Hospital Empanelment Under Ayushman Bharat drops over low rates

Data from the National Health Authority (NHA) reveals that the average monthly empanelment has fallen from 316 hospitals in 2024 to just 111 per month so far in 2025. Between January and April this year, only 443 hospitals joined the AB-PMJAY network nationwide, with a noticeable downward trend: 161 in January, 187 in February, plummeting to 40 in March, and 55 in April, according to the Times of India. The situation worsened in May, with just 20 new empanelments recorded.

Several healthcare associations have attributed the steep fall in participation to persistent issues such as low treatment package rates and significant payment delays, which have discouraged large private and corporate hospitals from enrolling in the scheme. These challenges continue to hinder the scheme's reach and effectiveness, particularly in urban areas where private facilities dominate.

Despite these concerns, a senior official from the NHA, which administers the AB-PMJAY, clarified that empanelment is ongoing. The official added that some of the new entries may not yet be reflected in the data due to a transition to a new system. Ayushman Bharat-PMJAY is India’s flagship health insurance scheme and is operational in all states and Union Territories except West Bengal. It provides free treatment up to Rs. 5 lakh per family annually, covering nearly 2,000 medical procedures, including those related to cancer care, emergency services, orthopaedics, and kidney diseases.

The recent dip in empanelment has raised concerns about the scheme’s future scalability and its ability to meet healthcare demands, particularly for economically weaker sections that rely heavily on this government-supported health initiative.

The CEO of a top hospital chain in Delhi told TOI that the input cost for several procedures under the scheme was way higher than the package rates. "We may join the scheme if the package rates are increased," he said. IMA members are also concerned about the number of packages and stated that the rates should be increased to cope up with the CGHS level.

“The reasons for hospitals voluntarily opting out include empanelment only for Covid period, hospitals were closed or non-functional, changes in hospital entity, hospital relocated, ongoing reconstruction or renovation, unavailability of specialist doctors, voluntary withdrawal from scheme, package rates, opting out due to certain treatment packages reserved for public hospitals only (Chhattisgarh and Gujarat), and no referral from public hospitals (Karnataka),” he added.