Dues keep private hospitals away from Aarogyasri, PMJAY

The stand-off between protesting hospitals and Aarogyasri Health Insurance in Telangana State over pending medical bills has once again brought to the fore the long-standing structural defects and difficulties in implementing state-sponsored health insurance schemes.

Inordinate delay in clearing medical bills by the State government is just one aspect among multiple challenges that affect not only Aarogyasri but even the Central government-sponsored Pradhan Mantri Jan-Arogya Yojana (PMJAY).

Empanelment, management of medical bills, outright denial of treatment, package costs, and quality are some of the major difficulties impacting both Aarogyasri and PMJAY in Telangana State.

Barring small and medium-sized hospitals, with patient beds ranging from 100 to less than 500, super-speciality and multi-speciality corporate hospitals in Hyderabad are not that enthusiastic about Aarogyasri or PMJAY.

Although the State government increased the health insurance coverage per person to Rs 10 lakh, corporate hospitals in Hyderabad still are reluctant to sign an MoU with Aarogyasri. The cost of treating a patient at a corporate hospital in Hyderabad is much higher than what is being reimbursed through Aarogyasri/PMJAY.

Moreover, such government-sponsored insurance schemes involve generating a lot of paperwork, hiring additional trained human



resources, having dedicated departments and most importantly, waiting for months for medical bills to clear. In contrast, private health insurance gets priority from private hospitals, as funds (medical bills) are released at the time of the patient’s discharge.

“There are hardly any corporate hospitals in Hyderabad that accept all kinds of Aarogyasri patients, although many of them are empanelled. They empanel themselves with Aarogyasri/ PMJAY out of fear of harassment by bureaucratic machinery. However, they often reject or deny admissions to patients under Aarogyasri/PMJAY by maintaining that specialists or departments are not available,” public health experts familiar with the sector said.

All major private hospitals in Hyderabad have a higher percentage of refusal to patients covered under Aarogyasri, PMJAY and CGHS. Instead of providing multispecialty services under one roof, each super-speciality hospital in Hyderabad provides coverage to a particular speciality to beneficiaries while providing all medical services to the general public.

Last year, the Comptroller and Auditor General (CAG), in a report following the audit of PMJAY, highlighted several such discrepancies and failures in implementing the health insurance scheme. The CAG reported major errors in the beneficiary database, a large number of empanelled hospitals did not have requisite infrastructure etc.