Industry Leaders Call for Pricing Reforms to Ensure Participation
New Delhi: As pressure mounts on corporate hospitals to enroll in the government’s public health insurance scheme, Ayushman Bharat, industry body NATHEALTH has stated that hospitals cannot participate until the scheme becomes financially viable for them.
Speaking at the 11th edition of NATHEALTH’s annual summit, Abhay Soi, President of NATHEALTH and Chairman & MD of Max Healthcare, emphasized that corporate hospitals primarily operate in urban areas, where costs are significantly higher.
“Until Ayushman Bharat offers viable pricing, corporate hospitals will be unable to join. Either the pricing needs to be adjusted to meet the minimum cost structure of private hospitals, or compliance costs—especially those related to infrastructure development—must be reduced,” Soi said.
Ayushman Bharat: Expanding Coverage, Growing Challenges
Launched as part of India’s National Health Policy 2017, Ayushman Bharat PM-JAY is the world’s largest health assurance program. It provides ₹5 lakh per family per year for secondary and tertiary hospitalization to over 12 crore vulnerable families—covering approximately 55 crore individuals.
In September 2024, the Union Cabinet expanded the scheme to include all senior citizens aged 70 and above, regardless of their income. This move is expected to benefit nearly 6 crore elderly citizens across the country.
According to the Ministry of Health and Family Welfare, as of September 9, 2024:
- 35.4 crore Ayushman cards have been issued.
- ₹1.07 lakh crore has been spent on 7.79 crore hospital admissions under the scheme.
- Over 29,000 hospitals, including 12,625 private hospitals, have been empaneled under PM-JAY.
Corporate Hospitals Remain Hesitant
Despite the government’s push, many leading corporate hospital chains have not yet empaneled themselves under Ayushman Bharat. Industry leaders argue that the financial model does not align with the high-cost structures of private hospitals.
Private Equity’s Role in Healthcare Expansion
When asked about the increasing role of Private Equity (PE) investors in Indian healthcare, Ameera Shah, Senior VP of NATHEALTH and Chairperson of Metropolis Healthcare, acknowledged that while PE financing is costly, it enables access to various structured loans and financial products that could make healthcare more viable and affordable.
Om Manchanda, Treasurer of NATHEALTH and MD of Dr. Lal PathLabs, added, “India’s healthcare sector requires massive capital investment. At this stage, private equity could help bridge the infrastructure gap.”
With ongoing discussions between healthcare leaders and policymakers, the future of Ayushman Bharat’s corporate hospital participation remains uncertain, hinging on potential reforms to its financial structure.
