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ABHA Card: Navigating the Trajectory of Digital Health in India

Executive Summary


The Ayushman Bharat Health Account (ABHA) card, a cornerstone of India's Ayushman Bharat Digital Mission (ABDM), marks a significant advancement towards a digitally integrated healthcare ecosystem. This report analyzes the current status of the ABHA card, examining its purpose, adoption rates, benefits for stakeholders, challenges, integration with other digital health initiatives, and its connection to the broader healthcare infrastructure. While substantial progress has been made with over 73.90 crore ABHA registrations as of February 2025, achieving universal adoption and realizing its full potential faces hurdles. Key challenges include a disparity between registration numbers and actual usage, with a study indicating only 11.7% household acceptance between November 2022 and January 2023 1, varying levels of digital infrastructure across healthcare facilities where approximately 35% have implemented Electronic Medical Record (EMR) systems 3, and the need for greater public awareness and trust in data security. The integration with platforms like DigiLocker, which helped generate around 85 thousand ABHA numbers for its 13 crore users , shows promise but indicates limited current utilization. To ensure the ABHA card's successful trajectory, targeted recommendations focusing on addressing awareness gaps, improving infrastructure, incentivizing stakeholder participation, and enhancing user experience are crucial.


Introduction: Vision of a Digitally Integrated Healthcare in India


The necessity for a robust digital health infrastructure in India has become increasingly apparent, driven by the need to improve healthcare access, enhance service delivery efficiency, and ensure quality care for a vast and diverse population. The Ayushman Bharat Digital Mission (ABDM) was launched as a transformative initiative to realize this vision, with the ABHA card as a central component. ABDM aims to build the essential digital framework to support an integrated healthcare ecosystem across the nation.4 This mission seeks to overcome existing disparities and inefficiencies by creating digital pathways connecting patients, healthcare providers, and other relevant entities.4 The primary goal is a seamless online platform facilitating data exchange and infrastructure services through open, interoperable, and standards-based digital systems, while upholding the security, confidentiality, and privacy of individuals' health information.4 The success of the ABHA card is intrinsically linked to ABDM's broader vision of transforming India's fragmented healthcare system into a cohesive and efficient digital network. Widespread adoption and effective utilization of ABHA will be critical for the overall success of this ambitious endeavor.


Understanding the ABHA Card: Purpose, Features, and Target Population


The Ayushman Bharat Health Account (ABHA) card serves as a unique health identifier for individuals within the Ayushman Bharat Digital Mission (ABDM). Its main purpose is to establish a standardized digital identity for every citizen, enabling the creation of longitudinal health records that can be securely accessed and shared with consent across different healthcare providers and facilities. Launched on September 27, 2021 7, the ABHA card features a distinctive 14-digit identification number that can be generated using an individual's Aadhaar details or a phone number.7 This unique number acts as a key to link an individual's health information, including medical history, consultations, diagnoses, prescriptions, and lab reports, in a digital format.


Beyond basic identification, the ABHA card offers several key features to foster a digitally empowered healthcare ecosystem. These include secure storage of health data, ensuring the confidentiality and integrity of medical records. Interoperability is another crucial aspect, facilitating the seamless exchange of health information between various network hospitals, clinics, and doctors, thereby ensuring effective and coordinated healthcare delivery. Registration for the ABHA card is voluntary, making it accessible to all Indian citizens regardless of age, income, or health condition. Moreover, the ABHA system provides access to a range of digital health services, enabling better coordination between doctors and patients through the secure sharing of medical records with registered healthcare professionals. The Ayushman Bharat Digital Mission (ABDM) aims to establish advanced digital health systems for managing core health data and infrastructure, create registries for clinical establishments, healthcare professionals, health workers, drugs, and pharmacies, enforce open standards for data exchange, and create a system of personal health records accessible with informed consent.4


The target population for the ABHA card is all citizens of India, with an ambitious goal set by the National Health Agency (NHA) to register over 100 crore citizens in 2023. Additionally, the NHA aimed to onboard 15 lakh healthcare professionals and 15 lakh healthcare facilities onto the ABDM platform within the same timeframe. The ABHA card is intended as a universal healthcare identifier, available to all Indian citizens, including those belonging to Scheduled Castes and Scheduled Tribes 10, creating a unified health interface for use across various healthcare providers.10 The voluntary nature of registration emphasizes the initiative's focus on empowering citizens to control their health information and participate in the digital health ecosystem at their own discretion.


