Ayushman Bharat Scheme — Economic Framework

Economic Framework

Ayushman Bharat is India's flagship national health protection scheme, launched in 2018, aiming for Universal Health Coverage (UHC) and a significant reduction in out-of-pocket (OOP) healthcare expenditures. It operates through two core components: Pradhan Mantri Jan Arogya Yojana (PM-JAY) and Health and Wellness Centres (HWCs).

PM-JAY provides a health cover of Rs. 5 lakh per family per year for secondary and tertiary hospitalization to over 10.74 crore poor and vulnerable families, identified via SECC 2011 data. It offers cashless and paperless treatment at over 28,000 empanelled public and private hospitals across India, covering pre- and post-hospitalization expenses, diagnostics, and medicines. The scheme's portability feature allows beneficiaries to seek treatment anywhere in the country.

HWCs, on the other hand, focus on strengthening comprehensive primary healthcare. They transform existing sub-centres and primary health centres into facilities offering an expanded range of services, including maternal and child health, screening and management of non-communicable diseases (NCDs), mental health services, and free essential drugs and diagnostics.

With over 1.6 lakh HWCs operationalized, they serve as the first point of contact for healthcare, emphasizing preventive and promotive health. Ayushman Bharat represents a paradigm shift towards a holistic, equitable, and accessible healthcare system, addressing both financial protection and foundational primary care, thereby contributing significantly to India's social security framework and public expenditure on health .

Important Differences

vs Rashtriya Swasthya Bima Yojana (RSBY)

Aspect	This Topic	Rashtriya Swasthya Bima Yojana (RSBY)
Launch Year	2018 (PM-JAY)	2008 (RSBY)
Coverage Amount (per family/year)	Rs. 5 lakh	Rs. 30,000
Beneficiary Identification	SECC 2011 data (deprivation criteria for rural, occupational for urban)	BPL (Below Poverty Line) families
Target Group	Poor and vulnerable families (approx. 10.74 crore families)	BPL families and 11 other defined categories
Scope of Services	Secondary & Tertiary care hospitalization (over 1,900 packages), includes pre/post-hospitalization	Mostly secondary care, limited packages
Portability	National portability across empanelled hospitals	Limited portability, mostly within district/state
IT Infrastructure	Robust, integrated IT platform (NHA)	Less sophisticated, fragmented IT system
Primary Healthcare Component	Yes, through Health and Wellness Centres (HWCs)	No dedicated primary care component
Funding Share	60:40 Centre-State (general), 90:10 (NE/Hilly states)	75:25 Centre-State (general), 90:10 (NE/J&K)

PM-JAY represents a significant upgrade over RSBY, offering substantially higher financial protection, a broader beneficiary base identified through more comprehensive criteria, and a wider range of covered medical procedures. Crucially, PM-JAY is part of the larger Ayushman Bharat initiative, which also includes the Health and Wellness Centres, thereby providing a holistic approach to healthcare from primary to tertiary levels. Its robust IT backbone and national portability further enhance its effectiveness and reach compared to its predecessor. From a UPSC perspective, understanding this evolution highlights policy learning and refinement in social sector schemes.

vs Central Government Health Scheme (CGHS)

Aspect	This Topic	Central Government Health Scheme (CGHS)
Target Beneficiaries	Poor and vulnerable families (SECC 2011 data)	Central Government employees, pensioners, and their dependents
Nature of Scheme	Health assurance/insurance scheme	Direct healthcare service provider and reimbursement scheme
Coverage Amount	Rs. 5 lakh per family per year	No upper limit (based on entitlement and medical necessity)
Access to Care	Cashless treatment at empanelled public/private hospitals nationwide	Treatment at CGHS dispensaries, polyclinics, and empanelled private hospitals (reimbursement or cashless)
Financing Mechanism	Government-funded (Centre & State share)	Contribution-based (monthly deduction from salary/pension) and government budget
Primary Healthcare	Provided through Health and Wellness Centres (HWCs)	Provided through CGHS dispensaries/polyclinics
Portability	National portability	Limited to CGHS-covered cities, transfer of card required for relocation

PM-JAY and CGHS cater to entirely different target populations and operate on distinct models. PM-JAY is a social welfare scheme for the economically vulnerable, providing financial protection through an insurance-like mechanism. CGHS, conversely, is a direct healthcare service and reimbursement scheme for government employees, offering comprehensive benefits without an upper financial limit, funded through contributions and government budget. While both aim to provide healthcare access, their scope, funding, and administrative structures are fundamentally different, reflecting their specific objectives and beneficiary groups. This comparison highlights the diverse approaches to healthcare financing and delivery in India.