Manorama Bakshi
Arjun Kumar
The Ayushman Bharat Digital Mission (ABDM) has officially crossed a historic milestone, with more than 90 crore Ayushman Bharat Health Accounts (ABHAs) now created across India. When the foundational elements of this digital public infrastructure (DPI) were conceived, the initiative was highly praised—largely drawing confidence from the monumental success of the CoWIN platform during the height of the COVID-19 pandemic. CoWIN proved to the world that India could scale an agile, secure, and nationwide health-tech response under extreme pressure.
Yet, while CoWIN achieved rapid integration by necessity, ABDM has taken several years of steady incremental building to finally touch this 90-crore high-water mark. While this structural scale is impressive, it brings us to a critical inflection point: What’s next?
The Paradox of Progress: Moving Beyond Administrative Use
Despite the massive volume of registered IDs, a stark reality remains on the ground: the actual utilization and preference for ABHA among ordinary citizens—when compared to private healthcare apps or out-of-pocket systems—remains heavily limited.
Currently, the digital health account is used mostly for administrative purposes, such as basic registration, checking government subsidy eligibility, or filing backend paperwork. To realize its true potential, increasing its usability as originally envisaged is crucial. It must evolve from a passive “identity repository” to an active clinical tool that enables seamless data portability, secure instant consent management, and immediate digital prescriptions. The citizen must feel the tangible ease of using their ABHA ID in their day-to-day medical encounters, matching the fluidity that UPI brought to daily commerce.
Laying the Ground for Universal Health Insurance Cover
This newly consolidated 90-crore digital baseline should not merely serve database statistics; it must actively lay the ground for a comprehensive Universal Health Insurance Coverage across India. We no longer need to speculate on whether large-scale public safety nets work. The country possesses massive empirical proof through the success of Pradhan Mantri Jan Arogya Yojana (PM-JAY) and an array of pioneering state government schemes:
The State Laboratories: States like Goa and Rajasthan have aggressively expanded health protection loops, with Rajasthan hitting near-universal benchmarks by breaking the traditional barriers of targeted welfare.
The Saturation Blueprint: The absolute saturation models executed in Jammu & Kashmir and several Union Territories have proven that covering 100% of a residency pool—rather than sorting people via stringent poverty-line classifications—is entirely achievable.
| THE INDIAN HEALTH INSURANCE NET | |
| AB-PMJAY (Central) | State Models (Local) |
| Targeted Vulnerable Base | Universal (J&K, Rajasthan) |
Lessons from the Global Stage
To scale this into a formal citizenship right, India can draw from established international best practices that treat health security as a non-negotiable social contract:
The United Kingdom (The NHS Model): Built on the bedrock principle that healthcare should be an inherent right of residency, funded through general public taxation rather than individual out-of-pocket vulnerability.
Thailand (The Universal Coverage Scheme): Proved to developing economies that a country does not need to wait to become a high-income nation to guarantee healthcare. By decoupling health benefits from strict employment categories, Thailand systematically eliminated medical debt in rural landscapes.
South Korea: Established a highly efficient single-payer national health insurance framework by standardizing clinical costs and leveraging unified public data registries.
The Catastrophic Cost and the PM Jan Aushadhi Shield
It has long been evident since the coronavirus times that catastrophic health expenses hurt every citizen, cutting across class, geography, and income brackets. The lower-middle class and unorganized workforce remain perpetually one severe diagnosis away from slipping straight back into poverty. Ensuring absolute health financial insulation is a moral and structural debt that has been long due to our people since the pandemic exposed our collective vulnerabilities.
To make universal insurance viable, the state must control input delivery costs. This is where India’s massive network of Pradhan Mantri Bhartiya Janaushadhi Kendras (PM Jan Aushadhi) becomes a strategic weapon. By offering top-tier, quality-assured generic medicines at a fraction of branded market costs, the Jan Aushadhi framework acts as an essential buffer. When a universal health card is combined with affordable generic drug pipelines, the financial drain on both public insurance funds and household wallets drops drastically.
Funding the Transition: The Fiscal Blueprint
A common policy hesitation is the underlying cost of universalizing insurance premium pools for 1.4 billion individuals. However, the modern Indian economy possesses the direct tools to absorb this transition seamlessly.
The universal insurance cost can be comfortably covered through a mix of optimized public health allocations, targeted health cesses, and—most importantly—the consistent, record-breaking expansion of GST collections. The systematic formalization of the economy has provided the state with the fiscal elasticity required to bankroll massive social security networks. Redirecting a small, strategic percentage of this expanding tax yield toward purchasing universal health insurance premiums will yield an enormous macroeconomic return: it unlocks trillions in precautionary household savings that can flow directly back into active market consumption.
Conclusion: The Vision of Viksit Bharat
As India actively marches toward its centenary milestone, the core guiding light of the Viksit Bharat Foundation must be “Health for All.” A nation cannot truly claim developed status if its citizens live under the constant shadow of medical bankruptcy.
The 90-crore ABDM infrastructure has successfully laid the technological rails. By shifting our focus from pure administrative registration to functional utility, and expanding our regional insurance successes into a non-negotiable national guarantee, we can fulfil the ultimate post-pandemic promise: a resilient, secure, and fundamentally healthy India.
About the Authors
Manorama Bakshi is a distinguished public health expert and policy advocate.
Arjun Kumar is Director, IMPRI Impact and Policy Research Institute, New Delhi.
Disclaimer: All views expressed in the article belong solely to the author and not necessarily to the organisation.
Read more at IMPRI:
The Real Glass Ceiling: Why the Right to Health is the Material Basis for Nari Shakti
The Portable Social Shield: Anchoring India’s $10-Trillion Ambition in Universal Health Coverage
Acknowledgement: This article was posted by Shreeya Dixit, a Research and Editorial Intern at IMPRI.
