Quick Overview
The Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) has expanded healthcare access for India’s vulnerable population, covering over 55 crore citizens. Despite the large-scale success, the National Health Authority’s 2024–25 report highlights the dominance of private hospitals, reflecting persistent challenges in India’s public healthcare infrastructure. Strengthening primary care, increasing public health spending, and integrating digital health systems remain vital for achieving true Universal Health Coverage (UHC).
Introduction
The National Health Authority’s (NHA) Annual Report 2024–25 underscores the mixed progress of Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). While the scheme has significantly expanded financial protection and access to secondary and tertiary care, it also exposes systemic issues — particularly the growing reliance on private hospitals and the underperformance of public health systems.
Key Findings of the Report
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Private Sector Dominance: Of 31,005 empanelled hospitals, 45% are private, yet they handle 52% of hospitalisations and 66% of total treatment costs.
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High Treatment Costs: Despite higher participation by private hospitals, treatment costs in these facilities remain significantly higher than public ones.
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Portability and Patient Mobility: States like Chandigarh, Uttar Pradesh, and Gujarat attract the most in-migration for treatment, indicating both accessibility and disparities.
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Digital Integration: With over 50 crore health records linked to the ABHA (Ayushman Bharat Health Account), India’s digital health infrastructure is rapidly evolving.
About the Scheme
Launched in 2018, AB-PMJAY is the world’s largest government-funded health assurance programme. It provides ₹5 lakh annual health coverage per family for secondary and tertiary hospitalisation. It targets the poorest 40% of India’s population, identified through the SECC 2011 database, and is implemented by the Ministry of Health and Family Welfare via the National Health Authority.
Achievements and Progress
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35.4 crore Ayushman cards have been issued.
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Gender inclusion: 49% of cards are issued to women.
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Financial impact: The programme has reduced out-of-pocket expenditure by 21% and emergency health loans by 8%.
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Healthcare equity: Public district hospitals have gained financially and operationally from the scheme.
Challenges to Universal Health Coverage (UHC)
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Low Public Health Expenditure: Only 1.84% of GDP, below the National Health Policy target of 2.5%.
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Limited Coverage: Excludes the “missing middle,” focusing heavily on inpatient services over preventive care.
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Rural-Urban Divide: Shortage of skilled staff and poor infrastructure in rural public hospitals.
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Regulatory Weakness: Inconsistent quality control and overcharging by private providers.
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Weak Primary Healthcare: Over-dependence on tertiary facilities, limiting early diagnosis and prevention.
Way Forward
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Increase Public Investment: Boost spending to 2.5% of GDP, focusing on primary healthcare and rural outreach.
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Integrate Insurance and Outpatient Care: Extend coverage to diagnostics and primary consultations.
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Human Resource Development: Strengthen the medical workforce, especially in rural regions.
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Leverage Technology: Expand telemedicine and strengthen the ABHA ecosystem.
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Improve Governance: Enforce quality control via the Clinical Establishments Act and promote transparency in pricing and services.
Conclusion
Ayushman Bharat represents a milestone in India’s pursuit of Universal Health Coverage. While it has improved access and financial protection for millions, its long-term success depends on reinforcing the public health system, strengthening primary care, and reducing reliance on the private sector to ensure equity and sustainability in healthcare delivery.
CLAT/Exam Relevance Summary
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Prelims Focus: Ayushman Bharat components, ABHA number, NHA functions, and funding pattern.
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Mains Focus: Role of AB-PMJAY in advancing UHC, issues of private dominance, and reforms to strengthen public healthcare.
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CLAT Legal Relevance: Policy analysis, healthcare as a socio-economic right, and government responsibility in public welfare schemes.