Why in News ?
Delhi has officially joined the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB PM-JAY). The first 30 beneficiaries received their Ayushman cards at an event held at Vigyan Bhawan. Citizens in Delhi can now register for the scheme, which aims to provide comprehensive healthcare coverage.
Introduction
The Ayushman Bharat Scheme, launched in 2018, marks a significant step toward achieving Universal Health Coverage (UHC) in India. Envisioned under the National Health Policy (NHP) 2017, Ayushman Bharat is a comprehensive, holistic, and inclusive health initiative aimed at transforming the Indian healthcare system. For UPSC aspirants, it is an essential topic under Government Schemes, Social Justice, Health Sector, and Welfare Initiatives.
Background and Context
India has long struggled with issues of inadequate public health infrastructure, high out-of-pocket expenditure (OOPE), and insufficient health insurance coverage. According to the National Sample Survey Office (NSSO) 2014 data, over 63 million people are pushed into poverty every year due to healthcare expenses.
To address these challenges, the Government of India launched Ayushman Bharat to shift the focus from sectoral and segmented approaches to a comprehensive and need-based health service delivery model.
Components of the Scheme
The Ayushman Bharat program has two major components:
1. Health and Wellness Centres (HWCs)
- Objective: To provide comprehensive primary healthcare.
- Aim: To transform 1.5 lakh Sub-Centres and Primary Health Centres (PHCs) into HWCs.
- Services provided:
- Maternal and child health services
- Non-communicable diseases (NCDs) screening
- Mental health, dental, eye care
- Diagnostics and free essential drugs
2. Pradhan Mantri Jan Arogya Yojana (PM-JAY)
- Launched: September 23, 2018
- Objective: To provide financial protection against catastrophic health expenditures.
- Target Beneficiaries: Over 10.74 crore poor and vulnerable families (approx. 50 crore individuals)
- Key Features:
- ₹5 lakh per family per year for secondary and tertiary care hospitalization
- Cashless and paperless access to services
- Covers three days of pre-hospitalization and 15 days of post-hospitalization expenses
- No cap on family size, age, or gender
Eligibility Criteria for PM-JAY
PM-JAY uses Socio-Economic Caste Census (SECC) 2011 data to identify beneficiaries in rural and urban areas.
Rural Criteria:
- Families with only one room and kutcha walls/roof
- No adult members between 16-59 years
- Female-headed households
- Landless households dependent on manual labor
Urban Criteria:
- Rag pickers
- Domestic workers
- Street vendors
- Sanitation workers
- Construction workers
- Other low-income professions
Implementation Mechanism
- Nodal Agency:
- National Health Authority (NHA)
- Mode:
- Insurance-based, trust-based, or mixed models by States/UTs
- IT Platform:
- PM-JAY has a robust IT backbone for portability and transparency
- Public-Private Partnership (PPP):
- Empanelment of private hospitals for wider reach
Funding Pattern
| Entity | Contribution |
|---|---|
| Central Government | 60% |
| State Governments | 40% |
Note: For North-Eastern and Himalayan states, the ratio is 90:10.
Achievements of Ayushman Bharat
| Parameter | Performance (As of 2024) |
|---|---|
| Beneficiaries covered | Over 55 crore |
| Hospital admissions under PM-JAY | More than 5 crore |
| Total empanelled hospitals | 27,000+ (public and private) |
| Operational Health and Wellness Centres | Over 1.6 lakh |
| Claims submitted and paid | ₹60,000+ crore |
Benefits and Significance
- Reduction in OOPE:
- Financial security for poor families.
- Improved Access:
- Remote areas benefit through HWC outreach.
- Gender-sensitive:
- Higher utilization by women (over 47% beneficiaries).
- Boost to Medical Infrastructure:
- Encourages private hospitals to invest in tier 2 and tier 3 cities.
- Digital Health Infrastructure:
- Supports ABHA IDs under the Ayushman Bharat Digital Mission (ABDM).
