Ayushman Bharat: Strengthening India’s Path Towards Universal Health Coverage
Context
On the eighth anniversary of Ayushman Bharat, the initiative’s progress was highlighted as an important step towards achieving Universal Health Coverage (UHC) in India. Launched on 23 September 2018, the programme seeks to create an integrated healthcare system combining financial protection, primary care, digital health infrastructure and stronger public-health capacity.
Ayushman Bharat and Its Four Pillars
Ayushman Bharat was conceived to move healthcare delivery beyond fragmented schemes towards a continuum of care, ranging from preventive and primary healthcare to hospitalisation and critical care.
1. Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)
AB-PMJAY provides financial protection against major hospitalisation expenses. Beneficiaries receive cashless coverage of up to ₹5 lakh per family per year for secondary and tertiary care.
The scheme has provided verified Ayushman cards to more than 48.51 crore people, covering around one-third of India’s population. More than 13.25 crore hospital admissions, involving treatment worth approximately ₹2.03 lakh crore, have been supported through the programme.
Its network includes over 38,000 empanelled public and private hospitals, covering around 1,961 procedures across 27 specialties.
2. Ayushman Arogya Mandirs
The primary-care component seeks to transform Sub-Health Centres and Primary Health Centres into comprehensive facilities providing preventive, promotive and basic curative services.
These centres provide 12 essential service packages, including screening and management of non-communicable diseases, mental healthcare, eye and ENT services, palliative care and AYUSH-related services.
The network has recorded more than 540 crore cumulative visits. Telemedicine has further expanded access, with over 50 crore consultations through e-Sanjeevani.
3. Ayushman Bharat Digital Mission
The digital pillar aims to establish an interoperable health ecosystem in which patients, healthcare professionals and institutions can securely exchange health information.
More than 97.61 crore ABHA IDs have been generated, while over 119.95 crore digital health records have been linked. The national registries also include more than 5.78 lakh healthcare facilities and around 11 lakh healthcare professionals.
The digital architecture includes ABHA, the Health Facility Registry, the Healthcare Professionals Registry and the Unified Health Interface, creating the foundation for interoperable prescriptions, records and claims.
4. PM-Ayushman Bharat Health Infrastructure Mission
PM-ABHIM focuses on strengthening the physical and institutional capacity of India’s public-health system, particularly for disease surveillance, diagnostics and critical care.
With an outlay of around ₹64,180 crore for 2021–26, the mission envisages 631 Critical Care Hospital Blocks, 744 Integrated Public Health Laboratories and 3,389 Block Public Health Units across priority areas.
Expanding the Beneficiary Base
The original beneficiary identification framework relied substantially on SECC 2011 deprivation and occupational criteria, covering vulnerable rural households and specified informal urban workers.
The programme has subsequently widened its reach. In 2024, coverage was extended to families of ASHA workers, Anganwadi Workers and Anganwadi Helpers, with more than 44.81 lakh cards issued.
Another major expansion brought all citizens aged 70 years and above, irrespective of socio-economic status, under the senior-citizen health cover. Around 1.36 crore Ayushman Vaya Vandana cards have been issued under this expansion.
Institutional and Financial Framework
AB-PMJAY operates as a Centrally Sponsored Scheme, with the Centre and States generally sharing expenditure in a 60:40 ratio. The ratio is 90:10 for North-Eastern States, Himachal Pradesh, Uttarakhand and Jammu & Kashmir, while Union Territories without legislatures receive full central funding.
For FY 2026–27, the Union Budget has provided ₹9,500 crore for the scheme.
Together, the four pillars create an architecture in which financial protection, primary healthcare, digital systems and health infrastructure reinforce one another rather than functioning as isolated interventions.
Key Challenges
Despite substantial expansion, several structural issues continue to affect the programme’s effectiveness.
Uneven private-sector participation: Private hospitals in Tier-2 and Tier-3 locations may be reluctant to participate because of concerns regarding delayed claim settlements and reimbursement rates that do not always reflect actual treatment costs.
Limited outpatient coverage: AB-PMJAY primarily protects beneficiaries against eligible hospitalisation expenses. Costs associated with outpatient consultations, medicines and diagnostic services can therefore continue to generate significant household expenditure.
Digital implementation gaps: The benefits of ABDM depend on hospitals and health centres adopting compatible digital systems. Limited technological capacity in remote facilities can interrupt the integration of health records.
Shortage of specialists: Rural and sub-district facilities continue to face shortages of specialised medical personnel, increasing dependence on referrals to tertiary hospitals.
Balancing access with financial sustainability: As coverage expands, stronger monitoring is required to prevent fraudulent claims, unnecessary procedures and inefficient utilisation of public resources.
Way Forward
Reimbursement packages should be periodically revised using actual treatment costs and actuarial evidence, particularly for specialised procedures and hospitals serving underserved regions.
AB-PMJAY could progressively address selected high-cost outpatient treatments and long-term therapies, especially where recurring expenses can push vulnerable households into financial distress.
The National Health Authority can strengthen data-driven fraud detection to identify abnormal billing patterns, phantom admissions and unnecessary interventions while protecting genuine beneficiaries.
At the same time, faster implementation of PM-ABHIM can improve the capacity of district hospitals, laboratories and critical-care facilities, reducing excessive dependence on tertiary centres.
Finally, wider digital literacy, simple consent mechanisms and strong health-data protection will be essential for increasing public confidence in ABHA and ensuring that digital health expansion does not exclude citizens with limited technological access.
Conclusion
Over eight years, Ayushman Bharat has evolved into a broad healthcare architecture combining financial protection, primary care, digital infrastructure and public-health capacity. Its next phase will depend not only on expanding coverage but also on improving the quality, affordability and continuity of care. Strengthening outpatient protection, healthcare infrastructure, specialist availability and digital inclusion can help translate expanded enrolment into more comprehensive Universal Health Coverage.
Source : PIB