Ayushman Bharat (PM-JAY)

Ayushman Bharat, launched in 2018, is India's flagship health initiative, designed to move the health system from a selective, fragmented approach to universal, comprehensive coverage. Anchored in the recommendations of the National Health Policy 2017 and the vision of Universal Health Coverage, it adopts a continuum-of-care approach and rests on two interconnected components — one for primary care and one for hospitalisation.

Two pillars

The first pillar is Health and Wellness Centres (now rebranded Ayushman Arogya Mandirs), which upgrade sub-centres and primary health centres to deliver comprehensive primary care — including maternal and child health, non-communicable diseases, and free essential drugs and diagnostics close to people's homes. The second pillar is the Pradhan Mantri Jan Arogya Yojana (PM-JAY), a health-assurance scheme for hospitalisation.

PM-JAY cover

PM-JAY provides health cover of up to ₹5 lakh per family per year for secondary and tertiary hospitalisation to poor and vulnerable families. There is no cap on family size or age, and pre-existing conditions are covered from day one. Beneficiaries were initially identified using the deprivation and occupational criteria of the Socio-Economic Caste Census (SECC) 2011, making it one of the largest such schemes in the world.

Cashless, paperless and portable

Beneficiaries receive cashless and paperless treatment at empanelled public and private hospitals using an Ayushman card. Because coverage is portable across states, a beneficiary from one state can avail treatment in another — valuable for migrant workers. It is an entitlement-based scheme, so no enrolment is needed if a family is on the eligible list.

Governance and expansion

The scheme is implemented by the National Health Authority (NHA) at the centre and State Health Agencies in states, and is a centrally-sponsored scheme with cost sharing between the Centre and states. Coverage has been expanded over time — for example, to all citizens aged 70 and above under a dedicated vertical, regardless of income.

Why it was needed — the health financing problem

India has historically had very high out-of-pocket health expenditure, meaning families pay for most medical care directly from their pockets. A single serious hospitalisation could wipe out savings or push a household into poverty — every year, tens of millions of Indians are estimated to fall into poverty because of health costs. Public health spending remained low as a share of GDP, and earlier insurance schemes like the Rashtriya Swasthya Bima Yojana (RSBY) offered only limited cover (around ₹30,000). Ayushman Bharat was designed as a decisive step towards Universal Health Coverage by both strengthening primary care and providing a large financial cushion against catastrophic hospitalisation.

Scale, impact and technology

PM-JAY is described as the world's largest government-funded health assurance scheme, with tens of crores of eligible beneficiaries, crores of Ayushman cards issued, and tens of thousands of public and private hospitals empanelled. It runs on a digital backbone for beneficiary identification, hospital empanelment, claims and fraud detection, and is increasingly linked with the Ayushman Bharat Digital Mission (ABDM), which creates unique health IDs (ABHA) and digital health records. Early evidence suggests it has increased access to hospitalisation for poorer families and reduced some out-of-pocket costs.

Challenges and criticisms

Despite its scale, PM-JAY faces criticism. Private hospitals sometimes argue that the fixed package rates are too low to be viable, affecting participation in some regions. Fraud and misuse — fake claims, unnecessary procedures — require constant monitoring. Empanelment is uneven, with fewer quality hospitals in rural and remote areas. Crucially, PM-JAY covers hospitalisation but not outpatient (OPD) care, which makes up a large share of health spending, and a few states initially stayed out or ran parallel schemes. Awareness gaps also mean some eligible families do not use their entitlement, so the scheme's real test lies in effective, honest implementation.

Why it matters for UPSC

PM-JAY details — the ₹5 lakh cover, the two pillars, SECC-based beneficiary identification, the National Health Authority and portability — are classic Prelims facts and useful Mains examples on Universal Health Coverage, out-of-pocket expenditure and welfare delivery.