Private hospitals account for majority of Ayushman Bharat’s claim payouts: NHA
The scheme’s reach has expanded steadily, with over 34.5 crore Ayushman cards issued so far. Women account for 49% of total hospital admissions under the scheme, signalling improved access to institutional healthcare for women.
- Oct 17, 2025,
- Updated Oct 17, 2025 6:33 PM IST
Private hospitals are emerging as the biggest beneficiaries of the government’s flagship health insurance scheme, Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB PM-JAY), accounting for nearly two-thirds of hospitalizations and the bulk of claim payouts, amounting to ₹80,000 crore, according to the National Health Authority’s (NHA) Annual Report 2024-25.
The report notes that India’s largest public health insurance scheme is increasingly powered by private hospitals and digital infrastructure. Since its launch in 2018, AB PM-JAY has provided free hospitalisation to more than 6.5 crore people, offering coverage of ₹5 lakh per family per year to around 55 crore citizens.
Private hospitals now handle about 64% of hospitalisations and nearly 69% of total claim payouts under the scheme. While public hospitals remain crucial in rural and low-income districts, private facilities dominate high-value procedures in areas like oncology, cardiology, and orthopaedics.
The NHA reports that private hospital participation continues to rise, with a 12% increase in empanelment in FY25. Out of the more than 32,000 hospitals empanelled under the scheme, about 13,000 are privately run. “Private hospitals contribute significantly to expanding the scheme’s reach and improving access to advanced care,” the report says.
The government’s push to integrate healthcare delivery through the Ayushman Bharat Digital Mission (ABDM) is also transforming how hospitals manage patient data and claims. By March 2025, over 61.8 crore Ayushman Bharat Health Accounts (ABHA) had been created, while 3.4 lakh healthcare facilities and 1.7 lakh professionals were registered on the platform.
“The integration of AB PM-JAY and ABDM is enabling paperless, cashless, and interoperable healthcare delivery,” the report states, highlighting that the digital ecosystem is helping speed up claims settlement and reduce fraud.
The scheme’s reach has expanded steadily, with over 34.5 crore Ayushman cards issued so far. Women account for 49% of total hospital admissions under the scheme, signaling improved access to institutional healthcare for women.
Analysts suggest that the scheme’s growing scale is creating new business opportunities for private hospitals, insurers, and health-tech companies. Large hospital chains like Apollo Hospitals, Fortis Healthcare, and Max Healthcare have steadily increased their empanelment under AB PM-JAY to tap into markets in tier-2 and tier-3 cities.
According to the report, reimbursement funds received by public hospitals under AB PM-JAY are being used for infrastructure upgrades, procurement of medical equipment, and hiring additional staff. This has helped improve services at government facilities, even as private participation remains dominant in tertiary care.
However, the NHA cautioned that the long-term sustainability of the scheme will depend on regular funding, faster claim settlements, and consistent participation from private hospitals across all regions. With several state health insurance programs now being integrated into AB PM-JAY, the total outlay for FY25 is expected to exceed ₹20,000 crore.
“The Ayushman Bharat Digital Mission has made measurable progress in building a unified digital health ecosystem. Its alignment with AB PM-JAY is improving efficiency and accountability in healthcare delivery,” the report adds.
Experts point out that as India’s public and private sectors become more intertwined through Ayushman Bharat, this model could shape the next phase of the country’s healthcare economy — where public financing is delivered through a network of digitally connected, privately managed care facilities.
“The latest NHA report highlights how Ayushman Bharat has transformed access to advanced healthcare for millions. With private hospitals now accounting for nearly two-thirds of hospitalisations and most claim payouts, it’s clear that the private sector plays a pivotal role in delivering specialized, high-value care under this scheme,” said Dr. Harsh Mahajan, FICCI Chair – Health & Services and Founder, Mahajan Imaging & Labs.
