A third of PM-JAY hospitals haven’t admitted patients

Nearly one-third of hospitals empanelled under the Centre’s flagship scheme Ayushman Bharat–Pradhan Mantri Jan Arogya Yojna have not admitted any patient since their empanelment, as per the data collected by the National Health Authority that implements the government-funded family medical insurance scheme for people belonging to the poor and marginalised section of society.

The maximum number of such hospitals is in Gujarat (2,552) followed by Tamil Nadu (1,881) and Andhra Pradesh (1,295). Six other states have more than 100 inactive hospitals—Rajasthan (658), Karnataka (421), Uttar Pradesh (238), Telangana (197), Madhya Pradesh (154) and Punjab (109).

Taken together, these nine states account for over 7,500 hospitals that came on board but didn’t implement the scheme.

Out of 28,586 empanelled hospitals, as many as 8,484 remained inactive from the very beginning. Asked about the reasons for hospitals staying away from the scheme, top NHA officials didn’t answer in the specifics, but an office-bearer of a private hospital association said low rates under the scheme and poor availability of specialists in hospitals in smaller cities and towns might have led to such a scenario.

“More than 26,000 hospitals have been onboarded under Ayushman Bharat PM-JAY.” These hospitals are our key partners in scheme implementation. While NHA has been actively working with SHAs (State Health Authorities) to expand the hospital network, it is also focusing on ensuring the active participation of these hospitals,” R S Sharma, Chief Executive Officer of the NHA, told DH.

“NHA has deployed a three-pronged strategy for the activation of hospitals: hand-holding support on the IT platform, timely claim settlement, and strengthening engagement with empanelled hospitals. Further, we have onboarded beneficiary facilitation agencies for public hospitals in a few states/UTs. This has helped significantly increase the participation of public hospitals,” he added.

Girdhar Gyani, director general of the Association of Healthcare Providers (India), said some of the hospitals gave the beds to those patients who paid by cash or private medical insurance, whereas many tertiary care hospitals in smaller cities didn’t have the specialists, compelling PM-JAY eligible families to skip such hospitals.

He also pointed out the huge difference in rates because of which many hospitals develop cold feet. For instance the government offers Rs 11,500 for cesarean delivery – one of the popular packages under the PM-JAY – but it would cost more than a lakh by private hospitals, according to an assessment made by AHPI. “Unless the government revises the package rates, the situation was unlikely to change,” he added.

Since the 2019 launch of the world's largest public funded medical insurance scheme under which a family insurance cover of Rs 5 lakh is provided to 10.74 crore families, low package rates were concerns that the private healthcare industry cited as the reason for many hospitals evading the scheme’s implementation.