New Delhi (ABC Live): Ayushman Bharat is one of India’s most ambitious public-health reforms. It aims to move India from fragmented welfare schemes toward a broader Universal Health Coverage (UHC) framework. However, its success depends on how well India connects primary care, hospital care, digital health records, fraud control, and public-health financing.
Two Pillars of Ayushman Bharat
The scheme has two major pillars. The first pillar is Ayushman Arogya Mandirs, earlier known as Health and Wellness Centres. These centres aim to provide comprehensive primary healthcare.
The second pillar is Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). It provides cashless hospital-care cover of ?5 lakh per eligible family per year for secondary and tertiary treatment.
Scale Versus Health Justice
The data shows large scale. As of 28 February 2026, the government reported 36,229 empanelled hospitals and 11.69 crore authorised hospital admissions under AB-PMJAY. Out of these admissions, 6.74 crore were in private hospitals.
However, scale alone does not prove health justice. India still faces high medicine costs, uneven public hospitals, shortage of specialists, claim-settlement disputes, fraud risks, and weak outpatient financial protection. Therefore, Ayushman Bharat must now shift from coverage expansion to quality, accountability, and health outcomes.
Key Points
| Issue | Data / Position | Critical Finding |
|---|---|---|
| Annual AB-PMJAY cover | ?5 lakh per eligible family per year | Useful for hospitalisation, but not enough for outpatient care, medicines, diagnostics, and chronic disease support. |
| Hospital network | 36,229 empanelled hospitals as of 28 February 2026 | Network expansion is significant, but patient access still depends on geography, package rates, and hospital conduct. |
| Hospital admissions | 11.69 crore authorised admissions | Utilisation is high, but outcome data must now become public. |
| Private hospital role | 6.74 crore authorised admissions in private hospitals | PMJAY relies heavily on private hospitals; therefore, regulation is essential. |
| Ayushman cards | 43.52 crore Ayushman cards created as of 28 February 2026 | Card creation shows reach, but entitlement must convert into real treatment access. |
| People aged 70 years and above | 1.14 crore Ayushman Vay Vandana cards created | This expansion strengthens social protection, but it also increases fiscal pressure. |
| Health benefit package | 1,961 procedures across 27 medical specialties | Package design must balance affordability, quality, and medical necessity. |
| Digital health accounts | More than 90 crore Ayushman Bharat Health Accounts (ABHA) | Digital health can improve continuity of care, but consent, privacy, and data security need strict safeguards. |
| Audit concern | Comptroller and Auditor General (CAG) reviewed implementation and data quality | Large welfare databases require continuous cleaning, validation, and independent audits. |
Why ABC Live Is Publishing This Report Now
Ayushman Bharat has entered a decisive phase. It is no longer only a flagship welfare scheme. It has become a national health-financing, hospital-access, primary-care, and digital-health platform.
Expansion Has Increased Public Importance
The scheme now covers a wider social base. The government has expanded AB-PMJAY to include people aged 70 years and above, irrespective of socio-economic status. As of 28 February 2026, the government reported 1.14 crore Ayushman Vay Vandana cards for this age group.
Accountability Questions Are Growing
At the same time, audit findings, fraud cases, payment disputes, and out-of-pocket expenses show that India must examine the scheme beyond headline numbers. Therefore, ABC Live is publishing this report to assess whether Ayushman Bharat is moving India toward real health justice or mainly creating a large hospital-insurance platform.
What Is Ayushman Bharat?
Ayushman Bharat is a national health reform built around two connected ideas.
Primary Healthcare Near Citizens
First, India needs stronger primary healthcare. Therefore, the scheme created Ayushman Arogya Mandirs to provide services closer to citizens.
These centres are expected to support maternal health, child health, communicable disease care, non-communicable disease screening, mental health, care for older people, palliative care, and basic diagnostics.
Protection From Hospital Bills
Second, poor and vulnerable families need protection from catastrophic hospital bills. Therefore, AB-PMJAY provides cashless hospitalisation cover of ?5 lakh per eligible family per year for secondary and tertiary care.
The government stated in March 2026 that AB-PMJAY provides this cover to 12 crore families constituting the bottom 40% of India’s population.
Why Both Pillars Must Work Together
This design is correct in principle. Primary care should prevent disease and detect illness early. Meanwhile, hospital insurance should protect families when serious illness needs admission.
However, both pillars must work together. If primary care remains weak, PMJAY becomes mainly a hospital-payment scheme.
What Is AB-PMJAY?
Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is the hospital-care pillar of Ayushman Bharat.
Cashless Hospital Treatment
It provides eligible families cashless treatment in empanelled public and private hospitals. The benefit cover is ?5 lakh per family per year.
In addition, the health benefit package provides cashless healthcare services for 1,961 procedures across 27 medical specialties, according to the government’s March 2026 update.
National and State-Level Implementation
The National Health Authority (NHA) implements AB-PMJAY at the national level. State Health Agencies implement it at the state level.
This federal model is useful because health delivery happens largely through states. However, it also creates variation in implementation quality.
Data Dashboard: Ayushman Bharat and AB-PMJAY
| Indicator | Latest / Available Data | ABC Live Interpretation |
|---|---|---|
| AB-PMJAY annual cover | ?5 lakh per eligible family per year | Strong protection for hospitalisation, but weak protection for outpatient costs. |
| Ayushman cards | 43.52 crore cards as of 28 February 2026 | Card creation shows reach, but real treatment access needs audit. |
| Cards for people aged 70 years and above | 1.14 crore Ayushman Vay Vandana cards | Coverage for this age group is socially important, but fiscal planning must improve. |
| Empanelled hospitals | 36,229 hospitals as of 28 February 2026 | Access has expanded, but rural distribution and quality still matter. |
| Public hospitals | 19,483 public hospitals | Public hospitals remain central and need direct budget support. |
| Private hospitals | 16,746 private hospitals | Private hospitals need strict regulation because they handle public money. |
| Authorised hospital admissions | 11.69 crore admissions | India has achieved scale; now it must show outcome quality. |
| Private hospital admissions | 6.74 crore admissions | Private-sector dependence creates both capacity and governance risks. |
| Health benefit package | 1,961 procedures across 27 specialties | Package rates must match real costs and quality standards. |
| ABHA accounts | More than 90 crore accounts | Digital health infrastructure has expanded rapidly. |
| Audit review | CAG Report No. 11 of 2023 | Independent audit remains essential for scheme credibility. |
The government’s March 2026 update reported 43.52 crore Ayushman cards, 1.14 crore Ayushman Vay Vandana cards for people aged 70 years and above, and 36,229 empanelled hospitals. The hospital network included 19,483 public hospitals and 16,746 private hospitals.
Major Achievements of Ayushman Bharat
1. India Created a National Health-Protection Platform
Ayushman Bharat changed the policy conversation. Earlier, many poor families relied on charity, loans, asset sales, or delayed treatment. Now, eligible families can access cashless hospital care through a national framework.
This change matters because serious illness can push a household into debt. Therefore, PMJAY’s financial-protection objective has social and constitutional importance.
2. Hospital Access Has Expanded
The hospital network has grown sharply. The government reported that empanelled hospitals increased to 36,229 as of 28 February 2026. This network included 19,483 public hospitals and 16,746 private hospitals.
However, hospital numbers need deeper analysis. India must ask whether these hospitals are located where poor patients actually live. It must also ask whether they accept PMJAY patients without delay, extra billing, or informal payment demands.
3. Private Hospitals Have Been Brought Into Public Health Financing
Public hospitals alone cannot meet India’s hospital-care demand. Therefore, PMJAY’s use of private hospitals has practical value.
Yet, this model creates a governance challenge. When public money flows into private hospitals, the State must ensure transparency, reasonable pricing, medical necessity, and patient rights. Otherwise, the scheme may finance procedures without guaranteeing health justice.
4. Digital Health Infrastructure Has Scaled Up
The Ayushman Bharat Digital Mission has crossed 90 crore Ayushman Bharat Health Accounts. The government describes ABHA as a digital health identity that helps citizens link, access, and share health records with consent.
Digital health records can reduce duplication, improve portability, and support continuity of care. However, health data is highly sensitive. Therefore, consent, privacy, cybersecurity, and patient control must remain non-negotiable.
5. People Aged 70 Years and Above Have Received Wider Protection
The expansion of coverage to people aged 70 years and above gives AB-PMJAY a stronger social-security character. This age group often faces higher hospitalisation risk, chronic disease burden, and recurring treatment costs.
However, this expansion also requires careful fiscal planning. Care for older people can require higher and more regular health spending. Therefore, India must strengthen claim management, chronic-care support, and public hospital capacity.
Critical Weaknesses of Ayushman Bharat and AB-PMJAY
1. PMJAY Is Not the Same as Universal Health Coverage
Universal Health Coverage means that people receive needed health services without financial hardship. It includes prevention, primary care, outpatient care, medicines, diagnostics, rehabilitation, palliative care, and long-term chronic care.
PMJAY mainly covers hospitalisation. Therefore, it does not fully solve the everyday cost of medicines, tests, doctor consultations, transport, and follow-up care.
2. Outpatient Care Remains a Major Gap
Many families spend money repeatedly before any hospital admission takes place. This is especially true for diabetes, hypertension, kidney disease, cancer follow-up, mental health care, and long-term medicine needs.
As a result, hospital insurance can reduce catastrophic expenses, but it cannot alone remove health-related poverty. Therefore, India should gradually add outpatient protection for the poorest households.
3. Primary Care Remains the Deciding Factor
Ayushman Arogya Mandirs are the most important pillar of Ayushman Bharat. If these centres work well, they can reduce avoidable hospitalisation. They can also detect disease early and provide treatment closer to home.
However, the key question is not how many centres exist. The real question is whether they have trained staff, medicines, diagnostics, telemedicine, digital records, and referral transport.
4. India Needs a Primary Care Quality Dashboard
India should publish a Primary Care Quality Dashboard. It should show doctor availability, medicine stock, diagnostic tests, patient footfall, referrals, follow-up rates, and patient satisfaction.
This data will help citizens understand whether primary care is actually functioning. Moreover, it will help policymakers fix weak districts before avoidable illness becomes hospitalisation.
5. Data Quality Problems Hurt Trust
The Comptroller and Auditor General examined AB-PMJAY through Report No. 11 of 2023, a performance audit covering September 2018 to March 2021. The audit reviewed implementation under the National Health Authority and the Ministry of Health and Family Welfare.
Data quality matters because a weak database increases fraud risk. Moreover, genuine beneficiaries may face denial, confusion, or delay. Therefore, data cleaning must become a permanent governance function.
6. Claim Settlement Needs Stronger Transparency
The government states that claim settlement under AB-PMJAY follows National Health Authority guidelines. It also states that the permissible turnaround time is 15 days for intra-state hospitals and 30 days for portability claims.
This rule is useful. However, ABC Live’s concern is whether hospital-wise claim-settlement performance is publicly visible. Patients and hospitals need clarity. Therefore, delayed claims, rejected claims, and pending claims should appear in a public dashboard.
7. Private Hospital Dependence Creates Policy Risk
Private hospitals provide essential capacity. However, dependence on them creates risks.
Some hospitals may avoid low-paying packages. Others may prefer profitable procedures. In some cases, hospitals may demand extra payment from patients despite cashless rules. Moreover, delayed claim settlement can reduce hospital willingness to treat PMJAY patients.
8. Public Hospitals Need Direct Investment
PMJAY can bring claim revenue to public hospitals. This is useful. However, public hospitals cannot depend only on insurance claims.
