Ayushman Bharat: Coverage and Preventive-Care Milestones

Why in News?

Official data released through late 2025 set out the cumulative scale of Ayushman Bharat, the Government of India’s flagship health programme, which completed seven years in September 2025. The numbers cover both of its arms — the hospital-insurance scheme PM-JAY and the primary-care network of Ayushman Arogya Mandirs — and confirm its standing as the world’s largest publicly funded health-assurance scheme.

As of December 1, 2025, around 42.48 crore Ayushman cards had been created and over 10.98 crore hospital admissions authorised, worth about Rs 1.60 lakh crore in cashless treatment, while roughly 1.82 lakh Ayushman Arogya Mandirs delivered expanded services, tele-consultations and mass screenings.

• About 42.48 crore Ayushman cards created as of December 1, 2025.
• Over 10.98 crore hospital admissions authorised, amounting to roughly Rs 1.60 lakh crore of cashless care.
• 1,81,873 Ayushman Arogya Mandirs operationalised, with cumulative footfall near 494 crore visits.
• Around 41.93 crore tele-consultations delivered through these primary-care centres.
• Preventive screenings (to Nov 30, 2025): hypertension 39.50 crore, diabetes 36.70 crore, oral cancer 32.40 crore, cervical cancer 15.23 crore, breast cancer 8.37 crore.
• PM-JAY gives Rs 5 lakh per family per year of secondary and tertiary hospital cover; the Ayushman Vay Vandana extension covers all citizens aged 70 and above.

The development matters in the context of:

• Why it matters: Ayushman Bharat is India’s primary vehicle for Universal Health Coverage (UHC) and a marker of progress on SDG 3 (good health and well-being).
• It operationalises a continuum-of-care model — linking primary-level prevention and screening to secondary and tertiary hospital treatment.
• Catastrophic health spending is a major driver of poverty in India; the scheme targets the financial-protection gap for poor and vulnerable households.

UPSC Relevance

Prelims Relevance

• Ayushman Bharat was launched in September 2018; it has two components — PM-JAY and the Ayushman Arogya Mandirs (the renamed Health and Wellness Centres).
• PM-JAY provides Rs 5 lakh per family per year of cashless secondary and tertiary hospitalisation cover, with no cap on family size or age.
• It is the world’s largest publicly funded health-assurance scheme; the nodal agency is the National Health Authority (NHA).
• Beneficiaries are drawn from the Socio-Economic Caste Census (SECC) 2011 deprivation criteria (rural and occupational categories).
• Ayushman Vay Vandana Card extends cover to all citizens aged 70 years and above, irrespective of income.
• Ayushman Arogya Mandirs deliver a Comprehensive Primary Health Care package — including screening for hypertension, diabetes and three common cancers.
• Funding is shared between the Centre and States (typically 60:40), administered by State Health Agencies.
• It is portable across the country, allowing treatment at empanelled public and private hospitals in any state.
• It maps to SDG 3 and the goal of Universal Health Coverage on the path to Health for All.
• The digital backbone is the Ayushman Bharat Digital Mission (ABDM), which issues Ayushman Bharat Health Accounts.

Mains Relevance

GS Paper 2

• Government schemes for vulnerable sections: PM-JAY as a tool for financial protection against catastrophic health spending.
• Issues relating to health: the design of demand-side health insurance versus supply-side strengthening of public health systems.
• Universal Health Coverage and the continuum-of-care model — bridging primary, secondary and tertiary care.

GS Paper 3

• Inclusive growth and human capital — health as an investment that lowers out-of-pocket expenditure and poverty risk.

Essay

• Health for all: the unfinished agenda of Universal Health Coverage in India.
• Public goods and the welfare state — financing health as a foundation for human development.

Background and Context

Two pillars of Ayushman Bharat

The programme combines a hospital-insurance arm with a primary-care network.

• PM-JAY (Pradhan Mantri Jan Arogya Yojana) is the insurance arm — cashless secondary and tertiary hospital care up to Rs 5 lakh per family per year.
• Ayushman Arogya Mandirs (formerly Health and Wellness Centres) form the primary-care arm, delivering a Comprehensive Primary Health Care package close to communities.
• Together they aim to provide a continuum of care — from prevention and early detection to advanced hospital treatment.
• The model shifts public health from selective, illness-centric services toward universal, prevention-led coverage.

Scale of PM-JAY by late 2025

Cumulative figures confirm its standing as the world’s largest such scheme.

• About 42.48 crore Ayushman cards created as of December 1, 2025, identifying eligible beneficiaries.
• Over 10.98 crore hospital admissions authorised under the scheme since launch.
• Cashless treatment authorised worth roughly Rs 1.60 lakh crore, sparing families large out-of-pocket bills.
• The cover is portable nationwide and usable at empanelled public and private hospitals.
• It remains the world’s largest publicly funded health-assurance scheme by population covered.

Ayushman Arogya Mandirs and preventive care

The primary-care network now drives mass screening and tele-medicine.

