Patna/New Delhi: In the last financial year, the central and Bihar governments paid nearly a third of Ayushman Bharat-Pradhan Mantri Jan Aarogya Yojana (AB-PMJAY) funds for the state, to facilities outside of it.
The reason: Lack of quality health services, which led a high number of AB-PMJAY beneficiaries to avail the scheme’s portability feature—allowing beneficiaries from one state to access healthcare in any other—and seek treatment in hospitals outside the state, at the All India Institute of Medical Sciences (AIIMS) in New Delhi and the Christian Medical College (CMC) in Vellore, among others.
As the state heads for a high-stakes assembly election later this year, the Bihar government has now intensified efforts to ramp up medical infrastructure, reaching out to beneficiaries of the Centre’s flagship health insurance scheme so they don’t have to go outside the state seeking treatment.
In addition, efforts are on to provide medical facilities for complex cases within Bihar by tying up with a higher number of private health facilities under the scheme.
The data shared by the Bihar health department shows that in 2024-25, the total spending on AB-PMJAY was Rs 1,010.38 crore, of which Rs 333 crore or 32.9 percent was spent through the portability feature.
However, the national spending under the scheme’s portability feature was just 2.8 percent or Rs 3,100 crore, out of a total Rs 1,07,125 crore spent overall under the scheme, but the government is trying every bit under AB-PMJAY till September 2024.
Under AB-PMJAY—which is aimed at providing cashless hospitalisation worth up to Rs 5 lakh to the poorest and most vulnerable population through a network of empaneled hospitals—the Centre and state bear the cost of treatment in a 60:40 ratio.
Sheshank Shekhar Sinha, chief executive officer of Bihar Swasthya Suraksha Samiti (BSSS), which oversees the implementation of AB-PMJAY in the state, said efforts were on to provide required medical care to patients closer to home.
“A large number of patients from Bihar have been going to places like Delhi, Mumbai and Chennai for seeking care, but the government is trying every bit to strengthen specialty and superspeciality care in the state apart from primary health services,” he said.
AIIMS, Patna, which is a centrally-run institute, was also being supported by the state government in every possible way, said Sinha, to emerge as a mega health hub in the state.
Bihar Swasthya Suraksha Samiti figures show that in 2024-25, 145 hospitals had been onboarded under the scheme. An additional 100 hospitals—mostly private hospitals offering single or multi-specialty care—are in the pipeline to be empanelled under the scheme, according to Shailesh Chandra Diwakar, administrative officer with the BSSS.
Since last year, according to details shared by the state government, authorities mapped all the registered hospitals in the state and districts and have been conducting field visits to assess potential empanelment readiness.
According to the AB-PMJAY dashboard maintained by the National Health Authority—the agency under the Union Health Ministry responsible for the scheme’s implementation—of the total 9.05 crore hospital admissions under the scheme since its 2018 launch, only 18 lakh admissions have involved patients from Bihar. For perspective, Tamil Nadu is among the states with the highest admissions, at over 1 crore.
Also read: Why nearly dozen multi-speciality private hospitals in Delhi aren’t too keen on AB-PMJAY empanelment
Strong focus on beneficiary identification
A key challenge, state government health officials said, has been relatively low awareness around AB-PMJAY.
Initially, beneficiaries were based on the deprivation and occupational criteria of Socio-Economic Caste Census 2011 (SECC 2011) for rural and urban areas, respectively, as per the central government norm. However, in 2024, the state decided to expand it to all those covered under the National Food Security Act, 2013, or all those with ration cards.
Following this, a major drive has been initiated to create Ayushman cards for the estimated beneficiaries.
This includes door-to-door campaigns by ASHA workers, whose incentives were revised from Rs 5 per card to Rs 15 per card; and the engagement of panchayati raj executive assistants for the purpose, apart from intensified awareness campaigns. A total of 2.83 crore Ayushman cards were created in 2024, Diwakar pointed out.
The statistics shared by the state government also showed that the government spending on the scheme jumped from about Rs 307 crore in 2023-2024 to 1010.38 crore in the last fiscal.
“This is a remarkable rise and testament to our commitment to let the needy take utmost advantage of the scheme,” a government official said.
Also while in 2023-24 the government had settled claims against 3.03 lakh hospital admissions in Bihar, in the next financial year, this number crossed 7.5 lakh hospital admissions.
But some public health specialists underlined that the state needs to work harder on improving the referral and primary health care.
“A 10-year-old rape victim recently succumbed to her injuries due to delay in treatment at two leading medical colleges in Bihar,” Amulya Nidhi, national convenor of Jan Swasthya Abihyan, a group that advocates patients’ rights, told ThePrint. Without improving the referral and primary health care, Ayushman cards won’t be of much help, he stressed.
The death of the 10-year-old Dalit girl from Muzaffarpur following her alleged rape by a neighbour, outside the Patna Medical College and Hospital—one of the state’s biggest government-run tertiary care centres—as she waited in an ambulance for admission, had triggered national outrage.
She was earlier reportedly denied treatment at Sri Krishna Medical College and Hospital in Muzaffarpur. The episode, which took a political turn, saw the suspension of two senior doctors at these facilities by the state administration on charges of dereliction of duty.
(Edited by Viny Mishra)
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