A Comprehensive Review of Ayushman Bharat: Achievements, Challenges, and Future Directions

Abstract 

The NDA government under the leadership of Prime Minister Narendra Modi, introduced the Ayushman Bharat scheme, a transformative healthcare initiative in India. Launched in 2018, it aims to provide financial protection and access to quality healthcare services for millions of vulnerable and underserved citizens. This ambitious program has made significant strides in improving healthcare accessibility and affordability across the country. 

Indian healthcare has evolved over the past three decades and is currently at a very critical juncture to achieve the 3As (Affordability, Accessibility and Availability) of healthcare. The Indian government’s innovative healthcare program has drawn much attention for its overarching goal of ensuring that every citizen has access to healthcare. This paper provides a nuanced analysis of the program’s successes, difficulties, and potential future possibilities. It highlights the important advancements made in expanding access to healthcare, reducing financial burdens on disadvantaged populations, and fostering healthcare innovation. It also draws attention to enduring issues including the need for consistent funding, the improvement of the healthcare system, and the reduction of regional inequities. This evaluation highlights the need to solve these issues as Ayushman Bharat moves forward and provides suggestions for possible directions for the program’s future development, providing equal and open access to healthcare for all Indians.It emphasizes how it adapts Obamacare’s guiding principles to the particular circumstances of India and explores these programs’ broader ramifications in the global healthcare reform environment. This analysis advances knowledge of the challenges and potential of global efforts to provide universal healthcare by comparing the experiences of India and the World and also among various states within India. 

The Ayushman Bharat program encountered significant challenges during the COVID-19 pandemic, primarily stemming from the inadequacies within the healthcare infrastructure. India is one of the developing nations that not only helped many other nations in need while managing the health problem with little resources. The SECC 2011 database was used to identify the beneficiary families, which total 10.74 crore families and 50 crore individuals, based on certain deprivation and occupational criteria in rural and urban areas, respectively. The paper attempts to look at various challenges to be faced in implementation of this scheme and role of various stakeholders required for its success.

Introduction 

After 75 years of independence, the majority of Indians still lack access to affordable, high-quality healthcare. According to the Economic survey only 25% of Indians are covered by both government-run and private health insurance programs. Under the 12th Five Year Plan, the government established a High Level Expert Group to address this issue, which issued a report with a focus on Universal Health Coverage as a Fundamental Component of Social Security. Ayushman Bharat Program, which aims to provide health insurance to 10 crore BPL families, was included in the Union Budget 2018.

Healthcare is a fundamental human right, yet millions around the world still lack access to quality medical services, and India, as one of the world’s most populous nations, faces this challenge on a colossal scale. In 2018, India launched a groundbreaking healthcare reform initiative known as Ayushman Bharat, with the ambitious goal of providing universal health coverage to its citizens. This comprehensive research paper delves into the multifaceted dimensions of Ayushman Bharat, exploring its origins, objectives, components, achievements, challenges, and future prospects.

India’s healthcare landscape is marked by both progress and persistent disparities. While the country boasts world-class medical facilities and skilled healthcare professionals, access to these services remains unequal, with a significant portion of the population deprived of essential care. Moreover, the financial burden of healthcare expenses pushes many Indian families into poverty.

Background 

The introduction of social health insurance has been one of the most significant innovations of the past decade. While public health spending (including both Centre and States) has seen only a marginal increase over the last decade, government spending on social health insurance has increased consistently. Spending on social health insurance (at current prices) has almost doubled between 2013-14 and 2018-19 due to increased coverage under RSBY and later Ayushman Bharat, rising healthcare costs, higher enrollment as more people became aware of and enrolled in these insurance programs, and the pool of insured individuals grew contributed to increased spending on premiums and healthcare services, inflation, improved infrastructure, and government commitment to healthcare access and affordability.

Meanwhile, the government in September 2018 revamped the existing Rashtriya Swasthya Bima Yojana (RSBY) and introduced the Pradhan Mantri Jan Arogya Yojana (PMJAY) or Ayushman Bharat scheme with an aim to expand the services to a larger number of households. The annual coverage also increased to  ₹ 5 lakh per household as opposed to ₹ 30,000 in RSBY.

According to the estimated demand and expenditure for PMJAY by the 15th Finance Commission on Ayushman Bharat (2019), the total costs (Centre and States) of PMJAY could range from ₹28,000 crore to ₹74,000 crore for the next five years. However, it is observed that the Government did not spend a significant amount as mentioned in the 15th Finance Commission report for PMJAY since its inception. In fact, actual spending was much lower than the budgeted estimates over the last three Budget periods as shown in figure.Coverage under the PMJAY scheme has significantly expanded, aiming to reach 10.74 crore families or approximately 55 crore individuals from the lowest socioeconomic strata, though achieving this goal may take time. However, the utilization of allocated funds has been subpar, with a decline from 83% in 2018-19 to 42% in 2020-21, despite the pandemic according to a report provided by the National Council of Applied Economic Research (NCAER) an economic think tank  in 2019. This decline suggests implementation gaps, lack of awareness among beneficiaries regarding their health benefits and the process to access them has been a significant issue, as highlighted by NCAER research.

Methodology: 

Review of the documentation desk : Early documents, presentations, notes from working groups, and resources are available on the website of the National Health Authority (NHA) which is a nodal agency for implementation of Ayushman Bharat, media stories, and other NHA-accessible documents were examined to compile data that was already in the public domain. However, the majority of sources and informational items the PM-JAY’s effort, and the NHA, did not concentrate on the first stages of concept was developed into a pan-Indian program and launched, incorporating ideation nationally in September 2018.

What is Ayushman Bharat and why was it needed ?

Ayushman Bharat emerges as a visionary response to these pressing issues.  Comprising two main components, Pradhan Mantri Jan Arogya Yojana (PM-JAY) and Health and Wellness Centers (HWCs), this initiative aspires to redefine healthcare accessibility and affordability in India. PM-JAY, often referred to as “Modicare,” offers health insurance coverage for secondary and tertiary care services, while HWCs are designed to strengthen primary healthcare at the grassroots level.

The Ayushman Bharat initiative was necessary due to India’s complex healthcare challenges. Despite economic progress, over 20% of the population lives in poverty, and a significant demographic shift with 34% aged 15-35 adds pressure. India faces a “triple burden of disease,” including communicable and non-communicable diseases and injuries. The healthcare system’s challenges include a heavy reliance on a small, unregulated private sector, primarily in urban areas, leaving many underserved. Public hospitals struggle with funding, a shortage of skilled professionals, inconsistent supplies, and overcrowding. Ayushman Bharat aims to address these disparities and provide healthcare access to the vast Indian population.

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