Delhi reached out to private hospitals to join Centre's PMJAY health insurance scheme

Mint

23-04-2025

New Delhi: The Delhi government is gearing up to implement the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PMJAY) and is onboarding large corporate hospitals to help reach the Centre's free health insurance scheme to more than 654,000 families.
However, big corporate hospitals have raised concerns over delayed payments and low package rates.
The National Health Authority, which is the implementing agency for the scheme is training state health authority officials and doctors on the scheme's modalities.
The Delhi government has allocated ₹ 2,144 crore for PMJAY, which is the world's largest health assurance scheme, benefiting the poor as well as over-70s.
'NHA informed that it has started handholding Delhi government to implement the scheme. It has started the training of the State Health Authority, sensitizing hospitals, officials etc to onboard the scheme,' said an official familiar with the matter requesting anonymity.
The official said the Delhi government is aware of the concerns raised by private hospitals and discussions are on.
Dr Girdhar Gyani, Director General, Association of Healthcare Providers said, 'Delhi government had earlier had its own scheme. The government had earlier issued an order that all those empaneled with the Delhi government schemes are deemed to be empaneled unless they certify that they are not interested. Those bigger hospitals who are not part of the Delhi government scheme had a meeting a few days back to discuss the key concerns regarding the scheme implementation.'
'The main issue is that hospitals are concerned about timely release of funds within one month. We have to understand that treatment package rates are low and if cash flow is not good, it would be difficult for them. Private hospitals are planning to meet the Delhi government to discuss the matter,' he said.
Major private hospital chains are not fully participating in the Ayushman Bharat scheme, primarily due to the inadequate pricing structure. The scheme's reimbursements fail to cover the genuine costs incurred by large hospitals, and these rates have not been adjusted for inflation, said on the corporate hospitals requesting anonymity.
Dr. Narin Sehgal, Sehgal, Medical Director, Sehgal Neo Hospital and Secretary Delhi Chapter AHPI said the basic problem with PMJAY is payments to the hospitals are very low.
'The smaller hospitals will be able to take the PMJAY willingly, but bigger corporate have been urging to modify the rates. PMJAY is very good scheme. But, hospitals like Max, Fortis and Apollo may consider the scheme if government consider their requests. We are in touch with the Delhi government to discuss PMJAY implementation in the city," Dr Sehgal.
Notably, Delhi has become the 35th state/UT to implement the PMJAY scheme. It is estimated that around three million poor and another 600,000 senior citizens will be the eligible beneficiaries, making a total about 3.6 million people in Delhi.
A senior Delhi government official aware of the matter said there is no shortage of funds and the government is in continuous talks with the bigger hospitals to onboard them on PMJAY.
'We have held several meetings with the big corporate hospitals to discuss the scheme implementation. We are listening to their concerns and we are hopeful that we will join us,' the official said.
A representative of Apollo Hospital said they are awaiting directions from the Delhi government.
Queries sent to the Delhi government, health ministry, Max Hospital, Fortis ands Apollo spokesperson remained.
First Published: 23 Apr 2025, 10:11 PM IST