The state-level distribution is the analytically interesting part. Bihar alone accounts for more than 7.30 crore transactions — comfortably ahead of larger and wealthier states — which shows that adoption of digital health infrastructure has tracked administrative push rather than income levels. The public-private split is equally telling: 24,323 of the 30,800 participating facilities are public institutions, so the service is at present overwhelmingly a government-hospital phenomenon, where queue lengths are longest and the time saved is greatest. For the exam, ABDM belongs with UPI, Aadhaar and DBT in the family of digital public infrastructure, and it is best understood as the health-sector application of the same design principle: a common identifier plus interoperable records, with private applications built on top.