New Delhi: More than 50 private and 15 Delhi govt hospitals have enrolled under the State Health Authority (SHA) to provide cashless treatment to patients under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY).
However, many private facilities are reluctant to join the scheme over concerns of low rates being offered by govt.
Most private healthcare facilities previously registered with AB-PMJAY through the National Health Authority (NHA) during the previous AAP regime were automatically transferred to city authority oversight.
However, several prominent private hospitals raised issues regarding AB-PMJAY reimbursement rates, stating these do not adequately cover treatment expenses and could lead to financial deficits.
While smaller healthcare facilities might find the scheme workable, larger hospitals consider it financially unviable due to substantial operational expenses, including infrastructure and advanced medical equipment.
Clarifying why corporate and larger hospitals are reluctant to participate, Dr Sunil K Khetarpal, director, Association of Healthcare Providers India (AHPI), cited inadequate package rates for advanced medical procedures.
He also highlighted concerns about delayed payments reported in some states implementing this scheme.
AHPI, representing about 15,000 private hospitals, including Fortis, Max Healthcare, Manipal, Medanta, Narayana and Apollo, has sought discussions with Delhi govt to address these concerns.
Girdhar J Gyani, AHPI’s director general, has written to chief minister Rekha Gupta, stressing the necessity of establishing a dedicated grievance redressal system and accelerating reimbursements process under Delhi’s recent inclusion in AB-PMJAY.
Dr Narin Sehgal, medical director, Sehgal Neo Hospital, and AHPI secretary, Delhi, acknowledged the scheme’s significance as the largest health insurance programme.
He noted widespread hesitation in enrolment and suggested reconsideration of rates by govt and timely payments, citing issues with similar schemes, like CGHS.
Despite AHPI’s intervention and NHA’s promises to revise the rates, the adjustments remained selective and insufficient, said Dr Sehgal.
On April 5, Delhi govt entered an agreement with the Centre to implement AB-PMJAY, with card distribution beginning April 10. Very few private hospitals joined afterwards. CM Gupta said Delhi govt will cover 2,35,000 families in the first phase.
Currently, 67 out of over 1,000 Delhi hospitals are participating in the scheme. Govt facilities include Lok Nayak, Deep Chand Bandhu Hospital, Rajiv Gandhi Super Specialty Hospital and Delhi State Cancer Institute while private participants include Dharamshila Narayana Superspeciality Hospital, Metro Hospital & Cancer Institute and Sri Balaji Action Medical Institute.
Most of the empanelled private hospitals are in New Delhi district and are dedicated to eye care, general surgery, oncology, obstetrics and gynaecology.
The scheme offers free treatment covering 1,961 medical procedures across 27 specialities, including medicines, diagnostics, hospitalisation, ICU care and surgeries.