“The growing synergy between private providers and India’s expanding digital health ecosystem is enabling faster, cashless, and more equitable care while reducing out-of-pocket costs. Going forward, stronger collaboration between public and private systems is essential to enhance quality, transparency, and sustainability — ensuring every beneficiary receives timely, world-class healthcare, regardless of geography or income,” he added.
Private hospitals are emerging as the biggest beneficiaries of the government’s flagship health insurance scheme, Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB PM-JAY), accounting for nearly two-thirds of hospitalizations and the bulk of claim payouts, amounting to ₹80,000 crore, according to the National Health Authority’s (NHA) Annual Report 2024-25.
The report notes that India’s largest public health insurance scheme is increasingly powered by private hospitals and digital infrastructure. Since its launch in 2018, AB PM-JAY has provided free hospitalisation to more than 6.5 crore people, offering coverage of ₹5 lakh per family per year to around 55 crore citizens.
Private hospitals now handle about 64% of hospitalisations and nearly 69% of total claim payouts under the scheme. While public hospitals remain crucial in rural and low-income districts, private facilities dominate high-value procedures in areas like oncology, cardiology, and orthopaedics.
The NHA reports that private hospital participation continues to rise, with a 12% increase in empanelment in FY25. Out of the more than 32,000 hospitals empanelled under the scheme, about 13,000 are privately run. “Private hospitals contribute significantly to expanding the scheme’s reach and improving access to advanced care,” the report says.
The government’s push to integrate healthcare delivery through the Ayushman Bharat Digital Mission (ABDM) is also transforming how hospitals manage patient data and claims. By March 2025, over 61.8 crore Ayushman Bharat Health Accounts (ABHA) had been created, while 3.4 lakh healthcare facilities and 1.7 lakh professionals were registered on the platform.
“The integration of AB PM-JAY and ABDM is enabling paperless, cashless, and interoperable healthcare delivery,” the report states, highlighting that the digital ecosystem is helping speed up claims settlement and reduce fraud.
The scheme’s reach has expanded steadily, with over 34.5 crore Ayushman cards issued so far. Women account for 49% of total hospital admissions under the scheme, signaling improved access to institutional healthcare for women.
Analysts suggest that the scheme’s growing scale is creating new business opportunities for private hospitals, insurers, and health-tech companies. Large hospital chains like Apollo Hospitals, Fortis Healthcare, and Max Healthcare have steadily increased their empanelment under AB PM-JAY to tap into markets in tier-2 and tier-3 cities.
According to the report, reimbursement funds received by public hospitals under AB PM-JAY are being used for infrastructure upgrades, procurement of medical equipment, and hiring additional staff. This has helped improve services at government facilities, even as private participation remains dominant in tertiary care.
However, the NHA cautioned that the long-term sustainability of the scheme will depend on regular funding, faster claim settlements, and consistent participation from private hospitals across all regions. With several state health insurance programs now being integrated into AB PM-JAY, the total outlay for FY25 is expected to exceed ₹20,000 crore.
“The Ayushman Bharat Digital Mission has made measurable progress in building a unified digital health ecosystem. Its alignment with AB PM-JAY is improving efficiency and accountability in healthcare delivery,” the report adds.
Experts point out that as India’s public and private sectors become more intertwined through Ayushman Bharat, this model could shape the next phase of the country’s healthcare economy — where public financing is delivered through a network of digitally connected, privately managed care facilities.
“The latest NHA report highlights how Ayushman Bharat has transformed access to advanced healthcare for millions. With private hospitals now accounting for nearly two-thirds of hospitalisations and most claim payouts, it’s clear that the private sector plays a pivotal role in delivering specialized, high-value care under this scheme,” said Dr. Harsh Mahajan, FICCI Chair – Health & Services and Founder, Mahajan Imaging & Labs.
“The growing synergy between private providers and India’s expanding digital health ecosystem is enabling faster, cashless, and more equitable care while reducing out-of-pocket costs. Going forward, stronger collaboration between public and private systems is essential to enhance quality, transparency, and sustainability — ensuring every beneficiary receives timely, world-class healthcare, regardless of geography or income,” he added.