, the rates offered by Mizoram Universal Health Care Scheme are far lower than the current rates used by hospitals. So, implementing the offered rates will result in the decline of the private health care sector in the state resulting in further decline in the health care system.”
It may be noted that private hospitals are the ones who first introduced MRI Scan, Laparoscopic procedures, Cardiac Cath Lab and many other innovations in health care for Mizoram.
In response to a question at the Mizoram Legislative Assembly held between February and March 2025 regarding the loan the government plans to take to cover the healthcare scheme, Lalrinpuii, Minister of the Health and Family Welfare Department, stated, “For the Mizoram State Health Care Scheme, as well as the new Universal Health Care Scheme, the state plans to take a loan of $108 million (US dollars).” She further explained that they were awaiting approval from the Department of Economic Affairs, Ministry of Finance, regarding the loan’s approval status.
This was an issue raised by Dr Lalrintluanga Jahau, a Surgeon and Director of Trinity Hospital, Aizawl, “Looking at the current financial situation in Mizoram and given the fact that Mizoram is a zero revenue generating state, it would not be possible for the government to do what it promises – to reimburse the hospitals within a month.”
The Health Minister had also mentioned plans to strengthen the existing government hospitals, increasing the bed numbers to 82, with 30 new cabins in ZMC and, taking in new employment, including 300 nurses.
In response to this initiative, Jahau said, “The officials claim they will strengthen the hospitals, but this is not feasible due to a lack of manpower. Additionally, maintaining government hospitals is extremely challenging. Across India, Private-Public Partnerships (PPP) are being implemented, especially when it comes to high-quality tertiary healthcare, where PPP is prioritised.”
What came to the surprise of many was that even church-run hospitals, including Synod Hospital, Lairam Christian Medical Center and Hospital, and Adventist Hospital were not in support of the Universal Healthcare scheme and were not included in the empanelled list of hospitals.
Dr. Eileen Lalrinpuii, Medical Director of Adventist Hospital, shared with EastMojo how their past experiences led them to this decision.
She said, “In 2001, the rate for a general ward at our hospital was Rs. 25. Over time, we gradually increased it, and now it’s around Rs. 300. Later, we became familiar with healthcare schemes, but with third-party administrators involved, the rates for everything, including bed charges and surgery prices, started rising. However, as a mission hospital, we never set rates higher than Synod’s. Even before the healthcare scheme, we have always stood by the poor as a charitable institution, often providing free care to patients. About 3-4 years ago, we decided to join the cashless healthcare scheme. The church doesn’t fund us—whatever we receive is used for our self-sustenance. But, after a year of providing cashless treatment under the Ayushman Bharat scheme, our self-support percentage drastically dropped. They promised reimbursement within 30 days, but this never happened, and the payments were delayed. There was no clear deadline for reimbursement, and everything turned into receivables. Eventually, we discovered they owed us Rs. 22 lakhs. We went to the healthcare office, but the administrators claimed they only owed us Rs. 10-11 lakhs. We genuinely want to help the underprivileged, but we cannot do it to the point that we lose everything.”
“For us, even with a new government and fresh promises, the system has repeatedly failed to live up to its commitments. There are countless cases like ours, where debts remain unpaid. For a small hospital like ours, even a loss of Rs 6 lakh is a huge burden. It’s becoming increasingly difficult for us to trust them,” she added.
Regarding the debts incurred by the government in the healthcare scheme, a health official clarified their position, stating that the insurance company partners had failed to make the full payments, which the government later reimbursed to the patients.
In the 2006-07 period, the official mentioned that ICICI Lombard had not fulfilled its payment obligations as per the agreement. Similarly, in 2008-09, Reliance General Insurance Co. Pvt. Ltd. (RGICL) failed to pay the hospitals and individuals, despite repeated reminders from the government.
The official further explained that, as a result, the government has decided to end its partnerships with insurance companies. Moving forward, the finances will be managed by the Health Care Society, with the full responsibility falling to the government.
The Universal Health Care Scheme has proved to be a cause of worry for people of all ages including expecting mothers.
Jacqueline Zote, a resident of Aizawl and an expectant mother, shared her woes with EastMojo saying, “The changes in the healthcare system mean having to pay out of pocket if I want to deliver in a private hospital, which will likely be the case since govt hospitals are overwhelmed as it is and choosing one would also mean having to change my ob-gyn. These costs can get high (upwards of ₹60,000) especially since I will be needing a C-section, not to mention the potential added cost if my future child gets newborn jaundice (which is very common). I’d already made plans to deliver in a private hospital with the hope that the government healthcare scheme would help cover the expenses, especially since my private health insurance doesn’t yet cover maternity expenses because the 2-year waiting period isn’t over yet.”
While the previous healthcare system where citizens pay hospital fees and apply for reimbursement might have been slightly inconvenient with delayed processing, Jacqueline suggests that it was at least reliable, “It also meant private hospitals could effectively provide patient care without the cost of a huge financial risk. Cashless systems in government hospitals and reimbursement systems in private hospitals could help strike some balance so citizens can make healthcare choices that are convenient for them,” she said.
The Medical Directors of private, non-government hospitals were also asked for their suggestions to the government.
Dr Vanlalsiama Chhangte from Ebenezer Hospital recommended that the government reconsider the order that cancelled the empanelment of non-government hospitals. He stated, “The immediate solution that would ease public suffering is for the government to revoke the order that cancelled all empanelment of non-government hospitals. Additionally, if the patient’s party could reimburse the costs through the Health Care Society, it would help. In my opinion, if the government allows the patient’s party to pay for the expenses not covered by the government health insurance, a middle ground could be found to ease the situation.”
Dr Eileen from Adventist Hospital suggested that the Mizoram government should take cues from the Meghalaya government, “I visited a hospital in Garo Hills, Meghalaya, where they run the facility under the PMJAY scheme. I spoke with the administrator, and he told me that they always receive payments within a month. He said they have a strong relationship with the administrators, which is why they trust the system. However, the Meghalaya government has the financial resources and prioritises funding and the health sector. For the central scheme to succeed, the state needs adequate funding. Health is undeniably important, but if the government truly prioritizes it, it must allocate sufficient resources to the health sector. Meghalaya has managed to do this because they prioritize health.”
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