SDG 3: Good Health and Well-being | SDG 16: Peace, Justice, and Strong Institutions
Institutions: Ministry of Health and Family Welfare
The National Health Authority (NHA) showcased its strategic implementation of Artificial Intelligence (AI) and Machine Learning (ML) at a CVC workshop, announcing a significant paradigm shift in digital health governance. The NHA is actively moving its fraud management strategy for schemes like AB PM-JAY from reactive fraud detection (investigating fraud after it occurs) to proactive integrity management (using AI to predict and prevent fraud before it happens).
The technique involves deploying AI-based tools and Machine Learning algorithms to analyze the massive transaction data generated by the AB PM-JAY and ABDM digital ecosystems. The ultimate result of this shift is enhanced transparency and accountability, ensuring that public resources are utilized efficiently and that beneficiaries receive their rightful access to care, bolstering equity in India’s universal health assurance mission.
This demonstrates a critical use case for AI in governance, where it is being deployed to safeguard public funds and enhance accountability in India’s largest social welfare programs. By shifting from reactive policing to proactive prevention, this model ensures the financial sustainability and efficacy of India’s universal health assurance mission.
What is Proactive Integrity Management in public service delivery? → Proactive Integrity Management is a shift in governance from waiting for fraud or corruption to occur and then investigating it (reactive) to using advanced data analytics, such as AI and Machine Learning, to anticipate, monitor, and prevent unethical or fraudulent activities before they can cause harm or result in resource leakage.
What is Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB PM-JAY)? → The AB PM-JAY is the world’s largest government-funded health assurance scheme, focused on providing financial protection to the poorest 40% of the population. It offers a crucial, portable, and cashless health cover of up to ₹5,00,000 per eligible family annually for secondary and tertiary care hospitalization across India. The scheme covers over 55 crore beneficiaries and is designed to mitigate catastrophic out-of-pocket expenditure, which often pushes vulnerable families into poverty, ensuring all pre-existing conditions are covered from the very first day.
What is Ayushman Bharat Digital Mission (ABDM)? → The ABDM focuses on building the digital backbone for an integrated national health ecosystem. Its primary goal is to ensure seamless, secure, and consent-based sharing of health records across the country. It achieves this through key digital components, including the Ayushman Bharat Health Account (ABHA) number (a unique health ID for every citizen) and centralized registries for health facilities (HFR) and healthcare professionals (HPR). The mission is critical for the long-term efficiency and accessibility of all health services by replacing fragmented, paper-based records with an interoperable digital highway.
Relevant Question for Policy Stakeholders: What institutional changes are required across states to standardize data collection and reporting to maximize the effectiveness of AI-driven, real-time fraud detection under AB PM-JAY?
Follow the full news here: Use of AI for AB PM-JAY