Replying to a question in the Rajya Sabha on 28 July 2026, the Minister of State for Health and Family Welfare, Prataprao Jadhav, informed Parliament that over 447.3 million Ayushman cards have now been generated under the Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PMJAY), and that as of 30 June 2026, the scheme had authorised 126.9 million hospital admissions worth INR 1,920 billion.
A post on this blog in December 2020 (PMJAY: Average cost per treatment is 2.5 per cent of the sum assured) ran a simple back-of-the-envelope calculation. At that time, the scheme had recorded about 14 million admissions worth INR 175 billion, averaging INR 12,500 per admitted patient. The question raised then was whether a scheme whose average claim was this modest really needed a headline cover of up to INR 500,000 per family per year. Five and a half years on, the same arithmetic is worth repeating.
The average cost of treatment has increased from INR 12,500 to INR 15,130. On the face of it, this is an increase, though it is worthwhile to ask whether INR 15,130 in 2026 is genuinely worth more than INR 12,500 was in 2020.
A number that barely moved
Piecing together the successive disclosures made by the Health Ministry in Parliament over the intervening years produces a remarkably flat line.
The intermediate figures are approximate, since the Ministry tends to round the cumulative amount in its replies, though the two endpoints are reliable. In nominal terms, the average authorised cost per admission has risen by roughly 21 per cent over five and a half years, which amounts to a compound annual growth of about 3.5 per cent. For a scheme that deals entirely in secondary and tertiary hospitalisation, that is a remarkably gentle slope.
The inflation lens
The rupee in 2020 and the rupee in 2026 are not the same, and any comparison must account for the intervening price increases. Adjusted for general retail inflation - Consumer Price Index (CPI), which averaged around five per cent a year over this period and eased to roughly two per cent in 2025, INR 12,500 in December 2020 is worth about INR 16,150 today. In other words, merely to hold its real value, the average PMJAY treatment ought to cost a little over INR 16,000. At INR 15,130, it has, in fact, contracted.
The contrast becomes sharper still when the yardstick is medical inflation, which has long run well ahead of the general price index. According to the paper published in The Actuary India - the Magazine of the Institute of Actuaries of India, the medical trend reached 12 per cent in 2024 and was projected to be 13 per cent in 2025, nearly triple the rate of general inflation. Aon's survey similarly projects a trend of 13 per cent for India in 2025 and 11.5 per cent for 2026, while WTW places India's figure at about 12.9 per cent (its Asia Pacific regional average being 13.2 per cent). Applying a conservative annual inflation rate of around 11 to 13 per cent, INR 12,500 in December 2020 would translate into roughly INR 23,000 to 25,000 for equivalent care today.
Placed side by side, the three figures tell their own story:
The scheme's average authorised cost per treatment has thus failed to keep pace with even ordinary inflation, let alone the medical inflation that governs the very hospital bills it is meant to cover.
What does this actually tell us?
A flat line of this kind can be read in two ways, and intellectual and academic honesty requires that we hold both. The more charitable reading is that PMJAY is a model of cost discipline. Because its package rates are administratively fixed rather than market-determined, the government can purchase tertiary care at a fraction of private list prices, and providers are prevented from inflating their claims to larger amounts. On this view, a real-terms decline in the cost per treatment is not a failing at all, but precisely the point of a large public purchaser negotiating on behalf of the poor.
The less charitable reading is that the line is flat precisely because the package rates have been held down and revised too slowly to keep up with real medical inflation. If reimbursement rates remain largely static while the costs of consumables, staff, and devices rise at 12 to 14 per cent a year, something must eventually give way. What usually gives way is either the willingness of good private hospitals to treat PMJAY patients at all, or the quality and completeness of the care that those patients receive. A suppressed average may be a sign of thrift. Equally, it may be a sign of underpayment slowly eroding the scheme from within.
The truth almost certainly lies between the two, and which way it tilts is an empirical question the government is well placed to answer by publishing package-wise cost trends, rejection rates, and provider participation. Whichever reading one prefers, the argument made here in 2020 still stands. At INR 15,130, the average claim remains only about three per cent of the INR 500,000 sum assured, which returns us to the familiar question of design: whether so high a notional cover is the most efficient use of scarce public money, or whether a lower and more realistic one, combined with better-funded package rates, would achieve a great deal more.
The point
None of this is to deny that PMJAY has genuinely widened access to care. With 126.9 million cashless admissions to its credit, the scheme has, in all likelihood, averted a real financial catastrophe for a great many families. But the health of a scheme is not measured by the number of cards it issues. When the average cost of the treatment it purchases has failed to keep pace with even ordinary inflation, and trails medical inflation by several thousand rupees per admission, we are entitled to ask whether we are witnessing admirable frugality or a slow and largely invisible squeeze on the quality of the care being bought. INR 15,130 appears to be a step forward, but when adjusted for the world in which it is actually spent, it may well amount to a step backwards.
As was argued here five years ago, a better-designed and better-funded scheme, one whose package rates move with medical inflation, whose cover is lower but more realistic, and whose reporting reflects what is spent rather than merely what is allocated, would serve a great many more citizens without draining the exchequer.
References
- Ministry of Health and Family Welfare, written replies in the Rajya Sabha on PMJAY hospital admissions, amounts authorised and Ayushman cards. Reply of 28 July 2026 (44.73 crore cards; 12.69 crore admissions worth INR 1.92 lakh crore as of 30 June 2026): https://health.economictimes.indiatimes.com/news/policy/over-44-73-crore-ayushman-cards-generated-under-ab-pmjay-govt/132697384. Reply of December 2025 (claims settled; senior-citizen coverage): https://www.newsonair.gov.in/government-informs-rajya-sabha-of-28-thousand-crore-rupees-claims-under-ayushman-bharat-scheme and https://www.pib.gov.in/PressReleasePage.aspx?PRID=2203007. Earlier data points (2020–2026) are drawn from successive parliamentary replies reported by PIB, DD News and newsonair.
- The Actuary India, “Measuring medical inflation in India” (medical trend of 12% in 2024 and 13% for 2025): www.theactuaryindia.org/article/measuring-medical-inflation-in-india
- Aon, 2026 Global Medical Trend Rates Report — India findings (13% for 2025, 11.5% for 2026): https://www.aon.com/apac/in-the-press/asia-newsroom/2025/india-outpaces-global-average-with-2026-medical-trend-at-11-5-percent-aon-reports
- WTW, 2026 Global Medical Trends Survey — India ~12.9%, Asia Pacific regional average 13.2% (2025): https://www.wtwco.com/en-hk/insights/2025/12/asia-pacific-medical-inflation-continues-to-soar-in-2026
- CPI (retail) inflation series — Ministry of Statistics and Programme Implementation (https://www.mospi.gov.in), with historical annual rates via Macrotrends (https://www.macrotrends.net/global-metrics/countries/ind/india/inflation-rate-cpi)
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