Ayushman Bharat's Scale Meets Its Limits

Ayushman Bharat, when measured merely by the number of enrolled members, is undoubtedly the world's biggest publicly funded health insurance scheme. It's not quite so easy to tell if that's been translated into consistent access on the ground.

The Numbers at a Glance

More than 43.5 crore Ayushman Cards have been issued so far and as of early 2026, a total of 36,229 hospitals, which include 19,483 public and 16,746 private hospitals, have been empanelled.

A total of 11.69 crore hospital admissions have been authorized under the scheme, which include 6.74 crore hospital admissions in private hospitals, with over ₹1.69 lakh crore worth of hospital admissions already authorized till January 2026, Union minister of state for Health Prataprao Jadhav told the Lok Sabha.

Areas where the system fails to meet its demands

However, research that has been undertaken of the empanelment patterns has revealed a significant negative correlation between the state level of poverty and the number of specialty hospitals that participate in the scheme; that is, the poorer a state is, the fewer specialty hospitals it has participating in the scheme.

In a study on Jammu and Kashmir, researchers concluded that the quality of the roads was a key constraint in the scheme reaching beneficiaries; it was found that the poor quality of the roads significantly lowered the chance that beneficiaries actually used the scheme, noting that “inadequate rural infrastructure restricts the reach” of the primary care centres designed to anchor the programme locally.

Public-private partnerships, Selectively

Private hospital empanelment has increased significantly, as have the number of providers that are "eligible" for empanelment, but a "large number of empanelled and eligible private healthcare providers are yet to fully integrate Ayushman Bharat services into their routine operations," analysts say.

There is no information from Parliamentary sources on the number of hospitals that have opted out of the scheme, but a Parliamentary questioner, Leader of the Opposition Rahul Gandhi, the official response to which said that de-empanelment does take place, though without giving any figures.

A separate report by the CAG in 2023 highlighted that about 7.5 lakh beneficiaries were registered using a same mobile number and that the government is probing and fixing the cases of upcoding and duplicate billing.

The need for a redress mechanism and continued reform

Any complaints regarding the treatment received at non-empanelled hospitals can be submitted using the Centralised Grievance Redressal Management System or 24-hour helpline and claims can be reimbursed within 15-30 days depending on whether the treating hospital is located in the state where the beneficiary resides or not.

The Scheme's coverage was extended to every citizen aged 70 years and over, irrespective of income, in 2024, which brought about an addition of about 6 crore senior citizens to the scheme's coverage, which officials view as proof of the programme's ongoing growth while geographic and administrative challenges with implementation have not been addressed.