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On June 8, 2026, West Bengal joined Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY), becoming the 36th and last state/Union Territory to implement the scheme. With this, the world’s largest publicly funded health-assurance programme now covers every state and UT in the country, completing a national footprint nearly eight years after the scheme’s launch. The milestone has revived a deeper policy debate: whether India’s health-system narrative is drifting from a population-based public-health model toward an individual-wellness and digital-records model, and whether brick-and-mortar primary care is being under-resourced in the process.
The Two Pillars of Ayushman Bharat
Ayushman Bharat, announced in the 2018 Union Budget, was conceived not as a single scheme but as a two-pillar architecture designed to move India toward Universal Health Coverage (UHC). Understanding this dual structure is essential, because public discourse often collapses the entire programme into the insurance card alone.
Pillar 1, Health and Wellness Centres (Ayushman Arogya Mandirs)
This is the primary-care pillar, the foundation of the pyramid. The earlier network of Sub-Health Centres and Primary Health Centres is being upgraded into Health and Wellness Centres, rebranded in 2023 as Ayushman Arogya Mandirs (AAMs). Their mandate is to deliver Comprehensive Primary Health Care (CPHC) close to the community, free of cost, including:
- Care in pregnancy and childbirth, neonatal and child health
- Management of communicable diseases (TB, malaria, HIV)
- Screening, prevention and control of non-communicable diseases (NCDs) such as hypertension, diabetes and three common cancers
- Free essential drugs and diagnostic services
- Wellness activities such as yoga and health promotion
This pillar embodies the population-health logic: prevention, early detection and primary care delivered at scale, where most disease burden can be averted cheaply.
Pillar 2, Pradhan Mantri Jan Arogya Yojana (PM-JAY)
This is the financial-protection pillar, the insurance/assurance layer that shields poor and vulnerable families from catastrophic hospitalisation costs.
| Feature | Detail |
|---|---|
| Launch | September 23, 2018 |
| Cover | Rs 5 lakh per family per year (secondary and tertiary hospitalisation) |
| Model | Health assurance (government-funded), not contributory insurance |
| Family size | No cap on family size or age |
| Beneficiary basis | Deprivation and occupational criteria (SECC 2011) |
| Portability | Cashless and paperless treatment across India, public and empanelled private hospitals |
| Vay Vandana extension | All citizens aged 70 and above eligible (irrespective of income), with an additional Rs 5 lakh top-up cover for the senior-citizen segment |
| Implementing body | National Health Authority (NHA) |
| Latest milestone | West Bengal joined June 8, 2026, the 36th and last state/UT |
The Vay Vandana expansion universalised the senior-citizen entitlement: every Indian aged 70+, regardless of socio-economic status, can now access AB PM-JAY cover, marking a shift from purely poverty-targeted coverage toward age-based universalism for the elderly.
ABHA vs Ayushman Card vs ABDM, Clearing the Confusion
A persistent source of public confusion is conflating the digital health ID with the insurance entitlement. They are distinct instruments serving different functions.
| Instrument | What it is | Function | Who gets it |
|---|---|---|---|
| Ayushman Card (PM-JAY card) | An entitlement card | Proves eligibility for the Rs 5 lakh cashless hospitalisation benefit under PM-JAY | Eligible families (deprivation criteria) and all citizens aged 70+ |
| ABHA (Ayushman Bharat Health Account) | A 14-digit digital health ID | Links and stores a person’s longitudinal digital health records; enables consent-based sharing across providers | Any citizen can create one voluntarily, regardless of PM-JAY eligibility |
| ABDM (Ayushman Bharat Digital Mission) | The digital ecosystem/mission | The umbrella infrastructure (health ID, registries, health information exchange) that creates the digital backbone for health services | Nation-wide infrastructure, not an individual benefit |
The crucial takeaway: an ABHA number is not health insurance. Having an ABHA does not entitle a person to the Rs 5 lakh cover, and having an Ayushman card does not by itself create a digital health record. Many citizens mistakenly believe creating an ABHA enrols them in PM-JAY; it does not.
The Population-Health vs Individual-Wellness Debate
The completion of the PM-JAY rollout has been accompanied by a strong policy push on the digital and individual-wellness axis: ABHA creation drives, tele-consultation, wellness apps and personal health records. Critics caution that this risks an inversion of priorities.
- Population-health model: Treats health as a public good. Invests in sanitation, immunisation, disease surveillance, nutrition and accessible primary care, interventions whose benefits accrue to the whole community and which prevent disease at source.
- Individual-wellness/digital model: Centres on the individual citizen managing personal health data, lifestyle and demand-side records. Useful and modern, but it cannot substitute for supply-side public infrastructure.
The concern is that a compelling digital narrative can mask under-investment in physical primary care, staffed sub-centres, drugs, diagnostics and human resources for health. A digital health ID is of limited value to a citizen whose nearest functional health centre lacks a doctor, medicines or a diagnostic lab.