Current Status of ABHA Card Adoption and Usage: Progress Towards Goals


Assessing the current status of the ABHA card requires comparing the ambitious targets set by the National Health Agency (NHA) with the actual progress in registrations and usage. Data from various sources provides a snapshot of the initiative's traction as of early 2025.

Metric

Target

Achievement (as of Feb 3, 2025)

Achievement (as of Dec 22, 2023)

Achievement (as of Sep 12, 2024)

Achievement (as of Jul 22, 2024)

Achievement (as of Sep 2024)

Citizen Registrations

Over 100 crore (in 2023)

Over 73.90 crore

Over 50 crore

Over 66.70 crore 2

64.86 crore

Nearly 54 crore

Healthcare Professionals

15 lakh (in 2023)

Over 4.7 lakh 11

2.6 lakh 14

4.06 lakh

N/A

N/A

Healthcare Facilities

15 lakh (in 2023)

Over 3.3 lakh 11

2.26 lakh 14

3.06 lakh

N/A

Over 1.3 lakh (ABDM-enabled)

Health Records Linked

Not explicitly stated

Over 42 crore

Over 33 crore 14

42.01 crore 2

39.77 crore

Over 350 million (as of Mar 2024) 15

ABHA App Downloads

Not explicitly stated

Over 50 lakh (as of Dec 2023)

Over 50 lakh 14

N/A

N/A

N/A

OPD Registrations (ABHA-based)

Not explicitly stated

Over 1.5 crore (as of Dec 2023)

Over 1.5 crore 14

Over 5 crore tokens generated (as of Sep 2024)

N/A

N/A

The data indicates significant progress in ABHA account creation, with over 73.90 crore IDs generated by February 3, 2025. This marks a substantial increase from the 23.3 crore reported in June 2023 , showing a strong upward trend. However, the initial target of 100 crore registrations by the end of 2023 was not fully achieved, suggesting that adoption rates may be influenced by factors like awareness and accessibility.


Beyond registration numbers, the actual usage of ABHA cards is crucial for assessing their effectiveness. As of December 22, 2023, over 1.5 crore patients had used the ABHA-based instant Out-Patient Department (OPD) registration service , and more than 50 lakh individuals were actively using the ABHA app to manage their health records digitally. Furthermore, the linking of over 33 crore health records with ABHA accounts by the same date highlights the growing integration of the ABHA card into the healthcare delivery system. By September 2024, linked health records surpassed 42 crore , and over 5 crore OPD tokens had been generated through ABHA, indicating reduced waiting times for patients.


However, a study from November 2022 to January 2023 revealed a lower household acceptance rate of 11.7% across six states, with 34.9% citing Aadhaar not being linked to a mobile number and 36.7% reporting a lack of awareness or interest as reasons for non-acceptance.1 This discrepancy between national registration figures and ground-level acceptance suggests challenges in translating registrations into active use and ensuring the population understands the benefits. It indicates that while digital infrastructure is developing, user-level barriers need to be addressed for widespread and meaningful adoption.


Benefits of ABHA for a Digitally Empowered Healthcare Ecosystem


The ABHA card has the potential to significantly benefit both healthcare providers and the public, fostering a more efficient, transparent, and patient-centric healthcare ecosystem in India.


For healthcare providers, the ABHA card facilitates seamless access to a patient's comprehensive medical history, enabling efficient evaluation of past treatments and diagnosis. This reduces reliance on physical documents and the risk of misplaced information. Simplified registration and identification lead to quicker patient check-ins and improved patient flow. Interoperability across public and private systems allows for seamless data sharing and better care coordination. In emergencies, immediate access to critical medical history aids quick and informed decisions. The ABHA card also supports the integration of telemedicine and e-pharmacies, digitizing processes and improving accessibility, especially in remote areas. Furthermore, the Healthcare Professionals Registry (HPR) under ABDM has verified over 4.7 lakh doctors and nurses , enhancing trust and connectivity within the digital health ecosystem.


