Ayushman Bharat — Basic Structure

Basic Structure

Ayushman Bharat is India's flagship healthcare scheme launched in 2018, comprising two components: Health and Wellness Centres (HWCs) for primary healthcare and Pradhan Mantri Jan Arogya Yojana (PM-JAY) for secondary/tertiary care insurance.

The scheme covers 50 crore beneficiaries from poor families identified through SECC 2011 data, providing ₹5 lakh annual coverage per family for hospitalization. Key features include cashless treatment, nationwide portability, coverage of pre-existing conditions, and over 1,900 medical procedures.

The scheme operates through 27,000+ empaneled hospitals with 60:40 central-state cost sharing. Constitutional basis lies in Article 21 (Right to Life) and Article 47 (DPSP on public health). Implementation follows cooperative federalism with states choosing trust, insurance, or hybrid models.

Digital infrastructure enables beneficiary verification, claim processing, and fraud detection. Major achievements include 6+ crore treatments, ₹70,000+ crore authorized, and 40% reduction in out-of-pocket expenditure.

Challenges include state-wise performance variations, quality assurance, fraud control, and sustainability concerns. The scheme represents India's commitment to Universal Health Coverage and demonstrates how technology can transform healthcare delivery in developing countries.

Important Differences

vs Rashtriya Swasthya Bima Yojana (RSBY)

Aspect	This Topic	Rashtriya Swasthya Bima Yojana (RSBY)
Coverage Amount	₹5 lakh per family per year	₹30,000 per family per year
Beneficiary Base	50 crore beneficiaries (SECC 2011)	12 crore beneficiaries (BPL families)
Service Scope	1,900+ procedures, includes primary care	Limited procedures, only hospitalization
Portability	Nationwide portability	Limited to state/district
Technology Platform	Advanced digital infrastructure with real-time monitoring	Basic IT systems with limited integration

Ayushman Bharat represents a significant evolution from RSBY with enhanced coverage, expanded beneficiary base, comprehensive service package, nationwide portability, and advanced technology integration. While RSBY provided basic health insurance, Ayushman Bharat aims for Universal Health Coverage through integrated primary and secondary care delivery.

vs Employee State Insurance (ESI)

Aspect	This Topic	Employee State Insurance (ESI)
Target Population	Poor and vulnerable families (bottom 40%)	Organized sector employees earning up to ₹25,000
Funding Source	Government budget (tax-funded)	Employer-employee contributions (4.75% + 0.75%)
Service Delivery	Empaneled public and private hospitals	ESI hospitals and dispensaries
Coverage Type	Defined benefit with package rates	Comprehensive healthcare including OPD
Geographic Scope	Pan-India with state flexibility	Notified areas with ESI infrastructure

Ayushman Bharat and ESI serve different population segments with distinct financing and delivery mechanisms. While ESI provides comprehensive healthcare to formal sector workers through contributory model, Ayushman Bharat offers financial protection to informal sector and poor through tax-funded insurance model.