Healthcare for everyone universally has proved to be a challenge for India, especially for economically weaker sections of society. Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PM-JAY) was launched in 2018 as a pioneering initiative towards universal health coverage.
National Health Authority But it is not necessarily the number of hospitals empanelled that guarantees success in such a scheme, but which hospitals are empanelled, how good they are, and how faithfully they adhere to the premises of fairness and affordability. In this article, I explain the idea of “top hospitals” in Ayushman, what “service value” means here, and challenges and way forward.
2. What Makes a Hospital “Top” Under Ayushman?
A hospital can be technically empanelled under PM-JAY, but not all empanelled hospitals are of equal value. Better hospitals are better at the following:
(a) Medical outcomes & reputation
Excellent past track records of surgery success rates, fewer infections, good recovery of patients, and well-established accreditations (e.g. NABH) distinguish better hospitals.
(b) Range of specialties & infrastructure
Hospitals that have cardiology, oncology, neurology, orthopedics, intensive care, etc., under one umbrella reduce patient referrals and waiting times.
(c) Patient experience & support
From nursing care, cleanliness, dignified personnel, open communication, and transparency of billing (i.e. no extra or hidden costs).
(d) Integrity & compliance
Those hospitals which strictly operate cashless billing, do not demand out-of-pocket payment when not permitted, adhere to package rates, and have good grievance redressal records.
(e) Geographical accessibility
The proximity of a hospital to where beneficiaries live (especially rural or far-flung locations) makes follow-up care more convenient.
3. What Is “Service Value” Under Ayushman?
“Service value” is a composite idea: worth provided to a patient by what the scheme (and taxpayer) remits. Key components are:
Clinical value: quality of diagnosis, treatment, and outcomes.
Cost-efficiency: hospitals must operate within pre-set package rates in PM-JAY.
Accessibility: ease of access to service (closeness, low denial rates, reduced delay).
Financial protection: truly cashless care without surprise or added charges.
Trust & transparency: honest communication, ethical practice, grievance redressal.
A hospital providing high clinical value and strict adherence to cashless, no-surprise billing provides greater service value.
4. Current Situation & Challenges
4.1 Scale of Empanelment
India boasts more than 30,000 hospitals empanelled under PM-JAY (public-private combined) across states.
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Uttar Pradesh is among the states with one of the largest numbers of empanelled hospitals.
4.2 Quality and Governance Gaps
Despite such a massive network, problems still mount:
Hidden Charges: A prevalent complaint is that hospitals impose additional payments when cashless is the assurance. One Delhi grievances study reported several patients complaining that hospitals demanded payment even under the scheme.
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Grievance trends: In a sample of over 110,000 grievances between 2018 and 2022, “poor quality of hospital services” was a constant refrain.
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Fraud and abuse: Some hospitals have been de-empanelled or penalized for fraudulent billing, billing fraud, over-charging, or non-conformity.
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Scaling constraints: The majority of empanelled hospitals are small (less than 30 beds) with incomplete specialisation, thus reducing their ability to manage complicated cases.
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4.3 Sustainability & Financial Viability
Payment rates under PM-JAY are negotiated and fixed; hospitals argue that in the case of procedures with high complexity, margins are thin. Recent research does suggest, though, that private hospitals can be profitably operated under these rates if run efficiently.
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4.4 Variability Across States
Some have more effective regulatory mechanisms, better enforcement, and better monitoring, which lead to better performing empanelled hospitals. Some are hampered by uneven implementation, delayed payments by state health agencies, and weak oversight.
5. What a “Top Hospital” Under Ayushman Looks Like: Exemplary Features
Let’s think of an ideal model hospital under Ayushman Bharat:
NABH-accredited or equivalent quality certification
Multi-specialty center (cardiology, neurology, oncology, etc.)
Zero out-of-pocket expenditures for beneficiaries (strict cashless)
Transparency of care pathway: patients know about services included
Effective grievance handling with speedy redressal
Good performance indicators (low readmission, low mortality, high patient satisfaction)
Regular audits by scheme authority
Reasonable cost containment even for complicated treatments
Hospitals nearing this ideal achieve high value from the service and help to maintain confidence in the scheme.
6. Roadmap: How to Improve Service Value Across the Network
To enhance baseline quality and make “top hospitals” more than a nameplate, the following are crucial strategies:
Stringent empanelment requirements
Enforce minimum bed capacity, specialty services, accreditation, and performance norms before empanelment.
Continued monitoring & audit
Use data analytics to raise red flags on suspicious claims, carry out field audits, and suspend hospitals that flout norms.
Transparent benchmarking
Publish performance data (mortality, readmission, grievance rates) so that beneficiaries and policymakers can compare.
Feedback loops & grievance redress
Strengthen real-time grievance mechanisms, provide responsive follow-up, and impose penalties for non-compliance.
Level reimbursement rates equitably
Re-evaluate package rates from time to time so that they align with current costs and promote quality.
Capacity building
Provide training, infrastructure facilities, and technology support to weaker hospitals to enable them to upgrade.
Public awareness & empowerment
Educate the beneficiaries on their entitlements under Ayushman (e.g. what is free, when to refuse additional demands).
State-level leadership & accountability
Stronger state health departments, timely payments, and regulation are necessary to avert services breakdown.
7. Conclusion
The success of Ayushman Bharat depends not just on extensive coverage but on value delivery in each hospital experience. A “top hospital” for this program is one that has good clinical outcomes paired with accessibility, transparency, and financial protection.