Health Insurance in Private Hospitals

Private hospitals are expected to play a key role in the implementation of government-sponsored health insurance schemes in India. Examining the availability and spread of private hospitals in the country and an analysis of their empanelment in government-sponsored health insurance schemes reveal that in low-income states of the country, empanelment of private hospitals by insurance companies is low and concentrated in a few pockets. This may indicate differences in entry conditions or low willingness of private hospitals to participate in these schemes, which has implications for the access to healthcare and insurance for the poor.

The authors are thankful to Pallabi Gogoi, Rashi Mittal and Rohit Dutta for support in data compilation and graphical presentations, as also to the anonymous reviewer of Economic & Political Weekly for valuable comments, suggestions and insights.

The expansion of government-sponsored health insurance (GSHI) schemes in India over the last decade has brought private healthcare providers to the forefront. Over the years, several GSHI schemes which rely mostly on private healthcare providers for service delivery have been initiated and expanded throughout the country. The most recent and largest of these initiatives is the Ayushman Bharat Pradhan Mantri Jan Aarogya Yojana (AB-PMJAY) announced by the Government of India, which intends to provide insurance coverage for secondary and tertiary hospitalisation to about 10 crore underprivileged households across the country.

The key role of private providers in AB-PMJAY is reflected in the fact that the National Health Agency—the apex body of the government for the implementation of the scheme—has held discussions with representatives of private hospitals to ensure smooth implementation of the scheme (Press Information Bureau 2018; Pilla 2018). However, little is known about the nature and spread of private hospitals in India. This article examines the availability and spread of private hospitals in the country to provide insights on the potential access to insured health services in GSHI schemes.