Even as the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) continues to expand its footprint as the world’s largest publicly funded health insurance programme, concerns remain over the uneven participation of private hospitals in its implementation in the country.
Detailed breakup of official data tabled in Parliament indicates that as of February 28, 2026, the empanelment of hospitals under the scheme has increased from 6,917 hospitals in fiscal 2018–19 (comprising 3,013 public and 3,904 private hospitals) to 36,229 hospitals (comprising 19,483 public and 16,746 private hospitals).
While this reflects substantial engagement from the private sector, experts note that a large number of empanelled and eligible private healthcare providers are yet to fully integrate Ayushman Bharat services into their routine operations.
At the same time, the growing number of admissions under private facilities suggests that, where implemented effectively, the scheme has been able to bridge critical gaps in access to care, especially for costly procedures that would otherwise be unaffordable for many families.
As per the data, a total of 11.69 crore hospital admissions has been authorized under the scheme, of which 6.74 crore admissions have taken place in private hospitals.
“All eligible beneficiaries under the scheme can avail treatment through a network of these 36,229 empanelled hospitals across the country,” said Union Minister of State for Health and Family Welfare Prataprao Jadhav in a written reply in the Lok Sabha.
The scheme, launched to provide financial protection to economically vulnerable populations, relies significantly on private hospitals to expand access to secondary and tertiary care. However, variations in participation across regions have led to gaps in service availability, particularly in areas where public healthcare infrastructure is limited.
According to sources, several private hospitals have been cautious in adopting the scheme due to concerns over package rates, delayed reimbursements, and administrative processes. These factors, they argue, have affected the willingness of some providers to accept beneficiaries under the programme on a consistent basis.
Strengthening the scheme’s reach, therefore, may require greater alignment between policy design and provider expectations. Streamlining claims processes, ensuring timely payments, and revisiting package rates in consultation with stakeholders could encourage wider participation from private hospitals, said the sources.
It is also being felt that the success of the Ayushman Bharat scheme ultimately depends on a robust public-private partnership (PPP), with private hospitals playing a crucial role in delivering quality healthcare at scale.
As the scheme moves into its next phase of expansion, addressing these operational challenges could help ensure that its benefits reach a broader section of the population, while also making participation more viable for private healthcare providers.
Jadhav further said that under the AB-PMJAY scheme, settlement of claims is a regular and uninterrupted process and claims are settled by respective State Health Agencies as per claim adjudication guidelines issued by the National Health Authority (NHA).
“For timely settlement of claims, the permissible turnaround time is within 15 days of claim submission for intra-state hospitals (hospitals located within the state) and within 30 days of claim submission in case of portability claims (hospitals located outside the state)."
“Under the scheme, claims submitted by empanelled hospitals are scrutinized based on the clinical documents, investigation reports, and other supporting records, in accordance with the prescribed standard treatment guidelines,” he said.
