The scheme is jointly funded by the Centre and the states in the ratio 60:40 (90:10 in the case of North-East and hilly states). Government hospitals account for 58% of all facilities empanelled.
In a country where the private sector anyway accounts for more hospitalisation cases — 60% in urban areas and 52% in rural areas — this trend affirms that for a big section of the population that was dipping into its savings for treatment in private hospitals, the Ayushman Bharat scheme has significantly reduced their out-of-pocket healthcare spending. The government’s own data suggests that average medical expenditure in private hospitals is 6-8 times that in government hospitals.
Launched in September 2018, AB-PMJAY aims to achieve universal health coverage and substantially decrease out-of-pocket healthcare expenses among the poor, for whom a health emergency often leads to further impoverishment and debts.
Of the Rs 72,817 crore total expenditure under the scheme since 2018, Rs 48,778 crore – 67% — went to private healthcare facilities.
The southern states of Tamil Nadu, Kerala, Karnataka, Andhra Pradesh, and Telangana together have just 17 per cent of Ayushman cards nationwide, but account for a substantial 53 per cent of the total patients in the country. This indicates the widespread utilisation of the scheme in the southern region.
And nearly 60 per cent of the total 5.47 crore patients who availed of the scheme over five years were from five states — Karnataka, Tamil Nadu, Kerala, Andhra Pradesh and Chhattisgarh. This suggests that despite controversies between the Centre and Opposition-ruled states over schemes and funding, the impact of the Ayushman Bharat scheme is not limited to states governed by the ruling party at the Centre.
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Delhi, Odisha and West Bengal have opted out of this scheme.
The scheme: scale and spread
The cashless and paperless scheme offers up to Rs 5 lakh annually per family for hospitalisations in 27,000 empanelled secondary (hospitals with basic specialties including medicine, gynaecology) and tertiary (super-specialty, like neurosurgery, cardiology, orthopaedics) healthcare facilities, with the benefits extending nationwide and without restrictions on family size, age, or gender.
What is the Ayushman Bharat scheme?
The scheme covers nearly 2,000 procedures and provides critical illness coverage for patients suffering from cancer, heart and liver diseases, among many more. Besides the expenses incurred during the hospitalisation, the scheme covers three days of pre-hospitalisation and 15 days post-hospitalisation expenses such as diagnostics and medicines.
Beneficiary families are identified from the 2011 Socio-Economic Caste Census (SECC), based on specific deprivation and occupational criteria across both rural and urban areas. Around 13.44 crore families (65 crore people) are potential beneficiaries of the scheme. So far, 32.40 crore people have been issued Ayushman Bharat cards.
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An analysis of data and documents obtained through the Right to Information (RTI) Act shows that between 2018 and 2023, 5.47 crore patients accessed treatment under the scheme. While the annual average hovered around 49 lakh patients in the first three years, the subsequent three years saw a surge, with an average of 1.33 crore patients accessing treatments through the scheme annually.
More patients availed of private healthcare
It’s the private sector that saw a bulk of the 5.47 crore patients over the last five years.
Consider some of these findings:
• While six out of 10 empanelled hospitals are government-run, when it came to hospitalisation, 54 out of 100 patients, or 2.95 crore patients of the total 5.47 crore who availed of the scheme in the last five years, accessed private hospitals for treatment under the scheme.
• The percentage of individuals seeking treatment at private facilities exceeded the national average of 54% in 15 states (see map).
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• In eight of these states and UTs, a staggering 70% of those who accessed treatment under the scheme did so at private hospitals – Uttar Pradesh (81%), Haryana (81.45%), Gujarat (78%), Chandigarh (76%), Maharashtra (77%), Tamil Nadu (74%), Jharkhand and Andhra Pradesh (~70%).
• Zooming out, the data reveals that a big chunk of the 2.95 crore beneficiaries who accessed treatment at private facilities were concentrated in just five states: Tamil Nadu (71.95 lakh patients), Andhra Pradesh (35.78 lakh patients), Uttar Pradesh (25.57 lakh patients), Gujarat (23.04 lakh patients) and Kerala (21.31 lakh patients) – pointing to disparities across states in access to healthcare services. These five accounted for around 60% of the 2.95 crore beneficiaries who sought treatment at private facilities.
• Of particular note is Uttar Pradesh, one of India’s largest states, which has consistently experienced double-digit growth in patients going to private hospitals over the previous year. For instance, 52,202 beneficiaries from the state received treatments at private facilities in 2018-19. The following year, that number rose to 2.17 lakh beneficiaries, a remarkable 316% increase. Over the next four years, the state consistently reported double-digit jumps when compared to previous years: 16%, 62%, 64%, and 42%, respectively.
• The data shows that the government incurred an expenditure of Rs 72,817.76 crore for treating patients under the scheme, of which Rs 48,778.61 crore or over 66% was spent for treatment at private facilities.
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• Of this total expenditure incurred for treatment at private facilities, 59% was in just five states: Andhra Pradesh, Gujarat, Madhya Pradesh, Uttar Pradesh, and Tamil Nadu.
Other findings
• While Uttar Pradesh, Bihar, Haryana, and Madhya Pradesh account for close to 24% of the total empanelled government hospitals, only 11% of the total patients accessed treatment in government hospitals in these states.
• Conversely, four states — Kerala, Jammu & Kashmir, Punjab, and Jharkhand — that together account for a mere 5% of total empanelled hospitals, however, served 22% of the total patients seeking treatment at government facilities nationally. This suggests some of these states have a relatively efficient government healthcare system, where a smaller number of hospitals are able to cater to a larger proportion of the population.
Post-Covid trend
In the last two financial years, there is a shift towards government facilities among patients accessing treatment under the scheme but not in spending.
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Consider this: In 2022-23, 64.96 lakh patients opted for private facilities, whereas 70.69 lakh chose government ones. The following year, 2023-24, 57.56 lakh patients preferred private facilities, while 70.89 lakh took the government route.
Yet, the cost dynamics tell a different story. In 2022-23, Rs 13,213.13 crore was spent on treatments in private facilities, dwarfing the Rs 7,055.12 crore spent at government hospitals. Similarly, in 2023-24, Rs 12,947.42 crore was shelled out for treatments at private facilities in contrast to Rs 6,528.33 crore spent at government ones.
What is the Ayushman Bharat scheme?