AB PM-JAY may move towards integrated framework to offer end-to-end healthcare

The Centre may expand the scope of the world’s largest government funded health insurance scheme Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) through an integrated framework that ensures continuum of care approach and enable strong referral linkages across primary, secondary and tertiary levels of healthcare.

The future roadmap of AB PM-JAY proposed by the National Health Authority (NHA) talks about expansion of Ayushman Bharat network to deliver services across the full continuum of care, supported by an effective referral system that connects primary, secondary, and tertiary facilities.

Spelt out in NHA’s Annual Report 2024-25, this integrated approach is expected to enhance access, efficiency, and resilience in Indian healthcare ecosystem.

The launch of Ayushman Bharat marked a significant shift from a segmented to a more comprehensive approach towards the healthcare system. It combined preventive, promotive, and primary care through Health and Wellness Centres and financial protection for secondary and tertiary care through AB PM-JAY. The plan is to look at all three tiers of care – primary, secondary and tertiary – as a continuum.

Since its launch seven years ago, Over 9.19 crore hospital admissions have been facilitated under AB PM-JAY with treatment worth Rs 1,29,386 crores. NHA has issued over 40.45 crore Ayushman cards issued covering 14.69 crore families till March this year. Of the 31,005 hospitals that are empanelled under the scheme, 55% are public healthcare facilities.

The NHA also proposes a set of strategic interventions to enhance coverage, service delivery, accountability, and system efficiency of AB PM-JAY. Achieving 100% saturation of Ayushman cards across all implementing States and Union Territories is one such plan. Since fully functional district implementation units (DIUs) are vital to last-mile implementation of the scheme, these units will be further strengthened and empowered to support Ayushman card saturation drives, coordinate with empanelled hospitals, and serve as a crucial link between State Health Agencies (SHAs) and beneficiaries to ensure smooth service delivery at the district level. Similarly, continuous upgrades and optimisation of IT infrastructure to make it seamless, user-friendly, and efficient are planned.  

Going forward, predictive analytics, real-time monitoring, and automated checks to proactively detect, deter, and address suspicious activities and fraudulent claims are expected to be further strengthened. Strengthening grievance mechanisms through national and state-level call centres, digital portals, and field-level support are planned to enhance beneficiary satisfaction and accountability.