Grievance Redressal Mechanism of Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana

Grievance Redressal Mechanism of Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana

GOVERNMENT OF INDIA
MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENT OF
HEALTH AND FAMILY WELFARE

LOK SABHA

UNSTARRED QUESTION NO. 3613
TO BE ANSWERED ON 21ST MARCH, 2025

VALIDITY OF AYUSHMAN CARDS IN PRIVATE HOSPITALS

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

(a) whether the Ayushman Card is mostly valid only in the Government hospitals and the card holders are not given importance in the private hospitals and becomes ineffective there, if so, the details thereof;

(b) whether the Ayushman Cardholder patients are not admitted by the private hospitals, if so, the details thereof; and

(c) whether there is any provision to severely punish such hospitals by identifying them, if so, the details thereof, State-wise?

ANSWER

As of March 19, 2025, the Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) has authorized over 8.9 crore hospital admissions through a vast network of 30,957 empanelled healthcare providers, which includes more than 13,866 private hospitals. This initiative aims to ensure that eligible beneficiaries receive necessary healthcare services without financial burden.

Under the scheme, both public and private hospitals are obligated to provide services to beneficiaries. In instances where treatment is denied, a well-structured grievance redressal system has been established at three levels: District, State, and National. Each level is equipped with dedicated nodal officers and Grievance Redressal Committees to efficiently address beneficiaries’ concerns.

Beneficiaries can file grievances through various channels, including the Centralized Grievance Redressal Management System (CGRMS), call centers, emails, or written communication to State Health Agencies. Actions taken in response to grievances may involve facilitating treatment for beneficiaries or imposing penalties on non-compliant hospitals.

In cases of severe misconduct, State Health Authorities have the authority to take strict measures against errant hospitals, which can include suspension, de-empanelment, issuance of warning letters, and even lodging FIRs against fraudulent practices.

The details of punitive actions taken against private hospitals across different States and Union Territories highlight the commitment to maintaining the integrity of the AB-PMJAY and ensuring that beneficiaries receive the care they are entitled to.

Note: Data as on 30.11.2024

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