AB PM-JAY for Senior Citizens
About:
The Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) is India’s flagship health insurance scheme aimed at providing financial protection and quality healthcare services to over 10.74 crore vulnerable families, including senior citizens, who are often the most vulnerable to health-related financial shocks.
Senior citizens, especially those without regular income, pensions, or family support, face significant challenges in accessing and affording healthcare. PM-JAY plays a crucial role in ensuring elderly care, financial risk protection, and access to secondary and tertiary healthcare without burdening the individual.Senior citizens, especially those without regular income, pensions, or family support, face significant challenges in accessing and affording healthcare. PM-JAY plays a crucial role in ensuring elderly care, financial risk protection, and access to secondary and tertiary healthcare without burdening the individual.
Key Developments Related to Senior Citizens under PM-JAY:
| Year | Development |
|---|---|
| 2018 | Launch of PM-JAY with inclusive eligibility—no age or family size limit |
| 2020 | Introduction of geriatric care packages under PM-JAY |
| 2021 | Integration of telemedicine services through Health and Wellness Centres |
| 2022 | Launch of special campaigns targeting elderly awareness in rural areas |
| 2023 | Enhanced hospital empanelment for geriatric care in Tier 2 & 3 cities |
| 2024 | Collaboration with NPHCE (National Programme for Health Care of the Elderly) for seamless care delivery |
Challenges and Issues
| Challenge | Explanation |
|---|---|
| Awareness Gap | Many eligible families remain unaware of benefits. |
| Quality Control | Variability in service quality among empanelled hospitals. |
| Fraudulent Claims | Cases of misuse in some states due to poor monitoring. |
| Infrastructure Constraints | HWCs still lack adequate personnel and facilities in remote regions. |
| Data Privacy | Concerns around patient data under ABDM. |
Ayushman Bharat Digital Mission (ABDM)
Launched in 2021, ABDM aims to digitize the Indian healthcare ecosystem.
Key Features:
- Unique Ayushman Bharat Health Account (ABHA) ID
- Digital health records
- Interoperability among health systems
- Healthcare Professionals Registry (HPR)
- Health Facility Registry (HFR)
Ayushman Bharat in Budget 2024–25
- Allocation:
- ₹7,200 crore for PM-JAY and ₹1,900 crore for HWCs
- Focus:
- Enhancing quality of care, telemedicine, and integration with ABDM
Ayushman Bharat vs Other Global Models
| Feature | Ayushman Bharat (India) | NHS (UK) | Obamacare (USA) |
|---|---|---|---|
| Nature | Insurance + Public Health | Government-funded | Market-based insurance |
| Coverage | Poor and vulnerable only | Universal | Subsidized coverage |
| Provider Mix | Public + Private | Mainly public | Private |
| Financial Risk Protection | High for low-income | Universal | Partial |
Ayushman Bharat & SDGs
Ayushman Bharat directly contributes to the following Sustainable Development Goals (SDGs):
- SDG 3:
- Good Health and Well-being
- SDG 1:
- No Poverty (by reducing health-induced poverty)
- SDG 10:
- Reduced Inequalities
Way Forward
- Enhanced Awareness Campaigns:
- To ensure that all beneficiaries are aware and utilize the scheme.
- Strengthening HWCs:
- More investment in infrastructure, diagnostics, and human resources.
- Fraud Control:
- Use of AI and real-time analytics to detect anomalies.
- Seamless Digital Integration:
- Ensure smooth functioning of ABDM with privacy safeguards.
- State Capacity Building:
- Equip state health agencies for efficient scheme management.
Conclusion
The Ayushman Bharat scheme has redefined healthcare delivery in India by integrating preventive, promotive, and curative care. It is not only a social welfare initiative but also a strategic health policy to drive India’s long-term growth and human development. For UPSC aspirants, mastering this topic is vital, as it cuts across multiple dimensions of governance, development, and public administration.
