Ayushman Bharat Yojana: What Led More Than 600 Private Hospitals To Opt Out Of The Scheme

Ayushman Bharat Yojana is a health insurance scheme that offers beneficiaries health insurance of Rs 5 lakh. The scheme has been extended to all resident seniors in October last year, aged 70 years and above. Beneficiaries can avail of benefits at the empanelled hospitals, including both government and private hospitals. However, in the last few years, more than 600 private hospitals have voluntarily opted out of the scheme. As per media reports, the reasons they cited include low reimbursement and delayed payment.

As of April 1, 2025, the scheme has a total of 31,846 empanelled hospitals, of which, 17,434 are government and 14,412 are private hospitals, per the official website. The scheme offers 1961 medical procedures under 27 medical specialities.

Private Hospitals Opting Out, Payment Delay A Key Reason

A total of 233 hospitals, the highest number of hospitals that have opted out, are from Gujarat. Kerala followed this with 146 opt-outs, and Maharashtra with 83 hospital exits from the scheme.

Ironically, the scheme is a tool to provide healthcare coverage to around 12 crore families and approximately an additional 6 crore senior citizens aged 70 years and above. However, if hospitals keep exiting the scheme, it will defeat the purpose of providing healthcare to more people.

Reportedly, private hospitals claim that their payments have been delayed by the government, and due to this, they are not willing to continue with the Ayushman scheme. In addition, the lower package rates are also a key reason for them to exit from the scheme. Private hospitals in Haryana haven’t received their payment worth in crores. Similarly, the states of Punjab, and Jammu and Kashmir also face the same issues.

Another hindrance is reserved procedures for government hospitals. Because of this, private hospitals don’t get the referrals.

However, as per the written reply by Prataprao Jadhav, Minister of State in the Ministry of Health and Family Welfare, on February 11, 2025, in Rajya Sabha, the government provides several incentives to the empanelled hospitals.

Government Incentives To Empanelled Hospitals:

It reads, “The scheme ensures quality treatment for the beneficiaries. For this, various incentives are provided to improve the quality of healthcare services. To encourage the participation of public, private, and corporate healthcare providers, empanelled hospitals are additionally incentivised for accreditation. The incentive of 10 per cent and 15 per cent over and above the package rate is provided to the hospitals with entry-level NABH accreditation and full NABH accreditation, respectively. Hospitals, which are imparting Post-Graduate education, are also incentivized at the rate of 10 per cent over and above the base rate of health benefits package (HBP) packaged master rates”.

In another reply in Rajya Sabha on March 25, the minister said that the claims under the Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), are settled by respective State Health Agencies (SHA). “The National Health Agency (NHA) has laid down guidelines for payment of claims to hospitals within 15 days of claims submission for intra-state hospitals (hospitals located within the State) and within 30 days in case of portability claims (hospitals located outside the State)”.

However, in practice, it doesn’t seem like happening.

Need Of A Robust System

Ayushman Bharat Scheme is aimed to benefit eligible beneficiaries and seniors (aged 70 years and above) and follows a ‘zero-tolerance approach’ towards any fraud in executing the scheme.

The authorities have even de-empanelled 1114 hospitals and suspended 549 hospitals for their alleged involvement in fraudulent activities. But, at the same time, there is also a need to increase the number of empanelled hospitals, make the claim settlement fast, and healthcare system robust to benefit more people.