Asian Bioethics Review

, Volume 11, Issue 1, pp 69–80 | Cite as

Ayushman Bharat National Health Protection Scheme: an Ethical Analysis

  • Vijayaprasad GopichandranEmail author
Original Paper


The Ayushman Bharat (Hindi for “India blessed with a long life”) scheme is a government health insurance program that will cover about 100 million poor and vulnerable families in India providing up to INR 0.5 million per family per year for secondary and tertiary care hospitalization services. In addition, it also proposes to establish 150,000 health and wellness centers all over the country providing comprehensive primary health care. The beneficiaries of the hospital insurance scheme can avail health care services from both public and empanelled private health facilities. This scheme is one of the largest government-sponsored health insurance schemes in the world. Previous experience with government-financed health insurance schemes in India has shown that they are inequitable, inefficient, and do not provide financial protection. There is a lack of clarity on the budgetary provisions over the years when the utilization is likely to increase. The Ayushman Bharat scheme in its current form strengthens the “for profit” private health sector, requiring greater emphasis on its regulation. The scheme, which has primary, secondary, and tertiary care components, places a great focus on the secondary and tertiary care services and requires more investment in comprehensive primary health care. The potential problems of “profit-motivated” supplier-induced demand by private health care providers and corrupt practices are possible ethical burdens of the scheme. For the Ayushman Bharat to meet the ethical principle of justice, it should first address universal coverage of comprehensive primary health care and move on to hospital insurance in a progressive manner. The scheme should have provisions to strictly regulate secondary and tertiary care hospitalization in the private health sector to prevent misuse. It is the ethical responsibility of the government to ensure a strong and robust public health system, but the current provisioning of the Ayushman Bharat scheme does not do this and the reasons for this are explained in this paper.


Ayushman Bharat Health insurance Universal Health Coverage India Health systems research Health financing 



The author would like to acknowledge the critical inputs of Dr Sudharshini Subramaniam MD, on a previous version of this paper.


  1. Bakshi, Harsh, Rashmi Sharma, and Pradeep Kumar. 2018. Ayushman Bharat initiative (2018): what we stand to gain or lose! Indian Journal of Community Medicine 43: 63. Scholar
  2. Bang, Abhay, Mirai Chatterjee, Jashodhra Dasgupta, Anu Garg, Yogesh Jain, A. K. Shiva Kumar, Nachiket Mor, Vinod Paul, P. K. Pradhan, M. Govinda Rao, et al. 2011. High level expert group report on universal health coverage for India. New Delhi. Available from: Accessed 29 Mar 2019.
  3. Chatterjee, Patralekha. 2018. India launches Ayushman Bharat’s secondary care component. Lancet 392: 997. Scholar
  4. Chokshi, Maulik, B. Patil, R. Khanna, Sutapa Bandyopadhyay Neogi, Jyoti Sharma, V.K. Paul, and Sanjay Zodpey. 2016. