Health Insurance or Health Illusion? A Look at Ayushman Bharat
Ayushman Bharat, launched in 2018 by the Government of India, was envisioned as a revolutionary step towards universal health coverage. Also known as the Pradhan Mantri Jan Arogya Yojana (PM-JAY), the scheme aims to provide free health insurance of up to ₹5 lakh per family per year to over 50 crore Indians, especially the economically vulnerable. It was hailed as the world’s largest government-funded healthcare program. But nearly seven years later, the question arises: is Ayushman Bharat truly delivering health insurance, or is it an illusion for millions still struggling to access quality care?
1. A Landmark Policy with Bold Promises
Ayushman Bharat was designed with two key components:
Health and Wellness Centres (HWCs): Aiming to provide comprehensive primary care closer to communities.
PM-JAY: A health insurance scheme offering cashless treatment for secondary and tertiary care in empaneled public and private hospitals.
The goal was to reduce the out-of-pocket health expenses that drive millions into poverty every year. By covering hospitalisation costs and encouraging preventive healthcare, the scheme promised to transform India’s health landscape.
2. Success Stories and Reach
Since its launch, Ayushman Bharat has indeed touched millions of lives. According to official data, over 6 crore hospital admissions have been recorded under PM-JAY. Poor families have been able to undergo surgeries, cancer treatments, and cardiac procedures without paying a rupee. States like Chhattisgarh, Kerala, and Gujarat have shown notable implementation success, especially in empaneling a good mix of public and private hospitals.
Health and Wellness Centres have started to bridge the gap in rural and remote areas by providing basic healthcare, maternal services, and screenings for non-communicable diseases.
3. Ground Reality: Gaps in Access and Awareness
Despite its large-scale success, a significant part of India’s population is either unaware of the scheme or unable to access it. Many eligible beneficiaries do not know they are covered or how to avail of the services. In several districts, health cards have not been issued to a large portion of the poor. Language barriers, lack of digital literacy, and weak last-mile connectivity further exclude those most in need.
Moreover, many private hospitals are hesitant to enroll in the scheme due to low reimbursement rates, leading to a limited network of service providers. This forces patients to travel long distances or rely on overburdened government hospitals.
4. Quality vs Quantity: The Private Sector’s Role
While PM-JAY has empaneled thousands of private hospitals, critics argue that the quality of care remains inconsistent. Some hospitals focus on high-cost, high-volume treatments rather than genuinely needed procedures. There are also cases of unnecessary surgeries, inflated bills, and denial of services—raising concerns about regulation and monitoring.
In addition, the scheme primarily covers hospitalisation costs, while outpatient care, diagnostics, and medicines (which account for a major portion of health expenses) are often not covered. For the poor, this can still mean spending out of pocket, defeating the purpose of financial protection.
5. Policy Limitations and Future Challenges
Ayushman Bharat’s structure focuses on hospital-based care rather than strengthening preventive and primary healthcare. Without robust public health systems and infrastructure, the scheme risks becoming overly dependent on private players. States like West Bengal and Odisha have even opted out of PM-JAY, citing concerns about centralization and overlap with their own health schemes.
Corruption, misuse of funds, and lack of transparency in claim settlements also continue to plague the program in some regions.
Ayushman Bharat is undeniably a visionary scheme with life-saving potential. For many, it has been a blessing in times of medical crisis. However, unless the gaps in awareness, access, quality, and regulation are addressed, it risks becoming more of a health illusion than a true health insurance. To fulfill its promise, the government must invest in stronger public health systems, increase transparency, and ensure that no beneficiary is left behind—only then will Ayushman Bharat truly live up to its name.
