आयुष्मान भारत के अंतर्गत प्रधानमंत्री जन आरोग्य योजना के तहत 10.74 करोड़ ग़रीब परिवारों को ₹5 लाख का वार्षिक स्वास्थ्य कवर देते हुए हमने 2022 तक 1,50,000 स्वास्थ्य एवं आरोग्य केंद्र स्थापित करने का कार्यक्रम भी शुरू किया।

The 2019 Sankalp Patra states this as an accomplishment already under way rather than a future plan: "While providing annual health cover of Rs. 5 lakh to 10.74 crore poor families under the Pradhan Mantri Jan Arogya Yojana under Ayushman Bharat, we also initiated a programme to set up 1,50,000 Health and Wellness Centres by 2022." The scheme had launched seven months earlier, on 23 September 2018.

The claim's first half — the ₹5 lakh cover — is straightforwardly true. It is the cover the scheme provides, for secondary and tertiary hospitalisation, per family per year. And it is being used at a scale that few public health programmes anywhere match: the CAG's performance audit records 3.57 crore claims worth ₹42,433.57 crore settled as of November 2022.

The second half — 10.74 crore families — is where the sentence gets ahead of the record. The audit, tabled in Parliament on 8 August 2023, states: "As per NHA records, 7.87 crore beneficiary households were registered, constituting 73 per cent of the targeted households of 10.74 crore (November 2022)." The 10.74 crore was the target, not the coverage, and three and a half years after launch a quarter of it had not been reached.

There is a second gap inside that number. Of the 7.87 crore registered, "2.08 crore households had been identified from SECC-2011 database, as envisaged in the Scheme guidelines" — the deprivation and occupational criteria on which eligibility was supposed to rest. The rest came in by other routes. The government has since changed the basis: in January 2022 it approved expanding the base to 12 crore families using National Food Security Act data instead.

The audit's findings on data quality are the part that most affects whether the right families got the cover. The registration system generates a match confidence score against the eligibility list; the audit found applications "were approved or rejected irrespective of the match confidence score", and that it "was not applied during the approval/rejection process" at all. Without that control, the database filled with errors: "invalid names, unrealistic date of birth, duplicate PMJAY IDs, unrealistic size of family members in a household". In Tamil Nadu, "4761 registrations were made against seven Aadhaar numbers". Registrations against a single or invalid mobile number ran "from 11 to 7,49,820 beneficiaries". In six states and union territories, ineligible households were registered and used the scheme, costing from ₹0.12 lakh in Chandigarh to ₹22.44 crore in Tamil Nadu.

One finding shows how far the transaction system could drift from reality. The audit had already told the National Health Authority in July 2020 that the system was accepting fresh treatment requests for patients recorded as having died; the authority said checks had been put in place from 22 April 2020. The audit then found that "patients earlier shown as 'died' in TMS continued to avail treatment under the Scheme": 88,760 patients were recorded dead during treatment, 2,14,923 claims shown as paid related to fresh treatment of those same patients, and 3,903 of those claims — ₹6.97 crore for 3,446 patients — were actually paid to hospitals.

And in four states the scheme's central premise failed at the counter: beneficiaries "were charged for their treatment in empanelled EHCPs resulting in increase in out-of-pocket expenditure" — 50 in Himachal Pradesh, 459 in Jammu and Kashmir, 36 in Jharkhand and 13,418 in Meghalaya. The scheme exists to remove that charge.

None of this is the audit's overall verdict, and it should not be read as ours. The audit says plainly that PMJAY is "an ambitious and well-intentioned programme" that "has had a strong positive impact on the economically weaker sections of the society who need healthcare facilities", and that what it needs is better implementation. On the manifesto's arithmetic, though, 10.74 crore families were the target and 7.87 crore were registered — so our verdict is partly accurate.