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Chink in Prime Minister's health insurance scheme

Health experts familiar with PMJAY says infrastructure or quality concerns may also be contributing to inactive hospitals

G.S. Mudur New Delhi Published 13.02.23, 03:41 AM
Narendra Modi.

Narendra Modi. File picture

Nearly a quarter of the 28,433 hospitals across India empanelled into the Centre’s flagship national health insurance scheme that covers hospitalisation costs for poor households have not admitted a single patient through the scheme, according to government data.

The data dashboard for the Pradhan Mantri Jan Aarogya Yojana (PMJAY) updated daily showed on Sunday that 6,414 (22.5 per cent) of the 28,433 hospitals have been “inactive since empanelment”, implying no patients under the PMJAY. And 5,084 (17.9 per cent) hospitals have been inactive over the past six months.


The Association of Healthcare Providers India (AHPI), a body of private hospitals, has attributed the large proportions of inactive hospitals to the scheme’s low reimbursement rates that the AHPI said make the scheme unviable for many private hospitals.

Sections of health experts familiar with the PMJAY said infrastructure or quality concerns may also be contributing to inactive hospitals. Some hospitals might have met the conditions for empanelment, yet lack the capacity to draw patients, said a healthcare expert in an academic institution.

The Narendra Modi government had launched the PMJAY in September 2018 to provide up to Rs 5 lakh per year per household for cashless hospitalisation services to an estimated 500 million people from poor households across the country.

The scheme, which has empanelled 15,505 government hospitals and 12,908 private hospitals since launch and uses a mix of central and state funds to reimburse hospitals, has supported more than 43.7 million hospital admissions, including more than 812,000 over the past month.

Patients in need of medical or surgical services for myriad health conditions, including cancer, cardiovascular disorders, kidney disease, among others or those who need ophthalmological or obstetric and gynaecological services have been among the scheme’s beneficiaries.

The proportions of the hospitals inactive since empanelment vary from state to state — from below 10 per cent in Maharashtra (70 of 1,110), Uttar Pradesh (257 of 3,363), and Kerala (49 of 761) to 17 per cent (487 of 2,728) in Gujarat to over 40 per cent in Delhi (52 of 109) and Andhra Pradesh (1,296 of 2,476).

“Some empanelled hospitals are possibly inactive because some of the current reimbursement rates under the PMJAY are illogical and unviable for private hospitals,” said Girdhar Gyani, the AHPI’s director-general. The AHPI has been urging the government to increase reimbursement rates.

Queries on the counts of inactive hospitals, including a question asking how many of them are private hospitals, sent by this newspaper to the National Health Authority (NHA), the government agency implementing the PMJAY, have not evoked a response yet.

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