?? Understanding the Challenges: Why Big Private Hospitals Are Not Participating in PMJAY ??

PMJAY, a scheme aimed at improving access to inpatient services, has been criticized for its low package rates and inability to attract private hospitals. Private providers account for 43% of the total empaneled hospitals, with only 50% active and providing service delivery.

The study by Dong D et al. (2019) found that private hospitals are relatively small, with over 77% reporting 50 or fewer beds and 44% with fewer than 25 beds. Price rationalization and differential pricing are key factors in the non-enrolment of private hospitals in the scheme. Low package rates make it difficult for hospitals to convince visiting consultants to offer reduced rates, and dissatisfaction with package rates is more pronounced in larger and well-resourced hospitals. Differential pricing, as per the level of hospital, could attract larger, well-resourced hospitals with higher prices.

However, the current treatment packages listed under PMJAY do not adequately factor in additional patient-specific conditions, such as comorbid conditions, complications, and age, which can influence the cost incurred by the hospital in treating them. To address this, PMJAY package lists should incorporate patient-specific variants and prices to be adjusted accordingly. This would help to address the technical and administrative complexity of the scheme and ensure that private hospitals are actively engaged in the treatment process.

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