The Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), the Indian government's flagship health insurance scheme, is facing challenges as private hospital enrollments have seen a significant dip. This decline is primarily attributed to concerns over low package rates and delays in claim reimbursements, which are deterring private hospitals, especially larger chains, from participating in the scheme.
Data from the National Health Authority (NHA), the implementing agency of AB-PMJAY, reveals a concerning trend. The average monthly empanelment of hospitals has dropped drastically from 316 in early 2024 to a mere 111 by April 2025. This substantial decrease underscores the growing reluctance of private healthcare providers to join or remain within the Ayushman Bharat network.
Several factors contribute to this reluctance. One of the most significant is the low package rates offered under the scheme. Many private hospitals, particularly large corporate chains, find that these rates are lower than their input costs, making it financially unviable for them to provide services to Ayushman Bharat beneficiaries. The CEO of a leading hospital chain in Delhi noted that the package rates for various procedures were simply too low to cover expenses.
Delayed payments further exacerbate the problem. Private hospitals have consistently reported delays in receiving reimbursements from the government, leading to cash flow problems and operational difficulties. In Haryana, for instance, over 600 private hospitals threatened to halt Ayushman Bharat services due to pending reimbursements amounting to ₹400 crore. The Indian Medical Association (IMA) has also highlighted the need for increased package rates to ensure the scheme's sustainability, suggesting that rates should be raised to at least the Central Government Health Scheme (CGHS) level.
The consequences of declining private hospital participation are far-reaching. Ayushman Bharat aims to provide healthcare coverage to a vast population, particularly those from economically weaker sections. The exit or reduced participation of private hospitals limits the options available to beneficiaries, potentially compromising the quality and accessibility of care. In states like Bihar, the situation is particularly dire, with a high number of families per empanelled provider and a significant proportion of inactive hospitals.
The government has taken some steps to address these concerns. The NHA claims that empanelment is ongoing and that some new enrollments may not yet be reflected in the data due to system migration. Additionally, the government provides incentives to empanelled hospitals, such as additional incentives for hospitals with National Accreditation Board for Hospitals & Healthcare Providers (NABH) accreditation. Delhi's Health Minister has also stated efforts are being made to onboard bigger private hospitals, blaming previous government for payment delays. However, these measures may not be sufficient to overcome the fundamental issues of low rates and delayed payments.
To ensure the long-term success of Ayushman Bharat, a more comprehensive approach is needed. This includes revising package rates to make them more attractive to private hospitals, streamlining the reimbursement process to ensure timely payments, and addressing the operational challenges faced by healthcare providers. Without these changes, the scheme risks failing to achieve its noble objective of providing affordable and accessible healthcare to all.
