[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)

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.