Context:

Launched in 2018, the Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is India’s flagship health insurance scheme designed to provide universal health coverage and reduce the financial burden of hospitalisation on poor and vulnerable families. Over the last seven years, it has transformed India’s healthcare landscape by making secondary and tertiary care more accessible.

• • However, the latest National Health Authority (NHA) annual report (2025) reveals an important paradox — even though government hospitals make up a majority of the empanelled facilities, private hospitals remain the primary beneficiaries of the scheme. This trend highlights the continued dominance of the private sector in India’s health ecosystem, raising questions about public health infrastructure and financing.

Key Highlights from the NHA Report:

1. Private Sector Dominance

Out of 31,005 hospitals empanelled under AB-PMJAY, only 45% are private. Yet, these hospitals account for 52% of all hospitalisations — more than 9.19 crore treatments — and received 66% of the total expenditure of ₹1.29 lakh crore under the scheme.

This means that while public hospitals are numerically higher, most patients continue to prefer private institutions, possibly due to better infrastructure, shorter waiting times, and perceived higher quality of care.

2. Treatment Trends

The most frequently availed treatment under Ayushman Bharat is haemodialysis, which makes up 14% of all treatments since 2018. This is followed by common ailments like fever (4%), gastroenteritis (3%), and animal bites (3%).

In 2024–25, the top three specialities used under the scheme were General Medicine, Ophthalmology, and General Surgery. The high share of haemodialysis reflects the growing burden of chronic kidney disease in India and the recurring nature of the treatment — patients often require dialysis two to three times per week.

3. Inter-State Patient Mobility

One of the key strengths of Ayushman Bharat is its portability feature, which allows beneficiaries to receive treatment in any state or union territory, irrespective of where their card was issued.

• • • Top In-Migration States:
      • Chandigarh – 19% of all portability cases
      • Uttar Pradesh – 13%
      • Gujarat – 11%
      • Uttarakhand and Punjab – 8% each
    • Top Out-Migration States:
      • Uttar Pradesh – 24% of total outbound cases
      • Madhya Pradesh – 17%
      • Bihar – 16%
      • Punjab and Himachal Pradesh – 7% each

These figures show how portability is enabling patients from underserved regions to seek care in better-equipped states, especially where private or tertiary care hospitals are concentrated.

4. Digital Health Ecosystem: ABHA and Integration

The report also highlights major progress under the Ayushman Bharat Digital Mission (ABDM), aimed at creating an integrated digital health infrastructure.

• • • 50 crore health records have been linked digitally.
    • Nearly 60% of Indians now have an ABHA (Ayushman Bharat Health Account) number — a 14-digit ID that enables individuals to store and share their medical data securely.
    • So far, 3.8 lakh healthcare facilities (38% of total) and 5.8 lakh health professionals (26%) have been registered on the platform.

This growing digital network is expected to streamline data sharing, reduce duplication of tests, and improve the continuity of care across public and private facilities.

About Ayushman Bharat–PMJAY:

The Ayushman Bharat initiative was conceived as a two-pronged approach to achieve Universal Health Coverage (UHC):

1.      Ayushman Arogya Mandirs (AAMs):

o    Aim to establish 1.5 lakh health and wellness centres providing free and comprehensive primary care — including non-communicable diseases, mental health, palliative and rehabilitative services, and basic diagnostics.

2.      Pradhan Mantri Jan Arogya Yojana (PMJAY):

o    Offers ₹5 lakh health insurance per family per year for secondary and tertiary hospitalisation.

o    Covers 12 crore families (approx. 55 crore people), targeting the poorest 40% of India’s population.

o    Beneficiaries are identified through the Socio-Economic Caste Census (SECC) 2011 and earlier RSBY lists.

The scheme is fully government-funded, with cost-sharing between the Centre and states in the ratio of 60:40 (for most states), 90:10 (for North-Eastern and Himalayan states), and 100% central funding for Union Territories without legislatures.

Achievements So Far

• • • Over 9 crore treatments facilitated since 2018, worth ₹1.29 lakh crore.
    • 35 crore Ayushman cards issued across 33 states and UTs.
    • 49% of cardholders are women, showing a significant push toward gender inclusion.
    • Out-of-pocket expenditure (OOPE) has declined by 21%, and health-related loans by 8%, indicating reduced financial stress on households.
    • District hospitals have reported positive financial returns, improving their capacity to deliver better services. 

Overall, Ayushman Bharat has strengthened the financial protection net for millions who earlier faced catastrophic health expenses.

Challenges and Structural Gaps:

1.      Low Public Health Spending:

India’s public health expenditure remains at 1.84% of GDP, far below the National Health Policy 2017 target of 2.5%. This limits investments in infrastructure, human resources, and quality care in government hospitals.

2.      Skewed Towards Hospitalisation:

AB-PMJAY focuses mainly on hospital-based secondary and tertiary care, while primary and outpatient care — which constitutes the bulk of out-of-pocket costs — remains under-covered.

3.     The “Missing Middle”:

Millions of citizens who are neither poor enough for government subsidies nor rich enough for private insurance remain outside any financial protection net.

4.     Rural–Urban Imbalance:

A majority of doctors and health professionals work in urban areas, leaving rural regions understaffed. This shortage pushes rural patients to travel long distances for even basic services.

5.     Private Sector Overdependence:

With two-thirds of Ayushman Bharat funds going to private hospitals, the scheme has inadvertently strengthened private dominance instead of building public capacity.

6.     Regulatory Weakness:

Lack of uniform quality standards, pricing regulations, and accountability mechanisms in the private sector has led to overcharging, variable quality, and ethical concerns in some cases.

The Way Forward:

1.      Boost Public Health Financing:

Increase government spending to 2.5% of GDP, focusing on strengthening primary healthcare and preventive services through Ayushman Arogya Mandirs.

2.      Expand Insurance Coverage:

Extend PM-JAY benefits to cover the missing middle, and include outpatient care, diagnostics, and medicines under the insurance umbrella.

3.     Build and Retain Health Workforce:

Expand medical and nursing institutions in underserved areas, incentivise rural postings, and invest in community health workers and paramedical training.

4.     Use Technology Effectively:

Integrate telemedicine and ABHA-based digital platforms to provide remote specialist consultations and improve data-driven health planning.

5.     Strengthen Regulation and Governance:

Enforce the Clinical Establishments Act, 2010 to ensure quality, standardised treatment, and transparent pricing in private hospitals.

Develop robust health data systems to improve monitoring, evaluation, and accountability.

Conclusion:

Ayushman Bharat has emerged as a transformative policy step towards universal health coverage, shielding millions from financial distress and widening access to hospital care. Yet, the growing dominance of private hospitals within the scheme underscores the urgent need to rebuild public trust in government healthcare facilities. For long-term sustainability, India must focus on strengthening public infrastructure, regulating private participation, and bridging the rural–urban divide. Only then can the promise of Ayushman Bharat — “No one should be denied healthcare for lack of money” — become a true reality.