Centre rejects demand to include primary healthcare in Ayushman Bharat Scheme

Union Minister of Health and Family Welfare JP Nadda has rejected Rajya Sabha MP Sanjeev Arora’s request to include primary healthcare cost coverage under the Ayushman Bharat insurance scheme.

In a response to Arora’s letter, Nadda clarified that the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is designed to provide health coverage of up to Rs 5 lakh per family per year, specifically for secondary and tertiary care hospitalisation. The scheme targets around 12.37 crore families, representing the bottom 40% of India’s population.

Nadda further informed that AB-PMJAY currently covers only in-patient treatment for 1,961 procedures, including several day-care treatments. Additionally, under the National Health Mission, more than 1.75 lakh Ayushman Arogya Mandirs (formerly Health and Wellness Centres) have been set up to address primary healthcare needs, including outpatient (OPD) consultations.

In his communication, Arora had argued that the exclusion of OPD services from the Ayushman Bharat scheme is adversely affecting the health of many citizens. He pointed out that around 70% of healthcare consultations in India occur in outpatient settings, but many families face financial barriers to accessing these services. According to Arora, the average cost of an OPD visit ranges from Rs 300 to Rs 1,500, making it unaffordable for a large section of the population.

Arora also referenced data from the World Bank, highlighting that investing in primary healthcare could yield economic returns of $4 for every $1 spent, while reducing long-term healthcare costs by preventing the escalation of health issues.

Despite these concerns, the Health Minister reiterated that the Ayushman Bharat scheme remains focused on providing hospitalisation coverage for secondary and tertiary care, while primary healthcare services are being managed separately through other initiatives like the Ayushman Arogya Mandirs.