For the public, the ABHA card provides a digital platform to access their comprehensive health records, eliminating physical paperwork. Patients have control over who accesses their data through consent-based sharing. It acts as a unique digital health identity, streamlining healthcare service access and reducing repetitive data submission. Integration with schemes like Ayushman Bharat ensures cashless benefits across providers. It also extends accessibility to AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homoeopathy) treatment facilities. Long-term, it empowers individuals in their health management by digitally storing records for monitoring and informed decisions. The voluntary opt-in/out feature provides complete control over participation.


Challenges and Criticisms Hindering Widespread ABHA Card Implementation


Despite the significant potential benefits, the widespread implementation and effectiveness of the ABHA card face several challenges and criticisms.

Source

Year (if available)

Ratio of Hospitals with Digital Records (or related metric)

Key Context and Limitations

N/A

~35% of Indian hospitals have implemented EMR systems

Majority are large private hospitals in urban areas. Significant room for growth compared to global standards.

Insights10

2019

76% of healthcare professionals using DHRs

Indicates usage by professionals, not necessarily full hospital-level adoption or integration with comprehensive EHR systems.

PMC

2014

76% (basic EHR), 97% (certified EHR)

Data from 2014, potentially outdated. "Basic EHR" might refer to limited functionalities compared to comprehensive systems needed for seamless ABHA integration.

Grand View Research

2030 (Projection)

Market growth projection (CAGR 6.8%)

Provides market size and growth trends but not the current ratio of hospitals with digital records.

Study in PMC 17

N/A

78% digital health ID uptake rate among participants

This study focused on a specific group and might not represent the national average for hospitals with comprehensive digital records.

 

A significant challenge lies in the current state of digital infrastructure within Indian hospitals. While the market for electronic health records is growing , the actual adoption rate across all hospitals remains relatively low. Recent reports indicate that approximately 35% of Indian hospitals have implemented EMR systems , with a concentration in large private hospitals in urban areas. This figure is considerably lower than in developed countries. The limited digitization of records in many hospitals, especially smaller and rural facilities, restricts the ABHA card's effectiveness in linking and sharing patient information seamlessly.20


Beyond infrastructure, public awareness about ABHA's purpose and benefits remains low. Many confuse it with the AB-PMJAY (Ayushman Bharat Pradhan Mantri Jan Arogya Yojana) insurance scheme 3 and are unaware of its role in digitizing medical records.3 Concerns about the security and privacy of digital health data also deter some individuals.25 Practical issues like the mandatory Aadhaar-mobile linking for registration create barriers.2 The digital divide, with limited internet connectivity and basic phone usage in rural areas, further hinders universal adoption.20 A study from November 2022 to January 2023 showed only 11.7% household acceptance, with 34.9% citing Aadhaar-mobile linking issues and 36.7% lacking awareness or interest.


Engagement from private healthcare providers and state governments has been uneven.20 Some private hospitals with existing systems may see limited benefit in joining ABDM.20 The lack of strong incentives for states and private players to actively promote ABHA also contributes to slower adoption.20 Interoperability issues across different digital health platform standards used by healthcare facilities also pose a challenge.20


Integrating ABHA with India's Digital Health Infrastructure


The integration of the ABHA card with other digital health initiatives is crucial for creating a unified and comprehensive digital health infrastructure in India. A significant integration is with DigiLocker, a secure platform for storing and verifying documents.19 This allows users to digitally store health records like vaccination certificates, prescriptions, and lab reports, linking them with their ABHA.21 DigiLocker first integrated by adding ABHA creation for its 13 crore users. The second level allows DigiLocker to function as a Personal Health Records (PHR) app, enabling ABHA holders to link and access their health records from ABDM-registered facilities.21 Users can also upload old records and share them with healthcare professionals.21


Through the initial integration, DigiLocker helped generate around 85 thousand ABHA numbers for its 13 crore users. While functional integration exists, this number is relatively small compared to the over 73 crore total ABHA accounts , suggesting that the integration might not be fully utilized yet. Enhancing awareness and simplifying the linking process could significantly improve this ratio and leverage DigiLocker's user base for wider ABHA adoption.


