Ayushman Card Holders Alert: Private hospitals say that the low rates fixed under the scheme and the delay in payment are making it difficult for them to function.
Ayushman Card: A big information has come to light regarding the ambitious health scheme of the Government of India, Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), launched in the year 2018. According to government data, since the launch of this scheme, more than 600 private hospitals have voluntarily decided to exit it. These hospitals have separated themselves from the scheme citing reasons like delayed payment and low reimbursement rate.
Most hospitals from Gujarat are out
Most of the private hospitals that have separated themselves from the Ayushman Bharat scheme are from the state of Gujarat. Here 233 hospitals decided to exit the scheme. After this, 146 hospitals in Kerala and 83 hospitals in Maharashtra have also taken similar steps. According to data shared by Minister of State for Health and Family Welfare Prataprao Jadhav in the Rajya Sabha, a total of 609 private hospitals have so far opted out of the scheme. This situation has become a matter of concern for the scheme, which aims to provide health security to 10 crore families or about 50 crore people in the country.
Complaints of private hospitals
Private hospitals say that the low rates fixed under the scheme and delays in payments are making it difficult for them to function. Many hospitals have claimed that they have not received money on time due to non-release of funds by the state governments, due to which they are unable to continue participating in the scheme. For example, in February, hundreds of private hospitals under the Haryana unit of the Indian Medical Association (IMA) announced to stop services under the scheme as payments of more than Rs 400 crore were pending there. After this, the Private Hospitals and Nursing Home Association in Punjab and Jammu and Kashmir also demanded similar suspension.
In states like Chhattisgarh and Gujarat, some treatment packages are reserved only for government hospitals and private hospitals are also opting out due to no referrals from government hospitals. Replying to a question in the Rajya Sabha, Minister of State for Health Prataprao Jadhav said that the National Health Authority (NHA) has laid down guidelines for hospitals to pay claims within 15 days of filing of claim for inter-state hospitals and within 30 days for portability hospitals (located outside the state).
Objective and current status of the scheme
The Ayushman Bharat Yojana was launched by Prime Minister Narendra Modi on September 23, 2018 in Ranchi, Jharkhand. The scheme provides free health insurance of up to Rs 5 lakh per year to poor and vulnerable families. The scheme initially covered about 10.74 crore poor and vulnerable families, who are the bottom 40 per cent of India’s population as per the 2011 Socio Economic and Caste Census (SECC). The beneficiary base was later revised to 55.0 crore individuals or 12.34 crore families in January 2022. In 2024 alone, the scheme was expanded to cover 37 lakh ASHA and Anganwadi workers and their families for free healthcare benefits, and at the end of the year, the government announced the inclusion of about 6 crore senior citizens aged 70 years and above. Later, Odisha and Delhi became the 34th and 35th states or union territories (UTs) to join PMJAY, taking the number of families covered under the scheme to over 70 lakh.
Government response
The government says it is taking steps to address the issue. Ankita Adhikari, joint CEO of Ayushman Bharat in Haryana, recently said the process of releasing funds has been initiated and the situation will be taken care of within a week. Apart from this, the central government has taken the complaints of private hospitals seriously and has said that it will review the package rates and speed up the payment process.
Challenges ahead
Although the scheme has benefited several crore patients so far and Ayushman cards have been issued to about 36 crore people, the exclusion of private hospitals can pose a threat to its future. Experts believe that if the payment system is not improved, more hospitals may be excluded from this scheme, which will harm the poor and needy patients the most.
Amidst these questions being raised about the Ayushman Bharat scheme, the biggest challenge before the government is to ensure that the participation of the private sector remains and the access to health services to the poor is not affected. Concrete steps need to be taken in this direction, so that this scheme can fulfill its basic objective.
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