AB-PMJAY provides health coverage of Rs 5 lakh per EWS family annually for secondary and tertiary care hospitalization.
NEW DELHI: Over the past decade, India’s healthcare expenditure has seen a consistent incremental rise. Prime Minister Narendra Modi is spearheading a campaign to transform India into a developed nation, akin to global superpowers, by 2047. This ambitious vision prioritizes education, healthcare, and security as its core pillars. Achieving this goal presents significant challenges, with a healthy India being the foundational step towards a strong nation.
In line with this mission, Delhi’s new government is poised to implement the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). On March 18, a Memorandum of Understanding (MoU) will be signed with the National Health Authority, marking Delhi as the 35th state or Union Territory to adopt this health insurance scheme. West Bengal will remain the only state yet to implement the scheme.
The previous Aam Aadmi Party (AAP)-led government had declined to implement AB-PMJAY, opting instead for its own health scheme. AB-PMJAY provides health coverage of Rs 5 lakh per family annually for secondary and tertiary care hospitalization, targeting approximately 55 crore beneficiaries from economically weaker sections.
Initially, the Delhi government plans to extend this scheme to six lakh residents, including Anganwadi workers and senior citizens aged 70 and above. The scheme is entirely digital and aims to cover around 45% of India’s population. In October 2024, the Prime Minister launched the Ayushman Vay Vandana Card, benefiting nearly six crore individuals aged 70 and above.
As of January 31, 2025, over 8.5 crore treatments have been administered under the Ayushman Bharat scheme, with approximately 4.2 crore in government hospitals and 4.3 crore in private institutions. External Affairs Minister S. Jaishankar highlighted India’s focus on health as central to development
Health expert Dr. Tamorish Kole asserts that India’s medical field is on the cusp of transformative growth in 2025, driven by technological advancements, policy reforms, and a commitment to universal health coverage. Programs like AB-PMJAY are expanding their reach, emphasizing preventive healthcare to address the needs of marginalized populations. The National Digital Health Mission (NDHM) aims to bridge urban-rural healthcare gaps through telemedicine, AI, and wearable devices. Infrastructure initiatives like the PM-Ayushman Bharat Health Infrastructure Mission are set to bolster health facilities in Tier-2 and Tier-3 cities, reducing disparities and enhancing access to advanced care. Efforts to improve medical education and expand the healthcare workforce aim to align with global standards. India’s healthcare strategy emphasizes preventive and primary care to tackle the rising burden of non-communicable diseases, supported by vaccination drives, nutrition programs, and mental health initiatives.
The Union Health Ministry’s 2023-24 annual report highlights significant achievements in the health sector, including the establishment of 780 medical colleges, a 101.5% increase since 2013-14. MBBS seats have risen by 130% to 1,18,137, and postgraduate seats have increased by 134.5% to 73,157. The government has approved 157 new medical colleges in three phases, with 131 already operational and the remainder to commence in the coming years. Of these, 40 colleges are being established in aspirational districts to address disparities in medical education.
For the fiscal year 2025-26, the government has allocated Rs 95,957.87 crore to strengthen the health sector, up from Rs 86,582.48 crore the previous year. This substantial investment aims to improve, develop, and maintain health services. Finance Minister Nirmala Sitharaman announced several key initiatives to bolster the country’s health system. The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana has been allocated Rs 9,406 crore to provide health facilities to the poor and needy. The PM-Ayushman Bharat Health Infrastructure Mission received Rs 4,200 crore to enhance healthcare infrastructure. The National Health Mission has been allocated Rs 37,226.92 crore to improve health services in rural and urban areas. Additionally, Rs 79.6 crore has been earmarked for the National Tele Mental Health Program to provide digital mental health services.
The government plans to establish 200 new cancer centers during the 2025-26 period, aiming to improve cancer treatment and extend healthcare services to more people. Additionally, there is a goal to set up daycare cancer centers in all district hospitals over the next three years to ensure cancer treatment facilities are accessible in remote areas.
In the field of medical education, the budget includes provisions to add 10,000 additional seats in medical colleges and hospitals in the coming year, with an objective to add 75,000 medical seats over the next five years. Over the past decade, there has been a 130% increase in undergraduate and postgraduate medical seats, totaling approximately 1.1 lakh, marking significant progress in medical education.
The Ayushman Vay Vandana Card, introduced in 2024 under the Ayushman Bharat scheme, aims to provide quality medical facilities to senior citizens aged 70 and above. This card allows beneficiaries to avail free treatment up to Rs 5 lakh at any hospital across the country, regardless of their annual income. An estimated six crore senior citizens are expected to benefit from this initiative.
Despite the scheme’s implementation nearly six years ago, states like Odisha, Delhi, and West Bengal initially resisted adoption. However, with the BJP’s ascent to power in Odisha and Delhi, these states have now embraced the scheme, leaving West Bengal as the sole state yet to implement it.
The central government has extended the coverage of AB-PMJAY to senior citizens aged 70 and above, irrespective of their income, benefiting approximately 60 million people. This extension is a significant step, considering that India has one of the highest out-of-pocket healthcare expenses globally.
In comparison, the healthcare system in the United States relies heavily on insurance-based models, resulting in higher healthcare costs. While India’s AB-PMJAY scheme aims to provide universal healthcare access, challenges remain. Reports suggest that private healthcare providers have shown reduced interest due to low reimbursement rates and delayed payments under the scheme. Despite these hurdles, the majority of the funds spent under AB-PMJAY since its launch have gone to private hospitals, highlighting the scheme’s growing dependence on the private sector for delivery of healthcare services.
The scheme has also faced issues of fraud and misuse. Several cases of fraudulent activity have been reported, particularly in Gujarat and Chhattisgarh. For example, in Gujarat, 1,700 health cards were issued under a single family name, while in Chhattisgarh, 109 health cards were issued under one family, with 57 members allegedly undergoing eye surgery. Additionally, 171 hospitals have been accused of submitting fake bills to claim payments under the scheme.
The Comptroller and Auditor General (CAG) of India identified major discrepancies in the implementation of AB-PMJAY. According to a CAG report presented in the Lok Sabha, between September 2018 and March 2021, around 7.5 lakh beneficiaries were registered under a single mobile number. The report also highlighted suspicious data regarding household sizes, with 43,197 families reportedly having between 11 to 201 members each.
Following these revelations, the National Health Authority (NHA) has implemented stricter guidelines to prevent misuse. The NHA has also developed a system to disable the option to add more than 15 members to a single beneficiary family account.
The CAG report also pointed out that pensioners in six states—Chandigarh, Haryana, Himachal Pradesh, Karnataka, Maharashtra, and Tamil Nadu—were wrongly enrolled under AB-PMJAY. In Tamil Nadu alone, 1,07,040 pensioners were listed as beneficiaries, leading the state health department to pay Rs 22.44 crore in insurance premiums on their behalf.
To prevent such irregularities in the future, the central government has directed state governments, social organizations, and healthcare institutions to work together in strengthening the verification process and improving the transparency of the scheme’s implementation.
Despite these challenges, AB-PMJAY remains a landmark healthcare initiative in India.