The Economic Survey 2024-25 highlights the effectiveness of the Ayushman Bharat PM-JAY scheme in reducing Out-of-Pocket Expenditure (OOPE) by saving over ₹1.25 lakh crore and significantly increasing government health spending, which rose from 29.0% to 48.0% between FY 2015 and FY 2022.
The Economic Survey 2024-25 emphasizes the significant impact of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) on reducing Out-of-Pocket Expenditure (OOPE) in healthcare. The program has led to savings exceeding ₹1.25 lakh crore by enhancing social security and increasing government health expenditure. Notably, it has contributed 2.63% to overall healthcare financing, alleviating financial burden on households. Between Fiscal Year 2015 and Fiscal Year 2022, Government Health Expenditure (GHE) rose from 29.0% to 48.0%, while OOPE declined from 62.6% to 39.4%.
As of March 24, 2025, more than 36.9 crore Ayushman cards have been issued under AB PM-JAY. The eligibility criteria for beneficiary families were initially determined using the 2011 Socio-Economic Caste Census (SECC), based on six deprivation and eleven occupational criteria across rural and urban regions. In January 2022, due to an 11.7% decadal growth rate, the Government revised the beneficiary base to 12 crore families and allowed States and Union Territories the flexibility to utilize alternative databases for identifying beneficiaries. The eligibility criteria were further expanded in March 2024 to include approximately 37 lakh Accredited Social Health Activists (ASHAs), Anganwadi Workers (AWWs), Anganwadi Helpers (AWHs), and their families. On October 29, 2024, the scheme was enhanced to extend free treatment benefits of up to ₹5 lakh per year to around 6 crore senior citizens aged 70 and above, encompassing 4.5 crore families regardless of socio-economic status.
AB PM-JAY ensures that empaneled hospitals cannot deny treatment to eligible beneficiaries. In instances of service denial, beneficiaries can lodge grievances through a three-tier grievance redressal system at the District, State, and National levels. Each level has dedicated nodal officers and Grievance Redressal Committees to effectively address concerns. Beneficiaries can utilize various channels for filing grievances, including a web-based portal called the Centralized Grievance Redressal Management System (CGRMS), Central and State call centers, emails, and direct correspondence with State Health Agencies.
All government hospitals offering in-patient services are automatically empaneled under AB-PMJAY, and reimbursements for services are aligned with those provided by private hospitals. To increase participation from private hospitals, the National Health Authority (NHA) has taken several initiatives, including the release of a revised Health Benefit Package (HBP) featuring 1,961 procedures, an increase in rates for 350 existing packages, and the introduction of new packages. Monitoring of claim settlements occurs at the highest levels to ensure timely resolution within defined turnaround times. The NHA has also launched an upgraded version of the Hospital Engagement Module (HEM 2.0) for improved hospital empanelment processes.
Additionally, both virtual and physical capacity-building efforts for hospitals have been implemented. To address the real-time concerns of hospitals, a hospital-specific call center has been established, and District Implementation Units (DIUs) regularly visit empaneled hospitals to gain insights into the challenges faced by beneficiaries and healthcare providers. Shri Prataprao Jadhav, the Union Minister of State for Health and Family Welfare, provided this information in a written response in the Lok Sabha, highlighting the continuous efforts to enhance healthcare access and financial protection under the AB PM-JAY scheme.
