‘Ayushman card helped my mother get timely treatment': Months after launch, how has the scheme fared in Delhi?

Indian Express

21 hours ago

It was June 27, a Friday. Jai Prakash was finally admitted to a private hospital in South Delhi.
Since December last year, he has been complaining of severe chest pain and palpitations. A check-up revealed that two of his heart valves were not functioning. He needed heart valve replacement surgery, and his local doctor suggested he go to Delhi.
But the cost — over Rs 3 lakh — was far beyond his means. A 70-year-old farmer from Agra's Anguthi village, Prakash grew wheat on a 200-yard plot and made money based on how the crop performed.
Then came a lifeline: the announcement that the Ayushman Bharat scheme was launched in Delhi.
For Prakash, that meant access to a good private hospital, empanelled under the scheme, in the national capital — something previously out of reach.
His cousin Ram Singh, who accompanied him from the village, said that 'the surgery and hospital admission, amounting to Rs 3.5 lakh, was covered under Ayushman Bharat.
All Prakash had to pay was Rs 1,500 for the doctor's consultation fee and Rs 10,000 for diagnostic tests.
It was Prakah's doctor in Agra who suggested he get the surgery done at the Delhi hospital, which specialises in heart health. 'Doctors are not that good where we live… Delhi is close by, a four-hour road journey from the village, and doctors here are more reliable. So, we came to the city,' says Singh, adding that Prakash underwent the surgery on June 28.
Singh, also a farmer, said if not for the Ayushman card, they would have had to sell a part of their land to pay for the surgery.
On April 11, the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) — the Central government's flagship health programme — was flagged off by the BJP Delhi government, promising health coverage of up to Rs 10 lakh per family per year. It was the BJP's biggest poll promise in the run-up to the Delhi Assembly elections.
Three months following its rollout, the scheme has emerged as a crucial support system for low-income families like Prakash struggling with the rising cost of private healthcare. But there are some hiccups. First, big private players are yet to come on board, citing the pricing difference. Second, officials have pointed to a lack of staff and infrastructure in hospitals for the scheme to take off.
So far, 69 private hospitals (including 7 daycare centres) and 39 central and state government hospitals (as per the PMJAY.gov.in) have been empanelled under the scheme. Among these, a majority of facilities offer Ophthalmology services, followed by General Medicine, General Surgery, Obstetrics & Gynaecology, and Orthopaedics.
Nodal officers have been appointed in these hospitals, and their numbers are provided on the website of the National Health Authority (NHA). The NHA is the apex body responsible for the scheme's implementation.
Since Delhi was onboarded onto the PMJAY, a total of 3,92,181 Ayushman cards have been issued to residents, and over 20,000 hospital admissions have taken place so far. Top procedures conducted in Delhi include chronic hemodialysis, cataract surgery, cesarean delivery, and common bile duct laparoscopic surgery.
To understand the early impact of AB-PMJAY in Delhi, The Indian Express visited 15 private hospitals empanelled under the scheme and spoke to patients and officials about the benefits and challenges.
Over the course of a week, The Indian Express found several patients from Delhi and nearby states availing of the scheme's benefits. Many also stopped by Ayushman kiosks set up at some hospitals to inquire about eligibility and services.
At one such hospital was Mahendri Devi. The 73-year-old had to undergo surgery for a broken leg — she had been hit by a bull at her home in Narela's Kheda Khurd village.
Her son, Manoj, a farmer, rushed her to a nearby private hospital and inquired whether the Ayushman card could be used. The hospital confirmed her eligibility under the scheme.
He said he had to pay Rs 15,000 for initial diagnostic tests, which were not covered, but the cost of the surgery and hospital admission was taken care of under the scheme.
'Thanks to the card, my mother received timely treatment,' he said. 'Otherwise, we would have spent lakhs.'
Devi received her Ayushman card from Delhi Chief Minister Rekha Gupta on April 28; she was among 40 elderly beneficiaries who were given the card at the launch of the Ayushman Bharat Vaya Vandana Yojana, a scheme for those aged 70 and above.
Manoj had one grouse, though — he said he was yet to receive any official confirmation detailing how much of the scheme's benefit was utilised for his mother's treatment.
At many hospitals, however, patients faced issues.
They complained that the scheme was not prominently advertised — The Indian Express also found no posters or display charts explaining its benefits. Many were also unclear about which services were actually covered.
Saaki Ram Lal from Jhansi, who recently underwent a bypass surgery at a private hospital in South Delhi, said he wasn't aware that the hospital provided coverage under Ayushman Bharat. 'There was no board or poster we could refer to. We did not inquire either,' he said.
Some patients reported information gaps. Manohar Lal (45), a prostate cancer patient, was undergoing treatment at a major cancer care hospital in West Delhi. He had been advised to undergo chemotherapy. But the hospital told him that it wasn't covered under Ayushman Bharat and would be billed for it — forcing him to stop treatment.
