More than 600 private hospitals withdrew names from Ayushman Bharat Scheme, Gujarat tops

A shocking fact has come out about the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), the ambitious health scheme of the Government of India launched in 2018. According to government data, more than 600 private hospitals have voluntarily decided to exit the scheme since the launch. These hospitals have separated themselves from the scheme citing reasons like delay in payment and low reimbursement rate.

Gujarat has the highest number of private hospitals exiting the Ayushman Bharat scheme. Here 233 hospitals have decided to get out of the plan. After this, 146 hospitals in Kerala and 83 hospitals in Maharashtra have also taken such a step. According to the data shared in the Rajya Sabha by Health and Family Welfare Minister Pratavarao Jadhav, a total of 609 private hospitals have been excluded from the scheme so far. This situation has become a matter of concern for the scheme, which aims to provide health coverage to 10 crore families or about 50 crore people of the country.

Complaint of private hospitals
That their work becomes difficult due to low rates and delays in payment under the scheme. Many hospitals have claimed that they did not get timely funds due to the state governments not issuing funds on time, which unable to continue participating in the plan. For example, in February, hundreds of private hospitals under the Haryana branch of the Indian Medical Association (IMA) announced that they would stop providing services under the scheme. Because payment of more than Rs 400 crore was outstanding. Subsequently, private hospitals and nursing home associations in Punjab and Jammu and Kashmir also made similar demands.

Some treatment packages in states like Chhattisgarh and Gujarat are being excluded from private hospitals, as they are reserved only for government hospitals and there is no referral from government hospitals. In response to a question in the Rajya Sabha, Minister of State for Health Prataprao Jadhav said that the National Health Authority (NHA) has fixed guidelines for hospitals to pay claims within 30 days of 15 days of filing claims for inter-state hospitals and within 30 days for portability hospitals (located outside the state).

The purpose of the scheme and the current status
The Ayushman Bharat Yojana was launched by Prime Minister Narendra Modi in Ranchi, Jharkhand on 23 September 2018. The scheme provides free medical insurance up to Rs 5 lakh per year to poor and weaker families. About 10.74 crore poor and weaker families were included at the beginning of the scheme. Which according to the socio-economic and caste census (SECC) of 2011 is the lowest of India’s population. Later in January 2022, the beneficiary Aadhaar was revised to 55.0 crore persons or 12.34 crore families. In 2024 alone, the scheme was expanded to 37 lakh Asha and Anganwadi workers and their families free health care benefits, and by the end of the year, the government announced to include about 6 crore senior citizens aged 70 years and above. Later, Odisha and Delhi became the 34th and 35th state or union territory (UT) to join the PMJAY. Due to which more than 70 lakh families were added under this scheme.

Government’s answer
It is that the government says that they are taking the right steps to solve this problem. Ankita Adhikari, a joint CEO of Ayushman Bharat in Haryana, recently said that the process of issuing funds has been started and the situation will be handled within a week. Apart from this, the Central Government has said to take the complaints of private hospitals seriously and review the package rates and speed up the payment process.

Further challenges
Although crores of patients have been benefited from this scheme so far and Ayushman cards have been issued to about 36 crore people. But going out of private hospitals may threaten the future of this scheme. Experts believe that even more hospitals may be out of this scheme if the payment system is not improved. This will lead to the most threat to the poorest and needy patients.

Amid the questions raised about the Ayushman Bharat scheme, the biggest challenge before the government is to ensure that private sector participation continues and the health services of the poor are not affected. There is a need to take concrete steps in this direction so that the basic objective of this scheme can be fulfilled.