• it covers all Indian above the age of 70

• projected to benefit 60mn persons

• provides 5 lakhs a year

• available to people already covered under private health insurance policies or employees statee insurance schemes

• people covered under central govt health scheme may choose either of the both

• number of persons above 60 years are 149mn in 2022 and can reach 347mn in 2050 it is a target under SDG - to provide UHC by 2030 - provision of health services to every Indian without imposing any financial hardship to achieve this India must atleast spend 2.5% of its GDP

• WB and WHO recommended 2 measures to monitor the implementation of UHC

1. extent of financial protection - assessed by out of pocket expenditure, etc…
2. the level of service coverage

out patient care and medicines are the largest contributor of out of pocket expenditure but out patient care isn't covered under PM JAY

CAG, 2023 report - several deficiencies in the performance of PM JAY

• fraud in patient registration
• quality deficit in accredited healthcare providers like non functioning equipment, deficient bed strength, lack of blood bank and emergency transport services
• co payment by patients, beyond the amount covered by insurance
• paucity of accreditation for eligible hospitals in tier 2 and 3 cities has curtailed penetration of PM JAY in some states

2/3rd of the money spent under PM JAY has streamed through private hospitals private hospitals

• aggrieved about payment delays
• reluctant to deal with cumbersome process

strengthen public health sector

talks about privatising district hospitals and proposals to create private managed care enterprises where private sector provide services across the board - from primary to tertiary

US - highest health expenditure and the lowest life expectancy among all OECD (organisation for economic co operation and development) countries life expectancy of US declined to 76 years in 2021

Union budget 2024 - 2025

• PM JAY to include ASHA workers
• but allocation fallen short - it got increased only by 1.4% compared to previous year

With the advent of privatisation under LPG policies, people were left at the mercy of market forces for access to better education and health services. 

While data on out-of-pocket health expenditure in the pre-LPG era is not readily available even up to 2000, it is believed that people, especially poor, spent very little of their own money on health services

When government health services are lacking, people are forced to spend out-of-pocket to access these services. 

After LPG, out-of-pocket expenditure on health facilities increased not only in absolute terms but also as a percentage of total health expenditure

Notably, in 1991, government expenditure on health was 2.36 per cent of GDP. By 2013-14, this figure had declined to 1.15 percent

people’s out-of-pocket expenditure on health had risen to 2.6 per cent of GDP, 64.2 per cent of total health expenditure in 2013-14

factors that led to the increase in out-of-pocket expenditure on health

Decline in public expenditure on health as a percentage of GDP, the consequent deterioration of public health facilities, the proliferation of private hospitals and nursing homes, and the growing awareness and concern about health among the general public, including the underprivileged.

Ministry of Health and Family Welfare said in a statement in January 2015 that 6.3 crore people are pushed into poverty every year due to “catastrophic” spending on health care, which neutralises the benefits of various government schemes aimed at reducing poverty and increasing incomes. 

recent WHO study published in the British Medical Journal (BMJ) said, “A growing number of people in Europe and Central Asia are spending so much on healthcare that they do not have enough money for their other essential needs – what is called ‘catastrophic health expenditure’, which occurs when a family’s out-of-pocket payment exceeds a certain level of paying capacity. And it is becoming more and more common

out-of-pocket expenditure as a percentage of total expenditure on health has come down from 64.2 per cent in the year 2013-14 to 39.1 per cent in 2021-22.

At the same time, government expenditure has increased from 28.6 per cent in 2013-14 to 48 per cent in 2021-22.

government expenditure as a percentage of total expenditure on health has increased from a mere 1.15 per cent in 2013-14 to 1.9 per cent in 2023-24.

introduction of a public health insurance programme called Ayushman Bharat Pradhan Mantri Jan Arogya Yojana.

Currently, there are about 35 crore beneficiaries of this scheme.

Ayushman Bharat card holders are provided assured treatment of up to Rs 5 lakh.

However, only treatment of indoor patients (IPD) is covered under this scheme, and not OPD patients.

government has set a target of taking public expenditure on health to 2.5 per cent by 2025.

World Bank data, in 2021 the out-of-pocket expenditure on health in upper-middle income countries was an average of 31.37 per cent of the total expenditure on health, and about 34 percent in middle income countries

Print

January 2025

Haryana suspends PMABY

Indian Medical Association, Haryana to suspend Ayushman scheme services from 3rd Feb due to alleged pending dues of empanelled hospitals in the state.

April 2025

Four components of Ayushman Bharat

1. AB PM JAY

• World's largest assurance scheme
• 40 crore + ayushman cards created
• 25 lakhs + enrollments for Ayushman Vay Vandana Cards under AB PM JAY

2. AAMs

• 1.76 lakhs + mandirs functional
• Providing comprehensive primary health care

3. ABDM

• A citizen centric interoperable digital health ecosystem

4. PM Ayushman Bharat Health Infrastructure Mission

• Strengthening health care infrastructure
• critical care hospital blocks in all districts with 5 lakhs+ populations
• integrated public health labs in all districts