Ethics Theory, TLP-UPSC Mains Answer Writing
Q. 5. “Ayushman Bharat aims to move India towards universal health coverage, yet challenges remain in its implementation.” Critically examine the strengths and limitations of the scheme. (250 words, 15 marks)
Introduction
Launched in 2018, Ayushman Bharat aims to achieve Universal Health Coverage by providing preventive and curative services through Health and Wellness Centres and financial protection via the Pradhan Mantri Jan Arogya Yojana.
Body
Key Features of Ayushman Bharat
- Health and Wellness Centres (HWCs): Targeting 1.5 lakh HWCs to deliver comprehensive primary healthcare including maternal, child, and non-communicable disease services. As of July 2023, over 1.6 lakh HWCs are operational.
- PM-JAY: Provides ₹5 lakh per family per year for secondary and tertiary hospitalization for 50 crore beneficiaries. As of November 2023, over 6 crore hospital admissions worth more than ₹77,000 crore have been authorised.
- Portability: Pan-India portability of services through empaneled public and private hospitals. As of 2023, around 26,800 hospitals, including 11,700+ private institutions, are empaneled.
- Cashless and Paperless: Empowers beneficiaries with Aadhaar-linked access without any out-of-pocket expenditure.
- IT Platform: National Health Authority manages the IT system for beneficiary identification, hospital empanelment, and claim settlement.
A critical assessment of the scheme reveals its transformative potential alongside significant implementation challenges.
Strengths of Ayushman Bharat
- Financial Risk Protection: As of 2023, over 6 crore hospital admissions and ₹77,000+ crore in claims were processed under PM-JAY, reducing catastrophic health expenditure.
- Access Expansion: Around 26,800 hospitals, including many private institutions, have been empaneled under the scheme, broadening access to quality care.
- Equity and Inclusion: Prioritizes vulnerable groups, with nearly 49% of beneficiaries being women and a focus on SC/ST households.
- Digital Health Infrastructure: The use of IT for real-time monitoring and fraud detection improves transparency.
- Boost to Public Health Infrastructure: HWCs enhance grassroots-level preventive care and reduce tertiary care burden.
Limitations and Challenges
- Coverage Gaps: Excludes outpatient care and diagnostics not linked to hospitalization; actual health expenses remain high for many beneficiaries.
- Awareness and Enrolment Issues: NFHS-5 revealed low health insurance awareness in several regions, indirectly reflecting PM-JAY outreach challenges.
- Regional Disparities: States like Tamil Nadu and Kerala have their own schemes and show limited integration with PM-JAY.
- Infrastructure Constraints: Shortage of specialists and diagnostics in rural areas undermines HWC effectiveness.
- Fraud and Abuse: As of 2025, fraudulent claims worth ₹582 crore have been detected under PM-JAY, with over 1,080 hospitals de-empaneled for misuse.
Way Forward
- Strengthen Primary Healthcare: Ensure adequate human resources and diagnostics at HWCs to prevent disease escalation.
- Expand Coverage: Include outpatient care and more disease categories under PM-JAY to reduce out-of-pocket costs.
- Robust Monitoring Systems: Deploy AI tools and independent audits to prevent fraud and track health outcomes.
- Capacity Building: Train health workers and administrators to ensure better scheme implementation.
Incorporate Committee Recommendations: Adopt insights from the High-Level Expert Group (HLEG) on UHC and NITI Aayog’s health strategy for phased reform.
Conclusion
Ayushman Bharat marks a significant step toward universal health coverage, echoing the spirit of the Alma-Ata Declaration and aligning with Article 47 of the Constitution, but its success depends on robust, equitable implementation.