The Spending Gap
| Indicator | Status |
|---|---|
| India’s public health spend | ~2% of GDP |
| National Health Policy 2017 target | 2.5% of GDP (by 2025) |
| NHP 2017 primary-care allocation goal | Two-thirds of public health spending on primary healthcare |
| Out-of-pocket expenditure (OOPE) | Historically the largest share of health spending in India, a key driver of impoverishment |
India’s public health expenditure remains around 2% of GDP, well short of the 2.5% target set by the National Health Policy, 2017. High out-of-pocket expenditure (OOPE) continues to push families into poverty each year. PM-JAY reduces catastrophic hospitalisation costs, but a large share of OOPE arises from outpatient care, medicines and diagnostics, precisely the domain of primary care that insurance does not cover. This is why strengthening Ayushman Arogya Mandirs is the structural complement to PM-JAY, not an optional extra.
Universal Health Coverage (UHC)
UHC means all people can access the quality health services they need without suffering financial hardship. It rests on three dimensions: who is covered (population), what services are covered (range), and how much of the cost is covered (financial protection). PM-JAY advances the financial-protection dimension for hospitalisation; AAMs advance the population and service dimensions. True UHC requires both pillars to be funded together, not one celebrated while the other is starved.
Analysis and Way Forward
The universalisation of PM-JAY across all 36 states and UTs is a genuine achievement of cooperative federalism and financial protection. The task now is to re-anchor the architecture to people, not just to platforms.
- Raise public health spending toward 2.5% of GDP, with the NHP-mandated two-thirds going to primary healthcare, so that the demand-side card is matched by supply-side capacity.
- Treat the digital push as an enabler, not the goal. ABDM and ABHA should reduce friction and improve continuity of care, but enrolment metrics must not become a proxy for health outcomes.
- Strengthen Ayushman Arogya Mandirs with assured human resources for health, free drugs and diagnostics, and robust NCD screening, so that prevention reduces the downstream demand for costly hospitalisation.
- Reduce out-of-pocket expenditure on outpatient care through free essential medicines and diagnostics at the primary level, addressing the largest unprotected component of household health spending.
- Use PM-JAY data and ABDM registries for population-health planning, disease surveillance and equity audits, ensuring the digital backbone serves public-health goals.
A health system measured only by cards issued and IDs created risks confusing coverage on paper with care in practice. The next phase of reform must convert near-universal enrolment into near-universal access to quality care.
UPSC Relevance
- GS Paper 2 (Governance, Social Justice): Government welfare schemes for vulnerable sections; issues relating to development and management of the health sector; mechanisms, laws, institutions and bodies constituted for protection and betterment of these sections.
- Mains angle: “Insurance-led financial protection cannot substitute for investment in primary public health.” Critically examine in the context of Ayushman Bharat’s two pillars.
- Prelims angle: Distinguish ABHA, Ayushman card and ABDM; know PM-JAY cover amount, launch year, implementing authority (NHA), Vay Vandana 70+ extension, and the NHP 2017 spending target.
- Linkages: Universal Health Coverage and SDG-3 (Good Health and Well-Being); National Health Policy 2017; out-of-pocket expenditure and impoverishment; cooperative federalism in scheme implementation.
Facts Corner
📌 Facts Corner, Knowledgepedia
- PM-JAY: World’s largest health-assurance scheme; provides Rs 5 lakh per family per year for secondary and tertiary hospitalisation; launched September 23, 2018; implemented by the National Health Authority (NHA).
- West Bengal joined AB PM-JAY on June 8, 2026, becoming the 36th and last state/UT to do so, completing nationwide coverage.
- Vay Vandana: AB PM-JAY extended to all citizens aged 70 and above, irrespective of income.
- ABHA vs Ayushman card: ABHA (Ayushman Bharat Health Account) is a 14-digit digital health ID for storing health records; the Ayushman card is the entitlement card for the Rs 5 lakh insurance cover. They are not the same. ABDM (Ayushman Bharat Digital Mission) is the digital-infrastructure umbrella.
- Ayushman Arogya Mandirs: The rebranded Health and Wellness Centres, the primary-care pillar delivering Comprehensive Primary Health Care free of cost.
- National Health Policy 2017: Targets public health spending of 2.5% of GDP; current spend is around 2% of GDP. NHP also targets two-thirds of public health spending on primary care.
- OOPE: Out-of-pocket expenditure remains a major driver of health-related impoverishment, largely arising from outpatient care, medicines and diagnostics.
Sources: National Health Authority, Ministry of Health and Family Welfare, The Hindu
Source: Re-Anchoring India's Public Health Architecture to People — Ujiyari.com | Free UPSC & State PCS Current Affairs
