Ayushman Bharat and the push for health cover

Ayushman Bharat, launched in 2018, is India's largest health programme. It has two parts. The first is a network of Health and Wellness Centres, now called Ayushman Arogya Mandirs, which upgrade sub-centres and primary health centres to provide comprehensive primary care, including screening for common conditions, maternal and child services, and free essential medicines and diagnostics. The second, and better known, part is the Pradhan Mantri Jan Arogya Yojana (PM-JAY), a health assurance scheme for hospital care.

PM-JAY was launched on 23 September 2018 at Ranchi, Jharkhand. It provides cashless cover of up to Rs 5 lakh per family per year for secondary and tertiary hospitalisation, for about 10.74 crore poor and vulnerable families — roughly 50 crore people — identified from the Socio-Economic Caste Census on deprivation and occupational criteria. Beneficiaries can use empanelled public and private hospitals across the country, and the cover is on a family floater basis, so any member can use it up to the limit. From 2024 the scheme was extended to all citizens aged 70 and above, regardless of income.

The design tries to solve a specific problem: hospital bills are the largest cause of catastrophic health spending. By paying hospitals directly, the scheme aims to stop families selling assets or borrowing for surgery or serious illness. Early evaluations found large numbers of hospital admissions funded, but also unevenness: empanelment and usage vary by state, some hospitals are accused of overcharging or unnecessary procedures, and the poorest and most remote households are the hardest to enrol and inform.

Ayushman Bharat does not replace the public health system, and its critics note that hospital insurance cannot fix weak primary care, staff shortages or drug supply. Its supporters reply that it is the first scheme of this scale to give poor households a portable, cashless entitlement, and that its data on admissions and costs is itself a tool for planning. For civil studies, the key point is the distinction between health cover and health care: insurance pays the bill, but only a functioning system of clinics, staff and medicines delivers the treatment.