The Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), India's flagship public health insurance program is witnessing a decline in hospital enrolments. Data indicates that the average monthly empanelment of hospitals has decreased from 316 in 2024 to just 111 by April 2025. This downturn is primarily attributed to growing dissatisfaction among private hospitals regarding delayed reimbursements and unviable package rates.
In Jharkhand, private hospitals have threatened to withdraw from the scheme due to prolonged delays in government reimbursements, with dues amounting to over ₹140 crore. Similarly, in Punjab, private hospitals have halted treatments under Ayushman Bharat, citing pending dues of ₹600 crore. Haryana's private hospitals have also suspended inpatient admissions under the scheme, protesting against the state government's failure to clear dues totaling over ₹200 crore.
Private healthcare providers argue that the reimbursement rates under Ayushman Bharat are often lower than the actual cost of treatments. This discrepancy makes it financially unviable for many hospitals to continue offering services under the scheme. The Association of Healthcare Providers India (AHPI) has highlighted that many tertiary care private hospitals are wary of joining the scheme due to these low rates and delayed payments.
Beyond financial concerns, private hospitals also face administrative burdens associated with the scheme. The complex paperwork and bureaucratic processes increase operational costs and divert resources from patient care. Additionally, technical glitches in the payment settlement systems have further exacerbated delays, leading to a piling up of dues.
In response to these challenges private hospital associations are advocating for policy reforms. Key demands include the reinstatement of a clause that mandates interest payments for delayed reimbursements and the introduction of a co-payment model. This model would allow hospitals to charge slightly higher than the predetermined rates based on their expenses, with the requirement to disclose these rates on their websites beforehand, giving consumers a choice.
The government has acknowledged the concerns raised by private hospitals. In Jharkhand, Health Minister Irfan Ansari assured that outstanding dues under the Ayushman Bharat scheme would be cleared soon, attributing current payment delays to investigations into hospitals flagged by the National Anti-Fraud Unit and technical issues with a newly introduced portal. However, private hospitals emphasize that without timely payments and viable rates, their continued participation in the scheme remains uncertain.
(Input from various sources)
(Rehash/Sakshi Thakar/MSM)