• It provides a cover of Rs. 5 lakhs (500,000) per family per year for secondary and tertiary care hospitalization across public and private empaneled hospitals in India.
• It provides cashless access to health care services for the beneficiary at the point of service, that is, the hospital.
• It covers up to 3 days of pre-hospitalization and 15 days post-hospitalization expenses such as diagnostics and medicines.
• There is no restriction on the family size, age, or gender.
• All pre–existing conditions are covered from day one.
• Benefits of the scheme are portable across the country. A beneficiary can visit any empaneled public or private hospital in India to avail cashless treatment.
• Services include approximately 1,393 procedures covering all the costs related to treatment. 

The scheme has benefited a large number of individuals and families since its launch. However, the full potential of the scheme is yet to be unlocked. Information asymmetry seems to be a major hinderance for the target population, in availing the benefits of the scheme. At least this is what our experience in one of the projects indicates. 

As on December 12, 2022, a total of 179 million Ayushman cards have been created. Madhya Pradesh (33.6 million), Uttar Pradesh (23.3 million), and Gujarat (16.4 million) are the top three states by the number of cards created. However, authorized hospital admissions are the highest in Tamil Nadu, Kerala, and Rajasthan. Prima facie, the number of hospital admissions seems to be correlated to the number of empaneled hospitals. Tamil Nadu has the highest number of empaneled hospitals. The correlation with this logic ends here. The second and third largest number of empaneled hospitals is in Karnataka and Uttar Pradesh. 

Assuming that the data on Ayushman Bharat provided in Pradhan Mantri Jan Arogya Yojana (PMJAY) website is error free, and assuming that a few hospitals are not reporting inflated/ fake data of admissions; a probable explanation for low use of Ayushman Bharat cards is some states is the low levels of awareness among the card holders. This is corroborated by our experience in one of the districts in North India, where we have witnessed cases of people not being able to avail of free treatment due to non-linkage with Aadhaar number. 

Our quest to understand more about the issues faced by the target population, led us to two neighboring families who had completely opposite stories to narrate. One of the families had put away their Ayushman card in a trunk after they received it. A few months later when one of the children fell il, they searched for it and took it to the hospital where they child was taken for treatment. However, they were denied the cashless treatment as the child’s Aadhaar number was not linked to the card. The neighbors had similar situation when one of the family members had a fractured leg and needed a surgery. The person’s Aadhaar was also not linked to the Ayushman card. However, they had the flexibility to delay the surgery. They immediately applied for update for Aadhaar number, which was updated within a week. Surgery was carried out and they saved about Rs.150,000. 

In both cases the card holders were not aware that there is a basic condition of linking of Aadhaar number with the card. Similarly, many people are not aware of the diseases that are covered, or the nearest empaneled hospital. Although, IEC material has been developed for customer awareness 

PMJAY has an information, education, and communication (IEC) component. However, its effect on the ground is not visible. Most recipients of the card are not aware about the eligibility criteria, its usage, terms & conditions, and empaneled hospitals etc. There is a need to have a proper structure for two-way communication: (a) mass awareness creation, and (b) to take feedback from the target population so that targeted delivery is continuously improved, and pain points are addressed. To make things simpler for the officials and the citizens, camps can be set up from time-to-time in different locations for linking of Aadhaar with Ayushman cards, with prior announcement about the same. Also, to increase awareness and take the message to the younger generation, who are quite eager to learn and are able to influence their parents and elders to a great extent, government can organize competitions such as quizzes, drawing/painting, debate etc. in schools and colleges. These additional activities will strengthen the program on the foundations of a well-informed and aware target population. 

There is no doubt that the government policies and laws are the most powerful instruments to bring about a change in the society, but citizens’ own contribution and participation is equally important. This fact becomes even more relevant in the context of the 73rd and 74th amendments of the Constitution. These amendments have ensured that the Gram Sabhas and urban local bodies are empowered to make laws by discussing their local issues. Over a period of time, the Gram Panchayat Development Plan or GPDP has become a powerful tool for the members of the Gram Sabha to develop an action plan listing out the development activities for an entire year. 

It is a matter of regret that most of the Gram Panchayats have not started using it as a long-term planning and development tool. Prima facie, the apathy of the Gram Sabha can be blamed for this. However, the main reason for this is the lack of knowledge about GPDP among most of the Gram Sabha members. Due to lack of information, the general public and their representatives are not able to use the objective for which the Gram Sabhas and the local bodies were given the powers of self-governance. There is a need to use tools like GPDP for issues such as rain-water harvesting and water conservation. Projects developed by the local population will not only be accepted by all but will ensure that they are executed properly. Also, serious problems like water crisis can be prevented well in time. Women's participation will strengthen decisions on such local issues as the availability of water directly affects their daily lives more than anyone else in the family. There is a need to create awareness on Gram Panchayat Development Plan (GPDP) and the importance of water. Democratization of water must be included as one of the agenda items on GPDP. For this to happen, individuals with influence in governance, administration, social institutions, and society must work together. It could be difficult, but it is not impossible.