CURRENT AFFAIRS

Ayushman Bharat Health Scheme–Progress Challenges in 2025

Introduction

Launched in September 2018, Ayushman Bharat—especially the Pradhan Mantri Jan Arogya Yojana (PM-JAY)—is India’s flagship public health insurance program, aiming to provide ₹5 lakh annual coverage per family to about 10.7 crore vulnerable households. Over time, it has expanded significantly in scope and reach .

Progress & Milestones

1. Beneficiary Reach

Covered more than 36 crore beneficiaries by 2024, reducing out-of-pocket expenses by around 21%.
Senior citizens (70+) now receive special coverage via the Ayushman Vay Vandana Card, providing ₹5 lakh free treatment annually.

2. Hospital Empanelment & Services

Over 27,000 hospitals empaneled nationwide, including both public and private institutions.
New health centers—Ayushman Arogya Mandirs—launched across Delhi, offering preventive, curative, and palliative care, plus drug access through Jan Aushadhi stores.

3. Digital Integration

Ayushman App, ABDM, DIKSHA, and token systems at 17,000+ health facilities have improved access—saving an estimated 3.3 crore patient-hours.

4. Training & Infrastructure Boost

Nearly 80,000 health and wellness centers upgraded; ASHA workers received expanded training for elder care, mental health, and disease screening.

Key Challenges

A. Infrastructure & Accessibility Gaps

Rural areas still lack empaneled hospitals; many beneficiaries remain unaware or digitally excluded.
In tribal-dominated districts like Palamu, ~7,000 eligible PVTG families have yet to receive Ayushman cards .

B. Fraud and Data Privacy

Several fraud cases, including 6,200+ bogus claims worth nearly ₹10 crore in UP, have highlighted systemic vulnerabilities.
Privacy advocates warn that patient data is publicly accessible via the Ayushman portal—violating patient consent and right to privacy.

C. Payment Delays and Provider Dropout

Reimbursement delays fuel disillusionment: hospital enrollments dropped from ~316 to ~111 per month in early 2025.
Gujarat hospitals report being owed ₹300 crore; Jharkhand pending ₹192 crore.

D. Exclusion and Scheme Non-Adoption

States like Kerala, Tamil Nadu, and West Bengal have either delayed or opted out in favor of state-specific plans.
This fragmentation affects nationwide access and creates discrepancies in beneficiary coverage.

Government Response & Initiatives

Fraud crackdown: National Anti‑Fraud Unit continues investigations; flagged hospitals are being de-empaneled.
Financial remedy: State-level assurances—like in Jharkhand—pledge prompt payments to hospitals.
Service expansion: Chandigarh to launch cancer-treatment payment kiosks, and Delhi to add new Ayushman Arogya Mandirs.

What Still Needs Improvement

Improve Rural Access – Add more empaneled facilities in underserved areas and streamline card issuance.
Reduce Fraud and Enhance Oversight – Strengthen digital audit systems, anonymize patient data, and enhance real-time claims tracking.
Ensure Timely Payments – Implement auto-release mechanisms to support hospital cash flows and incentivize participation.
Raise Awareness – Use multilingual campaigns and local outreach to inform families, especially in remote regions.

The Way Forward

Ayushman Bharat remains a transformative policy with large-scale impact, but its true success hinges on sustaining infrastructure, governance, and ethical safeguards. The next phase requires:

Consolidating digital health platforms like ABDM/DPI.
Ensuring universal, inclusive coverage, especially in remote and tribal areas.
Reforming claim processes to make the scheme durable for providers and patients alike.

Post Date: 10-10-2025