Government hospitals perform many functions that insurance does not fully reward. They provide emergency care, epidemic response, trauma care, maternal care, public-health surveillance, and free treatment for many non-PMJAY patients.
Therefore, PMJAY should supplement public hospitals. It should not replace direct budgetary investment.
Governance and Legal Analysis
Article 21 and the Right to Health
India does not have a single national Right to Health law. However, the Supreme Court has repeatedly linked health with the right to life under Article 21 of the Constitution.
Therefore, Ayushman Bharat has constitutional importance. It supports access to healthcare for poor and vulnerable citizens. However, a card-based hospital scheme cannot become the full meaning of the right to health.
State Duty Goes Beyond Hospital Insurance
The State’s duty includes primary care, emergency services, medicines, diagnostics, sanitation, nutrition, clean water, and public hospitals.
Therefore, AB-PMJAY should be treated as one part of health justice. It should not become a substitute for a full public-health system.
Federal Coordination Challenge
Health is largely implemented by states. However, AB-PMJAY has a national design. This creates both strength and complexity.
A national platform supports portability and uniform standards. However, state-level implementation differs. Some states have stronger hospitals, better claims systems, and better monitoring. Others face weaker infrastructure and delayed payments.
Accountability Gap
The scheme involves many actors: the Union Government, National Health Authority, State Health Agencies, hospitals, insurers or trust models, technology vendors, district units, and grievance officers.
For patients, this chain can become confusing. When a hospital denies treatment or demands money, patients need a simple answer: who will act immediately?
Grievance Redressal Must Work During Emergencies
The government has stated that beneficiaries can use the Centralized Grievance Redressal Management System (CGRMS) or the 24×7 toll-free helpline 14555 in cases of denial or irregularity. It also states that grievance redressal operates at district, state, and national levels.
However, grievance redressal must work during medical emergencies. Therefore, every empanelled hospital should display the local PMJAY officer’s contact details in clear language.
ABC Live Analysis
Ayushman Bharat is a necessary reform. It has created a national platform for health protection. It has also changed public expectations. Poor families now expect hospital access as a public entitlement, not as charity.
Insurance Cannot Replace Public Health
The scheme still faces a structural problem. India cannot insure its way out of weak public-health infrastructure.
Insurance helps when a patient reaches a hospital. However, it does not automatically provide a nearby doctor, regular medicines, clean diagnostics, emergency transport, or safe surgery.
Wider Healthcare Governance Context
This issue must also be read with India’s wider healthcare-governance reforms. For example, ABC Live earlier analysed the NDCT Amendments 2026, which concern drug trials, clinical research rules, and patient-safety regulation.
Together, these developments show that India’s health-policy challenge is not only about insurance cover. It is also about regulation, ethics, clinical accountability, and public trust.
Five Tests for the Next Phase
Therefore, Ayushman Bharat’s next phase must be judged by five tests.
| Test | Question |
|---|---|
| Access test | Can poor patients actually receive treatment without denial or extra billing? |
| Quality test | Are patients receiving safe and necessary treatment? |
| Equity test | Are rural citizens, women, older citizens, migrants, and weaker groups using the scheme fairly? |
| Financial test | Is household medical debt falling? |
| Integrity test | Is public money protected from fraud and misuse? |
If these tests improve, Ayushman Bharat can become a health-justice platform. However, if they do not, it may remain a large but incomplete hospital-insurance scheme.
Data-Based Critical Findings
1. India Has Built Scale, But Must Now Prove Quality
The scheme’s scale is impressive. However, health policy cannot rely only on cards, claims, and admissions.
India must now publish outcome data. This should include mortality rates, infection rates, readmission rates, treatment success, patient satisfaction, complaint disposal, and hospital-wise performance.
2. Private Hospitals Are Now Public-Health Actors
Because private hospitals handle a large share of authorised admissions, they are no longer only market players. They are also part of a publicly funded health system.
