Publication:

Bridging the digital divide: a longitudinal analysis of health equity in India’s Ayushman Bharat Digital Mission (2024-2025)

Background The Ayushman Bharat Digital Mission (ABDM) aims to provide unique digital health identities to India's 1.4 billion citizens. Deploying such technology in deeply unequal societies risks exacerbating the digital divide. This study examines whether ABDM adoption followed the "Inverse Care Law" or successfully bridged the gap between digital haves and have-nots.

Methods A longitudinal ecological study across 28 Indian states over 18 months (January 2024-July 2025) analyzed Ayushman Bharat Health Account (ABHA) generation data from the ABDM dashboard and Ministry of Health releases. States were stratified by NSDP per capita. Key indicators included ABHA saturation, percentage growth, and income-related inequality via the Concentration Index (CI) and Lorenz Curves.

Results National ABHA saturation rose significantly from 32.7% (±15.2%) to 53.9% (±16.1%) (p<0.001). A clear "Catch-Up Effect" emerged: the poorest state quartile grew by 145.2%, nearly three times the 58.4% recorded in the richest quartile. Inequality analysis revealed a striking inversion from a pro-rich distribution (CI= +0.062) to near-perfect equity (CI= -0.011). Lower-middle-income states such as Andhra Pradesh and Odisha were top performers, while wealthier states exhibited slower adoption due to "legacy friction".

Conclusions ABDM achieved rapid "regression to equity," driven not by organic demand but by supply-side "physical involvement in digital space" interventions frontline health workers facilitating assisted onboarding in rural areas. These findings offer a replicable blueprint for LMICs seeking to democratize digital health infrastructure.