On Govt table: Double Ayushman Bharat’s insurance cover limit, count of beneficiaries

The Ayushman Bharat Yojana, also known as Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana, is the incumbent government’s flagship health assurance scheme, often touted as the world’s largest. It provides an annual coverage of Rs 5 lakh per family for secondary and tertiary care hospitalisation to approximately 55 crore beneficiaries from 12.34 crore families, who are among the bottom 40% of the country’s population.

As of June 30, 7.37 crore hospital admissions worth Rs 1 lakh crore have been authorised under the scheme.

The BJP counts the scheme amongst the NDA government success stories and the party manifesto for the Lok Sabha polls this year also promised to increase its coverage to all citizens aged above 70 years. The different Groups of Secretaries were tasked to map goals from the BJP’s ‘Sankalp Patra’ and envision election timelines for the same.

Ayushman Bharat counter at AIIMS, Delhi. (Tashi Tobgyal)

According to the key action items for the Union Health Ministry under the theme ‘Expand Access and Participation’, one of the goals is to hike the annual insurance cover limit to Rs 10 lakh per family. However, this cover can be extended up to Rs 15 lakh in case of women “for specific diseases and specific circumstances” in the next five years.

Currently, women account for approximately 49% of the total Ayushman cards generated and approximately 48% of total authorised hospital admissions, according to data released by the Union Health Ministry late last year.

Further, the number of beneficiaries is targeted at 100 crore and a staggered increase of 4 lakh private hospital beds. Currently, there are about 7.22 lakh private hospital beds under the Pradhan Mantri Jan Arogya Yojana, which the Ministry hopes to increase to 9.32 lakh by 2026-27 and to 11.12 lakh by 2028-29.

The committee has also suggested enhancing the capacity of Jan Aushadhi Kendras — dedicated outlets that provide quality medicines at affordable prices — from 10,000 to 25,000 by the end of this government’s term.

According to ministry sources, the above proposals would be formalised and moved for approval from the Finance Ministry and Cabinet only after taking into consideration the recommendations of the committee set up under the chairmanship of NITI Aayog Member V K Paul. The panel was established earlier this year to evaluate implementation of Ayushman Bharat and suggest reforms, if any, to reduce frauds. It is expected to submit its report in a month.