Therefore, they must accept stronger transparency. Hospital-wise claims, complaints, penalties, and package performance should be available for public review.
3. Digital Health Needs Strong Privacy Protection
ABHA expansion can help patients carry health records across hospitals. However, health records are sensitive.
Therefore, the digital-health system must protect consent, privacy, data minimisation, cybersecurity, and patient control. Otherwise, a useful digital platform can create new risks.
4. Fraud Control Must Become Preventive
Fraud detection after payment is not enough. The scheme needs preventive controls.
For example, the system should flag unusual claim patterns before payment. It should also track repeated procedures, suspicious admission clusters, abnormal package use, and sudden claim spikes from specific hospitals.
5. Screening Must Connect With Treatment
Preventive screening is valuable only if positive cases receive treatment. Therefore, Ayushman Bharat should publish a screening-to-treatment chain.
This chain should show how many people screened positive, how many received confirmatory diagnosis, how many started treatment, and how many remained under follow-up.
Reform Agenda
1. Publish a National PMJAY Quality Dashboard
The government should publish hospital-wise data on:
| Area | Data Needed |
|---|---|
| Claims | Number of claims, amount claimed, amount approved, rejection rate |
| Timeliness | Average approval time and claim-settlement time |
| Patient rights | Complaints, extra billing cases, denial cases |
| Medical quality | Mortality, infection, readmission, complications |
| Enforcement | Penalties, suspensions, recoveries, criminal complaints |
| Equity | Rural-urban use, gender use, use by people aged 70 years and above, and migrant access |
This dashboard will help patients, researchers, hospitals, and policymakers.
2. Strengthen Ayushman Arogya Mandirs
The government should shift attention from centre counts to service quality.
Every Ayushman Arogya Mandir should have essential medicines, basic diagnostics, trained staff, digital records, telemedicine support, and referral links. In addition, each centre should publish monthly service data.
3. Add Outpatient Protection in Phases
India should not immediately overload PMJAY. However, it should begin phased outpatient protection.
The first phase can cover essential medicines and diagnostics for diabetes, hypertension, cancer follow-up, kidney disease, and care for older people. This will directly reduce household spending.
4. Use Real-Time Fraud Analytics
The National Health Authority should build stronger fraud-detection tools. These tools should flag suspicious claims before payment.
Hospitals involved in repeated fraud should face suspension, recovery of public money, removal from empanelment, and criminal prosecution. However, genuine hospitals should receive quick payment.
5. Protect Patients from Extra Billing
Every empanelled hospital should display PMJAY patient rights in local language.
Patients should receive a zero-bill certificate after treatment. If a hospital takes illegal payment, the complaint should trigger automatic inquiry. In serious cases, the hospital should face penalty and suspension.
6. Improve Claim Settlement
Delayed payments hurt hospital participation. Therefore, genuine claims should be settled within a fixed time.
If a claim is delayed without valid reason, the system should automatically escalate it. However, suspicious claims should remain subject to audit.
7. Invest Directly in Public Hospitals
PMJAY cannot replace public-health spending. India needs better district hospitals, medical colleges, trauma centres, emergency care, diagnostics, and specialist services.
Therefore, the Union and state governments must increase direct health investment alongside PMJAY.
Risks and Concerns
Risk 1: Insurance May Overshadow Public Health
If policymakers focus mainly on hospital claims, primary care may remain weak. This would increase avoidable hospitalisation.
Risk 2: Fraud Can Damage Public Trust
Fraud cases reduce public confidence. They also divert money from genuine patients.
Risk 3: Private Hospitals May Shape Package Use
If private hospitals prefer profitable procedures, the scheme may not reflect real public-health priorities.
Risk 4: Digital Expansion May Outrun Privacy Protection
ABHA growth is important. However, health-data misuse can harm citizens. Therefore, consent and cybersecurity must keep pace with digital scale.
