The Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), launched in 2018, has faced a significant setback as over 600 private hospitals across India have withdrawn from the scheme. The major reasons cited for this move include delayed payments and low reimbursement rates, making it difficult for hospitals to sustain operations under the program. Among the states, Gujarat has seen the highest number of hospital exits, followed by Kerala and Maharashtra.
Why Are Private Hospitals Exiting the Scheme?
Private hospitals play a crucial role in India’s healthcare system. However, many of them are now opting out of the Ayushman Bharat scheme due to multiple operational challenges:
- Delayed Payments: Several hospitals claim that state governments are not releasing funds on time, leading to significant financial distress. For instance, hospitals in Haryana reported pending payments exceeding ₹400 crore, prompting them to suspend their participation in the scheme.
- Low Reimbursement Rates: Private hospitals argue that the rates fixed under Ayushman Bharat are insufficient to cover the actual costs of treatment. This makes it financially unviable for them to continue offering services under the scheme.
- Limited Referral System: In states like Chhattisgarh and Gujarat, certain treatment packages are exclusively reserved for government hospitals, limiting private hospital participation and making the scheme less attractive.
- Increased Administrative Burden: The claim filing process and verification requirements are often cumbersome, further discouraging private healthcare providers from continuing with the scheme.
Which States Are Most Affected?
According to data presented in the Rajya Sabha by Minister of State for Health and Family Welfare Prataprao Jadhav, Gujarat has witnessed the highest number of withdrawals, with 233 private hospitals pulling out. Kerala follows with 146 hospitals, and Maharashtra comes third with 83 hospitals opting out. In total, 609 private hospitals have exited the scheme so far.
Government’s Response to the Crisis
The Indian government has acknowledged the concerns raised by private hospitals and has taken steps to address the issues:
- Faster Payment Processing: The National Health Authority (NHA) has issued guidelines to ensure that claims from hospitals are settled within 15 days for in-state cases and 30 days for inter-state claims.
- Review of Reimbursement Rates: The government is considering revising package rates to better reflect the actual cost of medical procedures and ensure fair compensation to private hospitals.
- Increased Funding Allocation: Authorities in Haryana and other states have announced that additional funds will be released soon to clear pending hospital dues.
Impact on Beneficiaries
The Ayushman Bharat scheme was designed to provide free health insurance of up to ₹5 lakh per year to nearly 50 crore Indians. The exit of private hospitals could severely impact the availability of quality healthcare for beneficiaries, particularly in states where private facilities constitute a significant portion of the healthcare infrastructure.
Although government hospitals are still participating in the scheme, their limited capacity and infrastructure constraints may lead to increased waiting times and reduced accessibility for patients in need.
Challenges and Future Prospects
Despite benefiting millions of patients and issuing over 36 crore Ayushman Bharat cards, the scheme now faces critical challenges. Experts warn that unless the government makes urgent reforms, more private hospitals might withdraw, ultimately affecting the poor and marginalized communities who rely on the scheme for essential healthcare services.
To maintain the success and reach of Ayushman Bharat, policymakers need to ensure that payment delays are minimized, reimbursement rates are competitive, and private sector participation remains strong. Without these improvements, the scheme’s goal of providing universal healthcare coverage could be at risk.
