Ayushman Bharat

Ayushman Bharat aims to achieve Universal Health Coverage through Ayushman Arogya Mandirs and PM-JAY, providing ₹5 lakh health cover and nationwide primary care.

Ayushman Bharat – Key Features, Components, Eligibility & Achievements

Syllabus: Govt. Schemes (UPSC Prelims, GS II)

Introduction

Ayushman Bharat, launched in 2018¹, is India’s flagship health initiative aimed at achieving Universal Health Coverage (UHC). It implements the recommendations of the National Health Policy, 2017, and aligns with the UN Sustainable Development Goals (SDGs).
The scheme has two key components:

Ayushman Arogya Mandirs (AAM) – strengthening primary healthcare
Pradhan Mantri Jan Arogya Yojana (PM-JAY) – providing financial protection for secondary and tertiary care

1. Ayushman Arogya Mandirs (AAM)

Ayushman Arogya Mandirs (formerly Health and Wellness Centres) deliver Comprehensive Primary Health Care (CPHC) by upgrading Sub-Health Centres and Primary Health Centres.

Services Offered

Preventive and promotive healthcare
Curative and rehabilitative services
Screening for NCDs
Maternal and child health services
Mental health care
Teleconsultations (via e-Sanjeevani)

These centres act as the first point of contact ensuring continuum of care, supported by diagnostics, medicines, and referral pathways.

2. Pradhan Mantri Jan Arogya Yojana (PM-JAY)

PM-JAY is the world’s largest government-funded health assurance scheme, offering:

₹5 lakh per family per year for secondary and tertiary hospitalization
No cap on family size, age, or gender
Pre-existing conditions covered from Day 1

Coverage & Services

Covers 1,949 medical procedures across 27 specialties
Includes:
- Pre-hospitalisation evaluation
- ICU and non-ICU services
- Medicines and consumables
- Diagnostics and lab tests
- Implants
- Food and accommodation
- 15 days post-discharge care
Cashless and paperless treatment via Direct Benefit Transfer

Continuum-of-Care Support

Tele-health and referrals
Expanded diagnostics
Medicines at AAMs
Provider payment reforms
Strengthened human resources and multi-skilling
Partnerships for knowledge and implementation
Community mobilisation and health promotion

Eligibility Under PM-JAY

Eligibility is based on SECC (2011) deprivation and occupational criteria.

Rural Eligibility

Covers households meeting at least one of the SECC deprivation indicators such as:

Landless labourers
Destitute families
Manual scavengers
Scheduled Caste households
Primitive tribal groups
Bonded labourers

Urban Eligibility

Covers 11 occupational categories such as:

Ragpickers
Domestic workers
Street vendors
Cobblers
Hawkers
Sanitation workers, etc.

Exclusions under PM-JAY

Not eligible if the person is:

Financial/Property-Based

Owner of a Kisan Credit Card with a limit ≥ ₹50,000
Owner of ≥ 5 acres of agricultural land
Possessing refrigerator, landline, or pucca house
Monthly income above ₹10,000

Employment-Based

Government employees (Central/State) or pensioners (₹10,000+)
Workers in government-managed non-agricultural enterprises

Vehicle/Equipment Ownership

Owners of 2/3/4 wheelers or motorised boats
Owners of mechanised farming equipment

Special Coverage for Senior Citizens (2024 Expansion)

The Government extended PM-JAY to all citizens aged 70+, regardless of income.

Key Features

₹5 lakh free insurance for every senior citizen
A separate Ayushman Vaya Vandana Card
Additional top-up cover of ₹5 lakh for seniors already in PM-JAY families
Senior citizens with private insurance or ESIC are still eligible

Ayushman Bharat Digital Mission (ABDM)

Launched in 2021, ABDM aims to build a state-of-the-art digital health ecosystem.

Core Goals of ABDM

National registries for health facilities, professionals, and pharmacies
Open digital standards for interoperability
Personal health records accessible to citizens
Digital health applications aligned with SDGs
National portability of health services
Participation from public and private sectors

Key Components

ABHA Number (14-digit health ID)
ABHA App & Personal Health Records (PHR)
Health Professional Registry (HPR)
Health Facility Registry (HFR)

Technology Backbone

Built on Aadhaar, UPI, JAM Trinity
Uses AI, cloud, IoT, and blockchain
Ensures secure, paperless, portable health data management

Ayushman Bhav Campaign (2023)

A nationwide initiative to ensure universal access to healthcare services.

Key Activities

Ayushman Apke Dwar 3.0 – Doorstep Ayushman card distribution
Ayushman Melas – Health camps at AAMs/CHCs
Ayushman Sabhas – Community meetings for awareness, ABHA creation, card distribution