The ABHA Card in the Context of National Health Programs


The ABHA card is closely linked to other national health programs, particularly the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY). While ABHA is a digital health ID for storing records, PMJAY provides health insurance coverage up to Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization to over 10.74 crore poor and vulnerable families (approximately 50-55 crore beneficiaries) based on Socio Economic Caste Census (SECC) 2011 data. While an ABHA card isn't mandatory for PMJAY benefits, it can link healthcare benefits from PMJAY and other schemes to a unique ABHA number.33


The PMJAY scheme is fully funded by the government, with costs shared between the Central and State Governments. In the financial year 2021-22, the funds allocated for PMJAY were Rs. 6400 crore.35 As of November 2023, approximately 6 crore hospital admissions worth Rs. 77,298 crores had been authorized under the scheme. As of September 9, 2024, over 35.4 crore Ayushman cards have been issued, and 7.79 crore hospital admissions amounting to Rs. 1,07,125 crores have been authorized.2 The scheme covers pre-existing conditions from day one and includes expenses for medical examination, treatment, consultation, pre and post-hospitalization, medicines, diagnostics, and more.


Linking ABHA ID with PMJAY benefits allows beneficiaries to have a digital record of their healthcare services under the scheme, improving continuity of care and potentially streamlining claims.33 Given the vast number of PMJAY beneficiaries, promoting ABHA registration among them could significantly increase ABHA adoption.33


Leveraging ABHA for Enhanced Healthcare Delivery and Access


The ABHA card has the potential to significantly enhance healthcare delivery and access across various aspects of the Indian healthcare system.

Specialty-based healthcare penetration is growing, particularly in the private sector, which holds a significant market share. Single-specialty hospitals, especially in eye care, dental care, fertility, dialysis, and oncology, are attracting increased investments. However, access disparities exist between urban and rural areas, with specialized care concentrated in metro cities. ABHA can help bridge this gap by facilitating telemedicine consultations, allowing individuals in underserved areas to connect with specialists remotely and securely share their medical records.


The government hospital infrastructure faces a shortage of beds compared to the National Health Policy 2017 recommendation of 2 beds per 1000 population; current availability is around 0.6 beds per 1000. As of March 31, 2023, there were 8,18,661 beds in public health facilities, including Primary Health Centres (PHCs), Community Health Centres (CHCs), Sub-District Hospitals, District Hospitals, and Medical Colleges. While ABHA can improve efficiency within existing facilities through streamlined processes and record management 38, it cannot fully address the need for increased physical infrastructure.38 As of 2010, there were only 605 district hospitals for 640 districts. The National Health Policy 2017 recommends 2 beds per 1000 population, with the Indian Public Health Standards (IPHS) 2022 recommending a minimum of 1 bed per 1000 and 2 as desirable .


The establishment of new All India Institutes of Medical Sciences (AIIMS) across states is progressing. 22 new AIIMS have been approved under Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) , with 6 fully functional in Bhopal, Bhubaneswar, Jodhpur, Patna, Raipur, and Rishikesh. Others are in various stages of development, with MBBS classes and OPD services operational in many. Proposals for AIIMS have been received from 17 states. These institutions can serve as key adopters of digital health initiatives like ABHA.39 Guidelines for AIIMS proposals emphasize aspects like clear research questions, literature review, methodology, budget, and ethical clearance.4


The COVID-19 pandemic spurred the development and deployment of digital health platforms like COWIN (COVID-19 Vaccine Intelligence Network) and Aarogya Setu. COWIN has now transitioned to primarily accessing and verifying vaccination certificates. Over 220 crore vaccine doses have been administered as of June 2024.35 Aarogya Setu, a contact tracing app with over 50 million downloads within 13 days of launch , saw high adoption during the pandemic. While its primary function has diminished, its technology and user base could potentially support ABDM and ABHA adoption.


Reviewing Medical History Through the ABHA Card: Functionality and Implementation


The core functionality of the ABHA card is to enable individuals to access and share their medical history digitally and securely. Upon registration, individuals receive a unique 14-digit ABHA number that can be linked to health records from various providers, creating a longitudinal health history.


Individuals can access their records via the ABHA mobile application or other ABDM-compliant Personal Health Record (PHR) applications. These apps offer a user-friendly interface to view consultations, diagnoses, prescriptions, lab results, and discharge summaries. Patient consent is central to the ABHA system; healthcare providers can only access medical history with explicit consent managed through the ABHA app or PHR applications.


