New Delhi, August 6, 2025 — The Central Government has directed states to introduce uniform price caps on caesarean deliveries under the http://Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY),Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), India’s largest government health insurance scheme.
This move follows growing concerns about inconsistent reimbursement rates across states and risin
g out-of-pocket expenses for women undergoing C-sections. By regulating these charges, the Centre hopes to curb unnecessary caesarean procedures and ensure cost transparency in maternal healthcare.
Under AB-PMJAY, over 12 crore families are eligible for free healthcare up to ₹5 lakh per year. But maternity packages, particularly for C-sections, have long varied between states and hospitals. The absence of a national standard has led to large gaps in pricing and medical practices.
According to the National Health Authority (NHA), states like Uttar Pradesh and Bihar reimburse as low as ₹8,000 for C-sections, while others go beyond ₹15,000. Private hospitals, however, often charge upwards of ₹30,000. This disparity impacts care quality and forces patients to pay extra or opt for alternatives.
In a recent circular, the NHA has advised all states and Union Territories to introduce a uniform ceiling price for C-section procedures across public and empanelled private hospitals under the scheme.
This standardization will likely be pegged to revised package rates under PMJAY’s Health Benefit Packages 2.3, which are being updated to reflect medical inflation and service complexity.
Officials say this is not just about price — it’s about trust. “When treatment prices vary wildly, people lose faith in the scheme. A national cap will ensure fairness and better monitoring,” said a senior NHA officer.
Dr. Arvind Srivastava, senior public health specialist with NHSRC, welcomed the move. “India’s C-section rate is rising beyond WHO’s recommended 10–15%. Setting a fair and uniform rate will help regulate practices, especially in private hospitals,” he said.
The Indian Medical Association (IMA), however, has warned against underpricing. “Pricing should reflect infrastructure, risk, and manpower. Otherwise, good hospitals may drop out of PMJAY,” said Dr. Suneel Mehra, IMA’s Maternal Health Chair.
India records over 27 million births each year, with C-section deliveries now accounting for more than 21% of all births, up from just 8.5% in 2005. While the rise indicates improved access to emergency care, studies also point to unnecessary surgical interventions in urban private settings.
The World Health Organization (WHO) has cautioned countries against financial incentives that promote C-sections without medical need. Uniform pricing could help curb that trend.
The Centre has given states a deadline of August 31 to submit new package proposals. If adopted, the revised rates will come into effect from October 1, 2025.
This step is part of the government’s broader mission under Ayushman Bharat 2.0, which focuses on digital health records, rational treatment pricing, and value-based care delivery.
Patients, meanwhile, can expect clearer cost disclosures at hospitals and better grievance redressal mechanisms linked with the NHA’s BIS portal.
To follow similar breakthroughs, visit MedicarePharmaBusiness.com.
