Over two months have passed since the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) was launched in Delhi, but the ambitious healthcare scheme is yet to find significant traction among the city’s major private hospitals. Despite its potential to transform access to quality healthcare, participation from top-tier hospitals remains worryingly low.
Only a Handful of Private Hospitals Onboard
Launched on April 10, the scheme has so far attracted just 93 hospitals in the national capital — a modest figure when compared to the hundreds of private healthcare facilities operating in Delhi. Leading hospitals like Fortis, Max, Gangaram, Apollo, and BLK have chosen to remain outside the fold, raising concerns about the scheme’s reach and effectiveness.
Insiders reveal that the core issue lies in the treatment and procedure rates set under Ayushman Bharat, which private hospitals claim are too low — reportedly only 30% to 40% of current market rates. Hospital administrators argue that offering services at these prices would not cover operational costs, especially when timely payment is not guaranteed.
Low Rates Aren’t the Only Problem — It’s the Delay in Payments”
Dr. Girdhar J. Gyani, Director General of the Association of Healthcare Providers (India), acknowledged that the concern is two-fold. “Yes, the rates are low — that’s undeniable,” he said. “But what truly worries hospitals is the history of delayed payments under similar government schemes. If the current administration can ensure reimbursement within 30 days, mid-sized hospitals may consider joining. For large hospitals, though, the present rates just don’t work.”
Dr. Gyani emphasized the need for accountability, suggesting that delayed payments should attract a 1% interest penalty. This, he said, would put necessary pressure on officials to process claims promptly. He also noted that the Central Government Health Scheme (CGHS) rates were last updated in 2014, while Ayushman Bharat began in 2018. “In a time of rising inflation, it’s crucial to revise these rates through a new scientific costing study. Until then, the government should implement temporary revised rates.”
A Co-Payment Model Could Bridge the Gap
To break the current stalemate, Dr. Gyani proposed a practical middle ground — the introduction of a co-payment model. “If a procedure costs ₹130, let the government cover ₹100 through the scheme, and allow the patient to pay the remaining ₹30,” he said. He cited examples from other countries where such models have worked efficiently, balancing affordability with quality care. This approach, he believes, would allow bigger hospitals to participate while still offering patients a fair choice.
What Needs to Change for Real Impact?
The hesitance of major hospitals to join Ayushman Bharat in Delhi underscores a deeper issue: while the scheme is robust in vision, its implementation needs fine-tuning. Without realistic treatment rates and a streamlined payment process, the scheme risks missing out on the very institutions that can deliver advanced care to the masses.
For Ayushman Bharat to become truly inclusive and effective, the government must engage proactively with private healthcare providers, revise pricing structures based on current economic realities, and build trust through timely financial commitments.
Until then, for many Delhi residents hoping for seamless access to high-quality treatment through their Ayushman cards, the doors of top hospitals may remain firmly closed.