'I didn't know it wasn't covered. I will now go to a government hospital,' he said.
An official in the state health department said cancer care is one of the biggest challenges when it comes to coverage under Ayushman Bharat, owing to how expensive it is. 'Since investment in cancer care is very high, hospitals are not very keen to cater to such patients.'
'Chemotherapy drugs can cost anywhere between Rs 40,000 and Rs 1.50 lakh,' he added.
In a similar case, Ram Singh (73) had taken his wife, Kalawati, to a private hospital in Southeast Delhi to get her cataract treated. He was charged Rs 1,500 for an OPD consultation in the ophthalmology department — he didn't know it wasn't covered under the scheme.
'They should have told me. I had no money… My son lives in Faridabad, while we live in Sangam Vihar. We are on our own,' he said.
Singh used to work as a contractor. He gets by with occasional support from his son.
He then reached out to the area MLA, who asked him to visit the hospital again with his ration card to avail of the OPD consultation under the EWS scheme for free.
Seventy-two-year-old Ashok Pandey and his wife Sita Devi faced trouble paying for diagnostic tests at a private hospital in Central Delhi. Devi was diagnosed with a tumour in her stomach.
The couple, who lives in Karawal Nagar, said the doctor had prescribed several tests, but they were not covered by the hospital under PM-JAY. 'We'll have to spend thousands on a CT scan and biopsy… Only after these tests are done will the treatment begin,' said Ashok, a retired MCD school teacher.
At some facilities, services under PMJAY have not started due to numerous reasons.
When The Indian Express contacted hospitals listed as empanelled on the official PMJAY website, it found that:
-Registrations at several hospitals were still pending.
-Some hospitals were in the process of setting up a portal for the billing system.
-Several were hiring new staff before beginning operations under the scheme.
-A few hospitals reported issues on the 'backend' of the system.
-Many were yet to sign the memorandum of understanding.
-Some were still completing the required documentation.
An official in the state health department acknowledged the issues. He said, 'Earlier, before the scheme was implemented in Delhi, it was the National Health Authority (NHA) that oversaw hospitals treating patients from other states. After the scheme was rolled out in Delhi, hospitals had to sign a fresh MoU with the state government, which has caused delays in the start of services.'
'We are facing challenges in the empanelment process, which we are actively working to resolve. Key issues include setting up the required infrastructure in each Delhi hospital, hiring staff for the scheme, deciding their salary structures, and establishing the billing portal,' added the official.
While Delhi government hospitals will provide services free of cost, implants and consumables for patients will be covered under the scheme.
According to sources in the state health department, a major challenge is that many empanelled hospitals are dissatisfied with delayed payments, reduced incentives from the NHA, and ongoing discussions over low tariffs. 'Hospitals have raised these issues with us, and we are trying to resolve them,' the official added.
He said this is also why many big players are not on board with the scheme. 'Officials have been in constant touch with private hospitals. Even hospitals providing services in other states, but not in Delhi, have shown reservations owing to the low tariff,' the official added.
Delhi Health Minister Pankaj Singh and the Delhi Health Secretary did not respond to calls and messages seeking comment.
To be sure, when the BJP government completed 100 days in power on May 31, Singh had said that all 'big hospitals' of Delhi would be brought under the Ayushman Bharat insurance umbrella in the next '20-25 days'.
At the time, Singh had said private hospitals were hesitant to sign up because the previous AAP government did not clear pending payments under other schemes: 'They did not make the payment on time from Delhi Arogya Nidhi (the financial assistance scheme run by the Directorate General of Health Services). Now I ensure that in the next 20-25 days, all big hospitals will be empanelled under Ayushman Bharat.'
The previous AAP government had refused to implement Ayushman Bharat in Delhi on the grounds that its own schemes were better. The AAP's schemes included free treatment for all citizens in government hospitals and free surgeries in 81 private hospitals for those who had to wait a long time for diagnoses and treatment in government-run hospitals.
Dr Vipender Sabherwal, convenor for Ayushman Bharat, who is also representing the Association of Healthcare Providers India (APHI), said the association is planning to issue a white paper to the NHA on the issues being faced.
AHPI represents about 15,000 private hospitals, including Fortis, Max Healthcare, Manipal, Medanta, Narayana and Apollo.
'We will do it in the next 10 days… There has been no headway so far, because of which major private players are not on board. Even those who are providing services are not very happy and are reconsidering their decision,' he added.
Despite the issues around coverage and services, beneficiaries are happy with the scheme.
Manoj, who is the sole breadwinner of his family comprising his parents, wife, and two children, said it took a load off his chest. He earns Rs 25,000 a month growing wheat and a few vegetables in the village.
'I was relieved. Otherwise, I would have been forced to take a loan or run around to arrange money for my mother's surgery,' he said.