While the COVID-19 pandemic revealed several gaps in India’s healthcare delivery system, it also enforced the idea that an accessible, equitable and affordable health system can secure public health and national stability in times of crisis. While much of urban India, nearly 70%, relies on private healthcare providers, the high out of pocket expenditure (OOPE) they demand can exclude vulnerable, poverty-stricken, or rural individuals and families from accessing health services when needed, exacerbating the dual threat of illness and financial hardship. The World Health Organisation (WHO) recognises that without health security, productivity at any level becomes unattainable because individuals cannot contribute to themselves, their families, or society writ large if they are not physically, mentally, or economically empowered. The global acceptance of this stance is reflected in Sustainable Development Goal (SDG) 3 pertaining to health, which positions Universal Health Coverage (UGC) as a crucial overarching mechanism and target for achieving “healthy lives and promoting well-being for all ages”.
PM-JAY- the world’s largest publicly funded health insurance program
To achieve India’s target of attaining Universal Health Coverage (UHC) by 2030, the Union Government launched the flagship Ayushman Bharat- Pradhan Mantri Jan Arogya Yojana (PM-JAY) in 2018, as per the recommendation set out by the National Health Policy 2017. The world’s largest publicly funded health insurance program, PM-JAY is implemented by the National Health Authority (NHA). As one of two components in the Ayushman Bharat scheme, PM-JAY provides health coverage of Rs 5 lakh per family per year for secondary and tertiary care hospitalisation. Along with the endeavour to create Health and Wellness Centres (HWCs), or Ayushman Mandirs that promote comprehensive primary health care, PM-JAY reflects a “continuum of care” approach to healthcare.
Efforts and achievements
The scheme targets vulnerable families facing poverty to help them ease or avoid the financial burdens caused by catastrophic health episodes and expenditures. Currently, 12 crore families, encompassing 55 crore individuals, have been brought within the ambit of the scheme. Reporting on progress made up till December 2023, the Ministry of Health and Family Welfare (MoHFW) claims that 26,901 hospitals including 11,813 private hospitals have been empanelled under AB PM-JAY to provide healthcare services to scheme beneficiaries. As of 2024, approximately 30 crore Ayushman Cards have been created since the inception of the scheme. 6.2 crore free hospital admissions, worth more than Rs. 79,157crores, provided under the scheme have saved out-of-pocket-expenditure of more than 1.25 lakh crore of poor and vulnerable population.
The NHA has also leveraged digital mediums to ensure the scheme reaches the last mile. The Ayushman App allows beneficiaries to create Ayushman cards on an android phone, and has been downloaded more than 52 lakh times, since its launch in September 2023. To ensure that various village- level healthcare schemes reach the most remote beneficiaries, the Ministry of Health and Family Welfare (MoHFW) launched the Ayushman Bhava initiative with interventions like ‘Aapke Dwar Ayushman 3.0’, ‘Ayushman Sabhas’, and ‘Ayushman Melas’, with the overarching goal of designating villages as ‘Ayushman Gram’.
Way forward
The Ayushman Bharat scheme received a 10% budgetary increase under the Interim Budget for FY 2024-25. With a proposal to bring in ASHA and anganwadi workers under the scheme’s health coverage, this can help create a motivated health workforce and improve the gender equity envisioned by the scheme. With a stronger budget, existing shortcomings in beneficiary identification and registration, scheme implementation, and inactivity of empanelled hospitals can be overcome.
