Health is the foundation on which a nation’s progress stands. A country cannot thrive if its people struggle to access affordable healthcare or fall into poverty due to medical expenses. Recognizing this challenge, the Government of India launched Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), one of the world’s largest publicly funded health insurance initiatives. Conceptualized under the National Health Policy 2017, the scheme reflects a bold step toward achieving Universal Health Coverage (UHC) and fulfilling India’s commitment to the Sustainable Development Goals (SDGs) with a promise to “leave no one behind.”
A Vision Beyond Health Insurance
Ayushman Bharat (meaning “Long Live India” or “Healthy India”) is not merely a medical insurance program—it represents a transformation in how healthcare is delivered and financed in the country. Before this scheme existed, millions of families had limited or no financial protection against illnesses. Treatment for major diseases often meant selling assets, borrowing money, or simply avoiding hospitals.
Ayushman Bharat aims to change this narrative by providing a holistic, inclusive, and equitable healthcare framework. Rather than offering fragmented assistance, the scheme adopts a comprehensive need-based approach, addressing healthcare from prevention and early diagnosis to treatment and rehabilitation.
Key Objective: Ending Financial Hardship Due to Illness
One of the core motivations behind Ayushman Bharat is to protect vulnerable families from catastrophic medical expenditures. India has historically witnessed a high percentage of out-of-pocket spending on health, pushing millions below the poverty line. The scheme is designed to reverse this trend by ensuring that eligible households no longer suffer financial distress due to illness.
How Ayushman Bharat Works
Ayushman Bharat operates through two important components:
1. Health and Wellness Centres (HWCs)
These centres form the backbone of preventive and primary healthcare under the scheme. The goal is to upgrade existing sub-centres and primary health centres across India into modern, accessible Health and Wellness Centres.
These centres offer:
- Free essential medicines
- Routine diagnostic services
- Maternal and child healthcare
- Vaccinations and public health awareness
- Screening for chronic conditions like diabetes, cancer, cardiac diseases, and hypertension
By focusing on early detection and lifestyle-based preventive care, HWCs reduce hospitalisation and long-term economic burden on families and the healthcare system.
2. Pradhan Mantri Jan Arogya Yojana (PM-JAY)
The second pillar, PM-JAY, offers health insurance coverage of ₹5 lakh per family per year for secondary and tertiary medical care. This includes treatment for serious diseases, surgeries, organ transplants, trauma care, and critical illnesses—conditions that previously required enormous personal savings or loans.
Under PM-JAY:
- Beneficiaries receive cashless and paperless treatment
- Services are available in both government and empanelled private hospitals
- No prior enrollment or premium payment is required from beneficiaries
- Coverage applies to more than 10 crore families identified based on socio-economic criteria
This ensures access to high-quality care, especially for families previously excluded due to financial constraints.
Who Is Eligible?
Ayushman Bharat coverage is extended primarily to economically vulnerable households identified through Socio-Economic Caste Census (SECC) 2011 data. Eligibility varies for rural and urban families based on deprivation criteria such as:
- Homelessness
- Manual labor workers
- Families without land or stable housing
- Tribal and caste-based vulnerable groups
- Destitute individuals and elderly citizens without support
With no cap on family size, age, or gender, the scheme ensures inclusivity for large or multi-generational households, which are common in India.
Cashless Treatment: A Key Game-Changer
One of the most significant features of Ayushman Bharat is the cashless hospitalisation model. Beneficiaries do not need to:
- Pay upfront fees
- Submit complex paperwork
- Worry about hospital bills
Hospitals verify eligibility using an e-card or Aadhaar-based authentication, ensuring transparency, dignity, and convenience for patients.
Strengthening the Healthcare Ecosystem
Ayushman Bharat is more than a welfare initiative—it is a structural reform meant to strengthen India’s healthcare backbone.
Some major systemic improvements include:
- Encouraging public-private partnerships
- Improving hospital infrastructure
- Enhancing digital record keeping and telehealth access
- Standardizing treatment packages across the country
By incentivizing hospitals to participate, the scheme boosts medical accessibility in both rural and urban regions.
Digital Support Through ABDM
The scheme is closely aligned with the Ayushman Bharat Digital Mission (ABDM), designed to create a unified digital health ecosystem. Features like digital health IDs, electronic medical records, and interoperable platforms help patients receive seamless treatment anywhere in the country.
Progress Since Launch
Since its inception, Ayushman Bharat has benefited millions. The number of hospitals empanelled and treatments covered has grown steadily each year. Many medical procedures that were once unaffordable for economically weaker sections are now being accessed without hesitation—marking a major shift in health-seeking behaviour.
Surgeries such as:
- Cardiac procedures
- Kidney transplants
- Cancer treatment
- Orthopaedic surgeries
have become accessible to families who previously regarded such treatments as out of reach.
Challenges and the Road Ahead
While the scheme has seen remarkable adoption, several challenges remain:
- Balancing public and private sector coverage
- Ensuring uniform quality of healthcare services
- Strengthening rural medical infrastructure
- Reducing fraud and improving claim transparency
Addressing these challenges will be crucial to maximizing the scheme’s long-term effectiveness.
A Step Toward a Healthier and More Equitable India
Ayushman Bharat represents a turning point in India’s healthcare landscape. Instead of treating healthcare as an individual burden, the scheme frames it as a shared national responsibility.
With its focus on affordability, accessibility, and dignity, the program ensures that illness does not become a reason for poverty or financial collapse. As the scheme continues expanding its reach and technological integration, it stands as a key milestone in making universal, equitable, and affordable healthcare a reality for all Indians.
