Ayushman Bharat: PM-JAY and Health Infrastructure

TOPIC CLASSIFICATION

Subject: Governance / Health | Topic: Health Policy Sub-topic: Ayushman Bharat, PM-JAY, Health Infrastructure, National Health Mission Prelims Focus: Benefits covered, eligibility, number of hospitals empanelled, sum assured Mains Focus: Impact on out-of-pocket expenditure, challenges in implementation

EXAMINER REASONING

Ayushman Bharat is the largest health insurance scheme globally and a flagship government programme. Prelims tests coverage details and sum assured. Mains explores its effectiveness in reducing catastrophic health expenditure and the challenges of fraud, awareness, and hospital empanelment.

Core Concept

Ayushman Bharat was launched on September 23, 2018 (from Ranchi, Jharkhand) with two pillars:

1. Pradhan Mantri Jan Arogya Yojana (PM-JAY) — Health insurance of ₹5 lakh per family per year for secondary and tertiary care.
2. Health and Wellness Centres (HWCs) — 1.5 lakh sub-centres upgraded to deliver comprehensive primary care near the community.

PM-JAY Key Features

• Coverage: 10.74 crore poor and vulnerable families (approx. 50 crore beneficiaries).
• Sum assured: ₹5,00,000 per family per year (no cap on family size; floater basis).
• Types of coverage: Pre-hospitalisation (3 days), post-hospitalisation (15 days), all pre-existing diseases covered from day 1.
• No restriction: On family size, age, or gender.
• Cashless and paperless: At point of care via Ayushman card / smart card.
• Portable: Across India (any empanelled hospital in any state).
• Beneficiary identification: SECC 2011 data + state govt additions.
• Hospitals empanelled: ~29,000 (public + private).
• Aadhaar-linked: For fraud prevention; bio-metric authentication at admission.

Health & Wellness Centres (HWCs)

• Target: 1.5 lakh Ayushman Arogya Mandirs (formerly HWCs) operational.
• Services: 12 packages including maternal care, NCD screening, mental health, oral health.
• Workforce: Mid-level health providers (MLHPs), Community Health Officers (CHOs).
• Impact: Reduced OPD burden on district hospitals; early detection of NCDs.

ABDM (Ayushman Bharat Digital Mission)

• Launched September 2021 (pilot); nationwide rollout 2022.
• Provides Ayushman Bharat Health Account (ABHA) ID to every citizen.
• Integration with DigiLocker, e-Sanjeevani, CO-WIN.

Key Facts