Risk 5: Expansion for People Aged 70 Years and Above May Increase Fiscal Pressure
Coverage for people aged 70 years and above is socially important. However, care for older people can require higher and more regular health spending.
Therefore, India must plan funding carefully. It must also strengthen geriatric care, chronic disease management, home-based support, and public hospital capacity.
What Happens Next?
Ayushman Bharat’s future will depend on whether India can move from enrolment to outcomes.
Five Priorities for the Next Phase
The next phase should focus on five priorities. First, strengthen primary care. Second, reduce medicine costs. Third, publish hospital-wise quality data. Fourth, prevent fraud in real time. Finally, invest more in public hospitals.
The Larger Policy Choice
If India follows this path, Ayushman Bharat can become a foundation for Universal Health Coverage. However, if India treats PMJAY as a complete solution, major gaps will remain.
Conclusion
Ayushman Bharat has given India a powerful health-protection framework. AB-PMJAY has expanded hospital access for millions of poor and vulnerable families.
The Architecture Is Ready
Ayushman Arogya Mandirs have pushed primary care into national policy focus. Meanwhile, Ayushman Bharat Health Account (ABHA) has created a large digital-health base.
These achievements matter because India needs a connected health system. However, the next challenge is not only expansion. It is quality.
The Real Test Is Health Justice
India’s health challenge is bigger than hospital insurance. Citizens need prevention, primary care, outpatient medicines, diagnostics, safe hospitals, emergency care, and strong public-health systems.
Therefore, Ayushman Bharat should now enter its second generation. The first phase built scale. The next phase must build trust, quality, accountability, and real financial protection.
In simple terms, Ayushman Bharat has built the architecture. India must now ensure that this architecture delivers health justice, not only hospital claims.
Sources and Methodology
ABC Live reviewed official government releases, National Health Authority-linked material, Comptroller and Auditor General audit findings, and ABC Live’s earlier healthcare-governance coverage.
Official Sources
- Press Information Bureau: Update on AB-PMJAY
Used for data on empanelled hospitals, authorised hospital admissions, private hospital admissions, grievance redressal, and claim-settlement timelines. - Press Information Bureau: Update on Progress of AB-PMJAY and Ayushman Bharat Digital Mission (ABDM)
Used for data on Ayushman cards, Ayushman Vay Vandana cards, health benefit packages, ABHA-linked records, and ABDM-enabled facilities. - Comptroller and Auditor General of India: Performance Audit of AB-PMJAY, Report No. 11 of 2023
Used for audit context, governance concerns, implementation review, and accountability analysis.
ABC Live Internal Link
- ABC Live: NDCT Amendments 2026
https://abclive.in/2026/01/28/ndct-amendments-2026
Used as an internal healthcare-governance reference to connect AB-PMJAY with India’s wider patient-safety and clinical-regulation framework.
FAQ
What is Ayushman Bharat?
Ayushman Bharat is a national health reform with two major pillars: Ayushman Arogya Mandirs for primary care and AB-PMJAY for hospital-care protection.
What is AB-PMJAY?
AB-PMJAY is the hospital-care pillar of Ayushman Bharat. It provides eligible families cashless treatment cover of ?5 lakh per family per year.
Is Ayushman Bharat the same as AB-PMJAY?
No. Ayushman Bharat is the wider mission. AB-PMJAY is one part of it. The other key pillar is Ayushman Arogya Mandirs for primary healthcare.
What is the biggest achievement of AB-PMJAY?
Its biggest achievement is large-scale hospital financial protection for poor and vulnerable families.
What is the biggest weakness of AB-PMJAY?
Its biggest weakness is that it mainly covers hospitalisation. It does not fully cover outpatient consultations, medicines, diagnostics, and long-term chronic care.
What reform is most urgent?
The most urgent reform is accountability. India needs hospital-wise data, stronger fraud control, faster claim settlement, patient protection from extra billing, and better primary care.