Ayushman Bharat: Parliament Reviews Private Hospital Engagement in India's Health Revolution

byYojana Central Published:
Image depicting a hospital building with the Ayushman Bharat logo, symbolizing private hospital participation in the scheme.

Parliament recently tabled crucial data on private hospital participation in Ayushman Bharat, revealing significant engagement but also persistent challenges. This analysis delves into the latest figures, the vital role of private healthcare providers, and the government's efforts to enhance their involvement for a more robust universal health coverage system.

Ayushman Bharat: A Pillar of India's Healthcare Revolution

Launched in 2018, the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) stands as the world's largest publicly funded health insurance program, aiming to provide financial protection to India's economically vulnerable populations. It offers an annual health cover of ₹5 lakh per family for secondary and tertiary care hospitalization, ensuring cashless and paperless services at empanelled public and private hospitals nationwide. This ambitious scheme has already made significant strides, leading to a remarkable 21% reduction in out-of-pocket healthcare expenditures and an 8% decrease in the incidence of emergency loans taken for health-related expenses. The program has been a true health revolution, reaching 43.5 crore lives and now expanded to senior citizens, demonstrating its commitment to inclusivity and comprehensive coverage.

Private Hospitals: A Crucial Role in Expanding Access

The success of Ayushman Bharat critically hinges on the robust participation of private hospitals, particularly in expanding access to specialized secondary and tertiary care. Recent data tabled in Parliament underscores the growing engagement of the private sector. As of February 28, 2026, the total number of hospitals empanelled under AB-PMJAY has surged to 36,229, an impressive increase from 6,917 hospitals in fiscal year 2018–19. This network comprises 19,483 public and 16,746 private hospitals. Furthermore, as of December 31, 2025, more than 15,733 private hospitals were empanelled under the scheme, with 1,259 of these strategically located in aspirational districts to strengthen healthcare access in underserved regions.

While public hospitals form a vital backbone, the voluntary empanelment of private facilities under PM-JAY is essential for bridging gaps in service availability, especially for complex procedures. The scheme's portability feature ensures that beneficiaries can avail treatment at any empanelled public or private hospital across India, providing flexibility and ease of access to care.

Despite comprising a smaller percentage of the total empanelled facilities, private hospitals play a disproportionately significant role in the delivery of healthcare services under Ayushman Bharat. According to the National Health Authority's (NHA) Annual Report 2024-25, private hospitals account for nearly two-thirds of hospitalizations and the bulk of claim payouts, amounting to ₹80,000 crore. Specifically, out of 11.69 crore hospital admissions authorized under the scheme since its inception, 6.74 crore admissions have taken place in private hospitals as of February 28, 2026.

The NHA report from October 2025 further indicates that private hospitals, which constituted 45% of the 31,005 empanelled facilities at that time, were responsible for 52% of the 9.19 crore hospitalizations and approximately 66% of the ₹1.29 lakh crore expenditure under the scheme. This trend highlights the critical reliance on the private sector for delivering high-value procedures, particularly in specialities like oncology, cardiology, and orthopaedics. Haemodialysis remains the most frequently availed treatment under the scheme, accounting for 14% of all cases, followed by treatments for fevers and gastroenteritis. The top specialities utilized in 2024–25 included general medicine, ophthalmology, and general surgery.

Challenges Hindering Robust Private Participation

While private hospital participation is undeniably crucial, several challenges continue to hinder its full potential. A significant concern raised by many private and corporate hospitals relates to low reimbursement rates and delayed payments, which impact their financial sustainability and willingness to fully integrate Ayushman Bharat services. For instance, in August 2025, 650 private hospitals in Haryana, including those in Gurugram, suspended services to AB-PMJAY beneficiaries due to outstanding dues amounting to approximately ₹490 crore. Similar issues regarding payment delays have been reported across various states, from Jammu & Kashmir to Nagaland.

Beyond financial viability, administrative processes, stringent empanelment criteria, and complex claims procedures also deter some private providers. A study conducted in Maharashtra revealed that only 13% of private hospitals in the state were empanelled under PMJAY/MJPJAY, with many citing economic unviability and inadequate administrative capacity as key reasons for non-participation. These issues can also lead to beneficiaries facing demands for payment for services that should be cashless, a leading cause of grievances according to a study on patient struggles. As of March 31, 2025, over 600 private hospitals had voluntarily opted out of the scheme since its inception in 2018, with Gujarat (233), Kerala (146), and Maharashtra (83) seeing the highest numbers of exits.

Addressing Reimbursement and Administrative Concerns

Recognizing these challenges, the government and the National Health Authority (NHA) have been proactive in introducing measures to enhance private sector participation and address operational bottlenecks. The NHA has released a revised Health Benefit Package (HBP) with an increased number of procedures (1,961 in total) and has specifically increased rates for 350 packages while adding new ones to improve viability for hospitals. Furthermore, claim settlement processes are monitored at the highest level to ensure timely disbursements within defined turnaround times. The launch of an improved version of the Hospital Engagement Module (HEM 2.0) is another step aimed at streamlining the empanelment process and administrative interactions. A three-tier grievance redressal system is also in place at district, state, and national levels to resolve issues faced by beneficiaries.

Strengthening the Digital Backbone and Future Outlook

The expansion and efficiency of Ayushman Bharat are significantly bolstered by its robust digital infrastructure, notably the Ayushman Bharat Digital Mission (ABDM). This mission aims to create a seamless online platform for healthcare services. As of October 2025, over 50 crore health records have been linked under the ABDM, and nearly 60% of India's population now possesses an Ayushman Bharat Health Account (ABHA) number, facilitating digital storage of medical data. In the current financial year 2025-26 alone, as many as 8.79 crore ABHA cards have been generated as of January 28, 2026, showcasing rapid digital health adoption. This digital ecosystem is crucial for speeding up claims settlement and reducing fraud.

The scheme has achieved a landmark milestone with 11.69 crore hospital admissions authorized and ₹1.73 lakh crore sanctioned, reflecting its massive impact on healthcare access and affordability for millions of Indians. Recent expansions, such as extending benefits to senior citizens aged 70 and above irrespective of income, and including ASHAs, Anganwadi Workers, and Helpers, further solidify Ayushman Bharat's commitment to universal health coverage. As the scheme continues to evolve, sustained collaboration between the government and private healthcare providers, coupled with continuous improvements in operational aspects, will be vital to ensure that its benefits reach every eligible citizen effectively and efficiently.

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