Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is one of the most ambitious healthcare schemes launched by the Indian government in 2018. It aims to provide free medical treatment to economically weaker sections of society. However, recent reports indicate that over 600 private hospitals have withdrawn from the scheme. In this blog, we explore the reasons behind this mass exodus and what the government can do to address the issue.
Why Are Private Hospitals Withdrawing?
1. Delayed Payments
One of the primary concerns of private hospitals is the delay in claim settlements. Hospitals are struggling with financial strain due to slow disbursement of funds by the government. For example, in Haryana alone, private hospitals are awaiting payments of over INR 400 crore.
2. Low Reimbursement Rates
Private hospitals argue that the package rates under Ayushman Bharat are significantly lower than the actual cost of treatment. This makes it financially unsustainable for them to continue providing services under the scheme.
3. Administrative Challenges
The scheme involves complex and lengthy claim processing, making it difficult for hospitals to navigate the bureaucratic hurdles. The cumbersome approval and documentation processes add to their operational burden.
4. Preference for Government Hospitals
In some states, certain medical procedures are reserved exclusively for government hospitals, limiting the number of patients that private hospitals can treat under the scheme. This reduces their incentive to remain part of Ayushman Bharat.
States with the Highest Number of Withdrawals According to government data, the states with the highest number of private hospitals opting out are:
- Gujarat: 233 hospitals
- Kerala: 146 hospitals
- Maharashtra: 83 hospitals
Government’s Response Officials have acknowledged the concerns and are working towards faster fund disbursement. In Haryana, Ayushman Bharat’s Joint CEO Ankita Adhikari has stated that the payment process has been initiated and should be resolved within a week. The central government is also considering a review of reimbursement rates to make the scheme more viable for private hospitals.
Challenges Ahead While more than 36 crore Ayushman cards have been issued, the withdrawal of private hospitals poses a major risk to the scheme’s effectiveness. If corrective measures are not taken soon, more hospitals may exit, limiting access to quality healthcare for the poor.
Potential Solutions
- Faster Payment Processing – The government must ensure that hospitals receive payments within 15-30 days to avoid financial strain.
- Revised Package Rates – Treatment costs should be re-evaluated to offer competitive reimbursement rates that align with actual medical expenses.
- Incentives for Private Hospitals – Tax benefits or financial assistance could encourage private hospitals to stay in the scheme.
- Technology-Driven Solutions – Implementing AI and blockchain-based claim settlement systems can enhance transparency and speed up the payment process.
Conclusion
Ayushman Bharat is a transformative initiative for India’s healthcare sector, but the growing distance between private hospitals and the scheme is alarming. Unless the government takes immediate action to resolve the financial and administrative concerns, the scheme’s efficiency and impact may be compromised.
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