[Evaluate AB PM-JAY's design choices — SECC 2011 targeting, insurance/trust mode, and portability — in advancing equitable healthcare.](/upsc-mains-answer/evaluate-ab-pm-jay-s-design-2bbe2d2)

Q. Evaluate AB PM-JAY's design choices — SECC 2011 targeting, insurance/trust mode, and portability — in advancing equitable healthcare. (15 marks, 250-350 words)

Ayushman Bharat PM-JAY offers ₹5 lakh per family annually for secondary and tertiary hospitalisation [2]. West Bengal's accession as the 36th State/UT in June 2026 completes sub-national coverage [1], making its three foundational design choices ripe for evaluation.

SECC 2011 targeting - Merit: deprivation and occupational criteria auto-identify roughly 10.74 crore families without an application process, minimising exclusion by paperwork [2]. - Merit: the 2024 Cabinet decision extending income-agnostic cover to all aged 70+ through the Ayushman Vay Vandana Card corrects the rigidity of a purely deprivation-based list [4]. - Limitation: a frozen 2011 base misses post-2011 urban migrants and informal workers — the "missing middle" above the poverty line but below insurance affordability.

Insurance / trust / mixed mode - Merit: states choose insurance, trust or hybrid mode, with 60:40 Centre-State funding (90:10 for North-Eastern and Himalayan states) [3] — respecting health as a State subject and enabling opt-in by earlier holdouts such as Delhi, the 35th [5], and then West Bengal [1]. - Merit: trust mode gives states direct control over claim costs and package rates. - Limitation: claim-settlement speed and fraud detection vary with State Health Agency capacity, so equal entitlement yields unequal service.

Portability - Merit: cashless treatment at any empanelled hospital nationwide is a genuine equity gain for migrant workers [2]. - Limitation: its value depends on hospital density; in districts with few empanelled private facilities, portability remains notional. Cover is also hospitalisation-only, leaving outpatient and diagnostic out-of-pocket spending untouched.

On balance, PM-JAY's architecture is strong on financial-risk protection and federal flexibility, but weaker on database currency and supply-side depth. Periodically refreshing the beneficiary base and pairing demand-side assurance with supply-side capacity — Ayushman Arogya Mandirs and PM-ABHIM — would carry the scheme from wide enrolment towards genuine universal health coverage, realising Article 47 and SDG 3.8.

(~320 words)

Sources: 1. West Bengal Set to Become the 36th State/UT to Implement AB PM-JAY, PIB (2026) — West Bengal as 36th State/UT; MoU with NHA 2. About PM-JAY, National Health Authority — ₹5 lakh cover, SECC 2011 targeting, 10.74 crore families, portability 3. Implementation of National Health Protection Scheme, PIB — 60:40 and 90:10 funding split; insurance/trust/mixed modes 4. Cabinet approves health coverage to all senior citizens aged 70 years and above, PIB (2024) — income-agnostic 70+ cover, Vay Vandana Card 5. Delhi becomes 35th State/UT to implement AB PM-JAY, PIB (2025) — opt-in by earlier holdout states