• 1,81,873 Ayushman Arogya Mandirs operationalised across the country, with cumulative footfall near 494 crore visits.
• Around 41.93 crore tele-consultations delivered, extending specialist reach to rural and remote areas.
• Population-level screening to November 30, 2025: 39.50 crore for hypertension and 36.70 crore for diabetes.
• Cancer screening: 32.40 crore for oral, 15.23 crore for cervical and 8.37 crore for breast cancer.
• Early detection of non-communicable diseases reduces the later burden of expensive hospital treatment.

Who is covered and how

Eligibility blends deprivation criteria with a universal senior-citizen extension.

• Core PM-JAY beneficiaries are identified from the SECC 2011 deprivation and occupational categories — poor and vulnerable households.
• There is no cap on family size, age or gender, and pre-existing conditions are covered from day one.
• The Ayushman Vay Vandana Card extends cover to all citizens aged 70 and above, regardless of income.
• Later expansions brought in groups such as ASHA and anganwadi workers and their families, and a push to cover gig and platform workers.
• Benefits are cashless and paperless at the point of care, settled directly with the hospital.

Universal Health Coverage and SDG 3

The scheme is India’s principal route to Health for All.

• Universal Health Coverage means all people get the health services they need without financial hardship.
• It maps directly to SDG 3 (good health and well-being) and the wider goal of Health for All.
• By cutting catastrophic out-of-pocket spending, PM-JAY protects households from medical-debt-driven poverty.
• The continuum-of-care design links the primary, secondary and tertiary tiers into one pathway.
• It dovetails with the Ayushman Bharat Digital Mission, building a digital health-records ecosystem.

Governance and persistent challenges

Implementation rests on cooperative federalism, but gaps remain.

• The National Health Authority (NHA) is the apex implementing body, with State Health Agencies running the scheme in states.
• Funding is largely Centre-State shared (typically 60:40), so coverage depends on state buy-in — a few large states have stayed outside or run parallel schemes.
• Concerns persist over fraud and unnecessary procedures, package-rate adequacy, and delayed reimbursement to hospitals.
• Demand-side insurance must be matched by supply-side investment — public hospitals, beds and human resources, especially in underserved districts.
• India’s overall public health spending remains modest relative to the long-stated target of about 2.5% of GDP.

Way Forward

Deepen and broaden coverage

• Update beneficiary lists beyond SECC 2011 and absorb the missing middle and informal workers.
• Scale the 70-plus Vay Vandana cover and gig-worker inclusion with smooth enrolment.

Strengthen quality and integrity

• Tighten fraud analytics and hospital empanelment standards to protect public money.
• Revise package rates periodically and clear hospital dues on time to keep private providers engaged.

The next phase must pair this demand-side cover with sustained supply-side investment — more public hospitals, beds and trained staff — so that an Ayushman card translates into timely, quality care, especially in underserved districts.

Conclusion

By late 2025 Ayushman Bharat had created over 42 crore cards and funded nearly 11 crore hospital admissions, while 1.82 lakh Arogya Mandirs took prevention and screening to the doorstep — confirming its scale as the world’s largest publicly funded health-assurance scheme.

Its real significance lies in the model: linking primary, secondary and tertiary care into a continuum, and shielding poor households from catastrophic medical spending on the path to Universal Health Coverage.

For UPSC, the scheme is a ready case study in welfare design, cooperative federalism, SDG 3, and the unfinished debate between demand-side insurance and supply-side health-system strengthening.

UPSC Practice Questions

Prelims MCQ 1

With reference to Ayushman Bharat, consider the following statements:

1. PM-JAY provides cashless secondary and tertiary hospital cover of Rs 5 lakh per family per year.
2. Ayushman Arogya Mandirs deliver comprehensive primary health care, including screening for non-communicable diseases.
3. The Ayushman Vay Vandana Card extends cover to all citizens aged 70 years and above irrespective of income.

How many of the above statements are correct?

(a) Only one (b) Only two (c) All three (d) None

Answer: (c) All three

Explanation:

All three are correct. PM-JAY offers Rs 5 lakh of secondary and tertiary cover per family per year; Ayushman Arogya Mandirs (the former Health and Wellness Centres) provide comprehensive primary care with NCD screening; and the Vay Vandana extension covers all those aged 70 and above regardless of income.

Prelims MCQ 2

Which body is the apex agency responsible for implementing Ayushman Bharat PM-JAY at the national level?

(a) Insurance Regulatory and Development Authority of India (b) National Health Authority (c) Indian Council of Medical Research (d) National Medical Commission

Answer: (b) National Health Authority

Explanation:

The National Health Authority (NHA) is the apex body that implements PM-JAY, supported by State Health Agencies in the states. IRDAI regulates insurance, ICMR coordinates medical research, and the NMC regulates medical education.

UPSC Mains Questions

1. Ayushman Bharat seeks to deliver Universal Health Coverage through a continuum-of-care model. Examine its two pillars and assess how far demand-side insurance can advance health outcomes without commensurate supply-side investment in public health systems.
2. Discuss the role of preventive and primary care in reducing India’s health burden. With reference to the Ayushman Arogya Mandirs, evaluate the case for shifting public health spending toward screening and early detection of non-communicable diseases.

Sources: National Health Authority / PIB and Newsonair (Prasar Bharati).

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