The National Health Authority released its annual report for 2024-25, revealing that over half of the hospitalisations under the Ayushman Bharat scheme occur in private hospitals, which also account for two-thirds of the total treatment costs. Haemodialysis stands out as the most accessed treatment, highlighting how the scheme is helping people manage chronic conditions like kidney failure without financial ruin, especially as private care dominates utilisation patterns. This development is significant now because it shows the scheme's growing impact on making expensive treatments affordable, while also pointing to the need for better public hospital involvement.
What is the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) and its main goals?
Ayushman Bharat is India's flagship health insurance scheme launched in 2018 to provide universal health coverage, especially for poor and vulnerable families. It covers over 55 crore people from the bottom 40% of the population, offering up to Rs 5 lakh per family per year for secondary and tertiary hospital care, like surgeries and specialised treatments. The goal is to protect families from high medical costs that could lead to debt or poverty, by making hospital care free at empanelled public and private facilities across the country.
How does the scheme work in terms of empanelment and benefits?
Hospitals get empanelled, meaning they join the scheme after meeting certain standards, to provide cashless treatment to beneficiaries who show their Ayushman card. Beneficiaries are identified through socio-economic data, and treatments are pre-approved to ensure quick access. This includes portability, where people can get care in any state, not just their home one, which helps in cases where local hospitals lack facilities. The National Health Authority (NHA) oversees it, ensuring payments to hospitals and monitoring quality.
Why is there higher utilisation in private hospitals under the scheme?
Private hospitals dominate because they offer advanced facilities and quicker services, which people prefer for serious conditions, even though costs are higher there. The report shows private sector handles 52% of cases but 66% of costs, as government hospitals, which form 55% of empanelled ones, are often overburdened or lack equipment. This trend, first noted in earlier investigations, means the scheme is successfully channeling people to private care without out-of-pocket payments, reducing financial stress in a country where private providers handle 60% of urban and 52% of rural hospital care.
What is haemodialysis and why is it the most sought treatment?
Haemodialysis is a medical process that cleans the blood for patients with kidney failure, acting like an artificial kidney by removing waste and extra fluid. It is needed regularly, about 2-3 times a week, making it repetitive and expensive without insurance. Under Ayushman Bharat, it accounts for 14% of treatments because India has a high burden of chronic kidney disease, with around 2 lakh new end-stage cases yearly. The scheme includes it in its free dialysis program, benefiting 25 lakh people, which explains its popularity as it saves families from ongoing costs.
What role does portability play in improving healthcare access?
Portability lets patients travel to other states for better treatment, addressing gaps in local healthcare. For example, states like Uttar Pradesh see both high in-migration (13%) for incoming patients and out-migration (24%) for those seeking care elsewhere, showing how it connects people to specialised hospitals. Chandigarh tops in-migration at 19% due to its advanced facilities, while Bihar and Madhya Pradesh have high out-migration (16% and 17%) because of limited local options. This feature makes the scheme more inclusive, especially for rural or underserved areas.
How is the digital infrastructure supporting the scheme?
The Ayushman Bharat Digital Mission, started in 2021, creates a shared digital system for health records. It has linked 50 crore records, allowing seamless sharing between doctors and hospitals. The ABHA number, held by 60% of Indians, is a 14-digit ID for a cloud-based health account to store reports, prescriptions, and history digitally. Additionally, 38% of health facilities (3.8 lakh) and 26% of professionals (5.8 lakh) are registered, building a national ecosystem that reduces paperwork, prevents fraud, and improves care coordination.
What is the broader impact on out-of-pocket expenditure and healthcare equity?
The scheme has lowered out-of-pocket costs from 62.6% of total health spending in FY15 to 39.4% in FY22, as per the Economic Survey 2024-25, by increasing government funding to 48%. This has saved over Rs 1.25 lakh crore, preventing poverty from medical bills. It promotes equity by covering vulnerable groups, with over 36 crore cards issued, and integrates with other programs like free vaccines and affordable medicines, making healthcare more accessible for all Indians.
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