The ABHA system also uses an ABHA address, a self-declared username (like xyz@abdm), for easy identification and sharing. Individuals provide their ABHA address to healthcare providers, who then send a consent request. Upon approval via the ABHA app, providers can securely view the relevant medical history.24 This consent-based mechanism ensures patient control over their health data, shared only with authorized personnel for healthcare purposes.


Successful implementation relies on widespread digital record-keeping by healthcare facilities and seamless integration with Hospital Management Information Systems (HMIS).43 Ensuring digital literacy and addressing data security concerns are crucial for building trust and encouraging ABHA usage for accessing and sharing medical history.13 User-friendly mobile applications and clear guidelines for patients and providers are also vital.42


Conclusion: Assessing the Trajectory of the ABHA Card - Take Off or Stall?


The ABHA card initiative has shown significant momentum in account creation, reaching over 73 crore registrations by February 2025. This indicates strong initial interest and a foundational step towards a digital health ecosystem. Increasing usage for OPD registrations and the growing number of linked health records are positive signs of practical application.


However, challenges persist. The gap between registration and the 11.7% household acceptance rate in a 2022-23 study 1 needs addressing. The limited adoption of digital records in hospitals, with only around 35% having EMR systems , hinders seamless data linking. Public awareness, digital literacy, Aadhaar-mobile linking issues, and data security concerns remain significant hurdles. While integration with DigiLocker has generated some ABHA IDs, its full potential is yet to be realized. Active participation from private and public healthcare providers and state governments is also crucial.20


Considering the progress and challenges, the ABHA card's trajectory appears to be a gradual take-off. The infrastructure is being built, and usage is increasing. However, realizing its transformative potential requires sustained efforts to address challenges, build trust, and demonstrate tangible benefits for all stakeholders.


Recommendations for Enhancing ABHA Card Adoption and Effectiveness


To accelerate the adoption and enhance the effectiveness of the ABHA card in India, the following recommendations are proposed:

1.     Enhance Public Awareness and Education: Launch comprehensive public awareness campaigns through various channels to educate citizens about the purpose, benefits, and functionalities of the ABHA card. Address data security and privacy concerns, emphasizing consent-based mechanisms. Utilize social media and educational institutions for targeted awareness.10

2.     Simplify Registration and Address Linkage Issues: Streamline the ABHA registration process and provide support for Aadhaar-mobile linking. Explore alternative registration methods.1 Consider hybrid offline-online (both offline and online) provisions.

3.     Incentivize Healthcare Provider Integration: Develop incentive programs for private healthcare providers to integrate with ABDM and promote ABHA adoption.20 Offer financial incentives, technical support, and recognition.27

4.     Bridge the Digital Divide: Implement assisted registration and access mechanisms in rural areas with limited digital literacy and internet access.20 Utilize registration camps and community health workers.

5.     Invest in Digital Infrastructure: Increase investment in digitizing health records across all facilities.20 Provide financial and technical assistance for EMR adoption.21

6.     Promote Interoperability and Data Exchange: Ensure seamless interoperability between ABHA and existing hospital systems.20 Develop user-friendly interfaces for healthcare providers.13

7.     Strengthen Data Security and Transparency: Continuously enhance data security measures and ensure transparency in data usage policies. Clearly communicate these measures to build public trust.38

8.     Demonstrate Tangible Benefits: Focus on showcasing the benefits of ABHA, such as improved access, reduced waiting times, better care coordination, and faster insurance claims. Highlight success stories.13

9.     Provide Training and Support: Offer training and support to healthcare professionals and the public on using ABHA and related tools.

10.  Leverage Existing Platforms: Utilize platforms like COWIN and Aarogya Setu to promote ABHA registration and usage. Explore integrating ABHA functionalities.

11.  Enhance Integration with DigiLocker: Conduct campaigns to raise awareness about linking ABHA with DigiLocker and simplify the process.

12.  Monitor Progress and Gather Feedback: Establish clear targets and monitoring mechanisms. Regularly gather feedback from users and providers.13

13.  Promote Use in National Health Programs: Actively promote ABHA use in programs beyond PMJAY.34

14.  Foster Collaboration with States: Work closely with state governments for active participation and alignment.20

By implementing these recommendations, the government and stakeholders can work towards overcoming challenges and ensuring the ABHA card's potential to revolutionize India's healthcare system.


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