PM-JAY Ayushman Bharat covers a 50 crore population with Rs 5 lakh secondary and tertiary hospital cover, yet out-of-pocket health expenditure remains among the highest in the world. Discuss the achievements and design limits of the scheme.
Subtopic: Social Justice · Welfare schemes — performance
How to structure your answer
Introduction: PM-JAY, launched on 23 September 2018, is the world's largest publicly funded health-assurance scheme, with Rs 5 lakh per family per year for secondary and tertiary hospitalisation and a 70-plus age-group expansion in 2024.
Body: Three dimensions — (i) Achievements: over 35 crore Ayushman cards issued, more than 8 crore hospital admissions, around 31,000 empanelled hospitals, integration with ABHA under Ayushman Bharat Digital Mission; (ii) Limits: covers only inpatient care, leaves out outpatient and medicine costs that drive about 60 percent of OOPE; private-empanelled hospitals dominate; missing trust-based vs insurance-based state variations; package-rate disputes; (iii) Equity: states like West Bengal and Delhi opted out for periods; tribal districts under-utilise; women's claim share lags.
Way forward / Conclusion: Add an outpatient and chronic-disease cover, raise the public-health spend toward the National Health Policy 2017 target of 2.5 percent of GDP, strengthen Health and Wellness Centres for primary care, and audit private hospital empanelment with WHO ICD-coded outcome data.
Written within the word limit
220 words · target 250 words · 14 min
Introduction:
PM-JAY Ayushman Bharat, launched 23 September 2018 under Article 47's mandate, is the world's largest publicly funded health-assurance scheme, providing Rs 5 lakh per family per year for secondary and tertiary hospitalisation and expanded in 2024 to cover all citizens aged 70-plus.
Achievements: Over 35 crore Ayushman cards have been issued, more than 8 crore hospital admissions authorised, and roughly 31,000 hospitals empanelled. Integration with ABHA under the Ayushman Bharat Digital Mission and convergence with 1.7 lakh Health and Wellness Centres extend reach to tribal and Aspirational districts.
Design limits: The scheme covers only inpatient care, leaving outpatient consultations and outpatient medicines — which drive about 60 percent of household out-of-pocket expenditure (NHA 2021-22) — outside the safety net. Private-empanelled hospital dominance, package-rate disputes (West Bengal opted out in 2019; Delhi delayed rollout), and trust-versus-insurance variation across States dilute uniformity. Women's claim share lags men's by roughly 10 percentage points.
Equity gaps: Tribal and Aspirational district utilisation remains below the all-India average; National Health Accounts records OOPE at 39.4 percent of total health expenditure (FY22), still pushing an estimated 6 crore Indians into poverty annually.
Way forward / Conclusion:
Add an outpatient and chronic-disease cover, raise public-health spending toward the National Health Policy 2017 target of 2.5 percent of GDP, strengthen Health and Wellness Centres for primary care, and audit empanelled hospitals with WHO ICD-coded outcome data to convert PM-JAY from financial protection to universal health coverage.
What an examiner expects to see
- PM-JAY launched 23 September 2018; Rs 5 lakh family-floater for secondary and tertiary care
- Covers approximately 12 crore poorest families (about 55 crore beneficiaries), 70-plus universal cover added September 2024
- Over 8 crore hospital admissions and around 31,000 empanelled hospitals as of 2025
- Ayushman Bharat Digital Mission — ABHA ID, Health Facility Registry, Health Professional Registry
- Out-of-pocket expenditure still around 39.4 percent of total health spending (NHA 2021-22)
- Public health expenditure remains around 1.84 percent of GDP, below NHP 2017 target of 2.5 percent
- Outpatient and pharmaceutical costs largely excluded, despite driving most household health distress
Concrete cases, schemes and judgments
- PM-JAY 70-plus expansion (October 2024)
- Ayushman Bharat Health and Wellness Centres (renamed Ayushman Arogya Mandirs)
- Ayushman Bharat Digital Mission (ABHA)
- PM-ABHIM Pradhan Mantri Ayushman Bharat Health Infrastructure Mission
- National Health Authority claims-management platform