Six months of Ayushman Bharat in Delhi: What are patients getting treated for?

The scheme promises health coverage of up to Rs 10 lakh per family per year. It was the BJP’s biggest poll promise in the run-up to the Delhi Assembly polls.

Several hospitals The Indian Express spoke to said that so far, those availing the scheme are mostly from outside Delhi.

At Hakeem Abdul Hameed Centenary Hospital, there has been a threefold increase in the number of patients availing services under the scheme.

According to Medical Superintendent Dr Sandeep Kumar, the hospital has been providing services under Ayushman Bharat to patients from outside Delhi — mainly from Uttar Pradesh, Bihar, and Jammu and Kashmir. “Now we have started getting patients from Delhi as well; they mainly include patients above 70 years of age,” he said.

He said in the last three months, the top five procedures at the hospital include: laparoscopic cholecystectomy (gall bladder surgery); cataract; orthopaedic procedures, including fractures; tympanoplasty; and non-surgical procedures where admission is required such as cases of chronic obstructive pulmonary disease, pneumonia, chronic kidney disease and congestive heart failure.

Sources from the hospital’s Ayushman Bharat implementing authority said that 50% of patients visit for dialysis under a daycare package, a facility introduced a year ago. “More than 4,000 patients have been treated under Ayushman Bharat. Since April, we have been seeing local patients as well,” said an official.

At the National Heart Institute, CEO and Chief Cardiac Surgeon Dr O P Yadava said the hospital has been offering coronary angioplasty, balloon valvuloplasty, bypass surgery, and valve replacement surgery under the scheme. He, too, noted that most patients are from outside Delhi. “Very few are from Delhi; the majority come from other states,” he said.

At Sanjeevani Hospital, patients are accessing services under the scheme for procedures not available at many government hospitals, said Dr Prem Aggarwal, founder of the hospital and senior cardiologist and interventionist.

“We are treating patients with conditions like stroke, heart attacks, cancer — including chemotherapy — and providing neonatal care,” he added.

Sources at Dharamshila Narayana Super Speciality Hospital said the facility is offering services under the Ayushman Bharat in cardiology, urology, and cancer treatment. “Currently, we are only providing inpatient (IPD) care,” a source said. The hospital spokesperson was unavailable for comment.

At Sharp Sight Eye Hospital, CEO Deepshikha Sharma said the most common procedures performed at its Delhi facilities under the scheme include cataract surgeries with intraocular lens implants; retinal procedures for diabetic retinopathy and other degenerative diseases; glaucoma treatment through surgery and laser therapy; and oculoplastic surgery for eyelid and orbital disorders.

At Dr Shroff’s Eye Hospital, the most commonly performed surgeries are for cataract, glaucoma, and retinal conditions. “Cataract is the top procedure being conducted across all our centres under Ayushman Bharat,” said Manish Lal, deputy manager at the centre’s branch in Daryaganj.

Big hospitals yet to join

The status quo on private hospital empanelment remains unchanged, with larger hospitals demanding higher tariffs and assurances of timely payments.

Hospitals have said high-cost surgeries and complex interventions are financially unsustainable under current packages. “The package includes pre- and post-hospitalisation expenses, consultation, diagnostics, and medicines — making the net reimbursement unfeasible…,” stated a letter submitted to the State Health Agency by the Association of Health Care Providers (India) (AHPI) last week.

According to the AHPI’s Delhi State Chapter and the DMA Nursing Home Forum, there are delays and pending dues even in other states. “Reimbursements are delayed for months, with many hospitals reporting dues pending for over 12 months. For example, in Haryana, over Rs 500 crore is pending across 650 hospitals, leading to widespread threats of withdrawal,” the letter said.

The letter added that such delays disrupt cash flow and day-to-day operations, especially in small and mid-sized hospitals. It further stated that claims are often rejected or only partially paid due to clerical errors (mismatched dates or minor documentation issues).

It also said deductions are made even after pre-authorisation is granted, undermining trust and discouraging hospital participation. Additionally, there is no effective appeals mechanism for hospitals to contest these deductions, it added.

Speaking with The Indian Express, Health Minister Dr Pankaj Kumar Singh said the government is working on the empanelment of more private hospitals and, soon, all key players will be a part of it. “We are in talks with them and increasing the number of private hospitals day by day. I am confident that we will get this done,” he said.

He said payments are being made on time to hospitals, and the rates are as per the central government’s rates. “We are in talks and the people concerned are looking into it,” he said.

The minister said the government is also actively increasing the number of smaller hospitals under the scheme, which are crucial in providing services to patients.

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