In 2018, India launched the Pradhan Mantri Jan Arogya Yojna (PMJAY) as a push for Universal Health Coverage. PMJAY covers families listed in the SECC 2011 database under deprivation criteria (e.g. No proper housing, low income, landless labourers etc) and specific vulnerable groups and rural poor. The government has progressively expanded the eligibility to cover increasingly more people under the scheme. Now it also includes all senior citizens above the age of 70 years. The scheme offers up to ₹5 lakh per family annually for secondary and tertiary care hospitalisations, benefiting over 50 crore citizens.
PMJAY offers cashless, paperless healthcare at over 30,957 empanelled hospitals (as of March 1, 2025), including 13,866 private and 17091 public facilities. Till the same date, the scheme has paid ₹1.26 lakh crore for over 8.9 crore hospitalisations. With Odisha and Delhi joining the scheme in early 2025, all states except West Bengal have been onboarded for Ayushman Bharat.
Mental health coverage
PMJAY includes 22 procedures for mental health conditions within its coverage of 1,967 covered procedures across 27 specialties. Coverage includes hospitalisation, diagnostics, medications and follow-up care, aligning with the Mental Healthcare Act 2017.
Mental health claims
- Parliamentary data from Lok Sabha Unstarred Question No. 2196, answered on August 02, 2024), reveals utilisation of hospital services for mental health related conditions under PMJAY. The questions raised concerns about the implementation of PMJAY with regard to mental health, highlighting issues like hospital empanelment, claim processing, and beneficiary awareness. The response outlined the government's efforts to address these challenges and expand the scheme’s reach,
- The data shows that between FY 2021–22 to FY 2023–24, 1.35 lakh hospital admissions for mental health conditions were authorised, totalling ₹ 120.2 crore, with average hospital stays dropping from 13 to 11 days. The claims for mental illness coverage more than doubled from FY 2021-22 to FY 2022-23, increasing from ₹ 23,63,76,672 to ₹ 48,35,65,318. Claims marginally declined the following year.
Figure 1
There were significant variances across states and union territories in spending on mental illness claims. The map highlights the amount spent on mental illness and the number of claims under PMJAY across the three years.
Figure 2
State-wise analysis:
For deeper analysis, we have divided the States into Larger States and Smaller States and Union Territories based on NITI Aayog’s classification, which considers factors such as population, geographical size. This categorisation helps in analysing the distinct utilisation patterns, as larger states often have robust infrastructure and more resources as compared to smaller states or union territories.
Larger states
Figure 3
Figure 4
- Total claim amount for mental illness hospitalisation rose from ₹23.4 crore in FY 2021-22 to ₹47.3 crore in FY 2022-23, dipping slightly to ₹46.1 crore in FY 2023-24.
- Karnataka emerges as a leading state in mental health claim utilisation though its share declined from 39% to 33% over this time period.
- In FY 2023-24, Karnataka, Andhra Pradesh and Rajasthan cumulatively had largest shares of PMJAY spending at 60%, with both Andhra Pradesh and Rajasthan seeing growth from the previous year by 58% and 21% respectively.
- The median claim amount per person/ count in FY 2023-24 was INR 10,883. Jharkhand reported the highest average amount per claim at INR 43,202, while Rajasthan is an exception in terms of a very low average amount per claim, due to the highest number of claims (24,466) in all of the larger states .
Smaller states and UTs
Figure 5
Figure 6
- For smaller states and UTs, claims grew dramatically from ₹25 lakh to ₹107 lakh and further to ₹2.2 crore over three years.
- Meghalaya dominated the smaller states in FY 2021-22 with a 40% share of total claims, while Tripura dominated the category in FY 2022-23 with a 38% share and FY 2023-24 with a 56% share of total claims.
- Sikkim’s high per-person claims at ₹6.48 lakh is an outlier.
General observations
- States like Andhra Pradesh, Rajasthan, and Chandigarh exhibit sustained growth, while Bihar, Uttarakhand, and Dadra and Nagar Haveli have seen declines.
- Sikkim’s high average claim per person in FY 2023-24 and Puducherry’s massive spike in FY 2022-23 are anomalies that require further investigation
- Average claims per person varied widely across states and years, with states like Sikkim (Smaller States) and Jharkhand (Larger States) showing exceptionally high values in FY 2023-24, while others like Rajasthan remained low.
Comments
- The overall increase in the claims is likely due to an increase in the number of empanelled hospitals that have gone up from 23,000 in 2021 to 30.259 (17,063 public and 13,466 private) in 2024, thus providing increased access to patients along with increased awareness about the scheme.
- Along with this, in 2022, there was an upgrade of the HBP (Health benefit package) under which daycare packages for mental health such as psychometric evaluation, investigations, counselling and pharmacologic and non-pharmacologic treatments were included.
- Although, these are encouraging signs, considering the total PMJAY budget and reimbursements, the mental health component is less than 1% of the funds released, showing that much needs to be done.
Budgetary spending and mental health spending on AB-PMJAY 3, 4
Figure 7
The larger states have higher utilisation compared to the smaller states due to poor supply-side factors, including a low number of empanelled hospitals, an inefficient beneficiary identification system, and weak health governance, particularly in states with greater poverty and disease burdens. Additionally, portability means that patients from less resource-rich states travel to states with higher resources for treatment.
Conclusion
The integration of mental health services into the Pradhan Mantri Jan Arogya Yojana (PMJAY) is a good step and the steady rise in claims, particularly after the expansion of the Health Benefit Package in 2022, reflects improving awareness and access. However, the mental health component still constitutes less than 1% of total PMJAY expenditure, highlighting the urgent need for further prioritisation. The disparities in utilisation across states and UTs underscore persistent
3: https://sansad.in/getFile/annex/263/AU423.pdf?source=pqars
4: https://sansad.in/getFile/loksabhaquestions/annex/1714/AU2196.pdf?source=pqals
