Experts suggest linkages between wellness centres and PHCs, among others. | Photo Credit: H S MANJUNATH
Since its launch, the scheme has expanded to encompass additional beneficiaries, medical conditions, and healthcare facilities, yielding success stories of individuals receiving free treatment funded by the program. However, concerns regarding delayed payments to hospitals and allegations of fraud have arisen. Experts suggest that an independent impact assessment is necessary to evaluate the program and identify opportunities for consolidation.
The Ayushman Bharat initiative consists of two primary components. The Pradhan Mantri Jan Arogya Yojana (PMJAY) offers health insurance coverage of ₹5 lakh for families, benefitting over 12 crore families and approximately 55 crore individuals. The initiative also supports ₹1.5 lakh-plus health and wellness centres focused on preventive care.
JVR Prasada Rao, a former Health Secretary of the Central government, emphasizes that hospitalization coverage under Ayushman Bharat has reduced out-of-pocket expenses, allowing patients access to free treatments. Nonetheless, he notes that the effectiveness of such schemes hinges on their implementation, flagging issues like funding delays and grievances from states about payment discrepancies. Addressing these issues is crucial for fostering hospital participation in the program.
Balancing act
Rao advocates for enhanced integration with wellness centres to facilitate the referral of critical cases to hospitals. He highlighted the challenges faced by individuals accessing the scheme while working in a different state, advocating for better coordination to resolve issues related to portability and the collaboration between wellness centres and primary health care centres (PHCs). He stressed the need to clarify the relationship between national health schemes and state-level programs.
Rao calls for an independent evaluation of the scheme, emphasizing the importance of understanding personal experiences and addressing issues raised on the ground.
From the private healthcare perspective, Vishal Bali, Executive Chairman of Asia Healthcare Holdings, commends the PMJAY as a commendable effort towards universal healthcare. However, he stresses the importance of sufficient funding for the initiative to be sustainable in the long term and addresses complaints regarding delayed payments from hospitals in various states.
Time to consolidate
Dr. Indu Bhushan, the founding Chief Executive Officer of Ayushman Bharat, acknowledges the remarkable expansion of the scheme, particularly in reducing out-of-pocket expenses and widening coverage across age groups and diseases.
To enhance the program further, Bhushan identifies several areas for improvement: improving linkages between wellness centres and PHCs, leveraging technology for treatment follow-ups and fraud detection, streamlining overlaps between PMJAY and other national and state schemes, employing AI to enhance service quality and manage fraud, and ensuring timely payments to healthcare providers.
Bhushan asserts, “Payments should ideally be processed as quickly as possible; we indicated that payments would be made within 15 days. Any delays should incur interest.” He adds that both the central and state governments must prioritize monitoring and timely payments to sustain trust among hospitals. He proposes innovative financial solutions, such as risk-based loans, to support hospitals with a favorable risk profile in securing working capital.
Bhushan suggests that corporate hospitals will only join the initiative if their experiences are favorable, recalling his assurance to hospitals during his tenure to prioritize timely payments over pricing concerns.
As Ayushman Bharat progresses, Bhushan emphasizes the need for consolidation to ensure the effective rollout of resources already committed, especially for senior citizens.
Published on September 22, 2025
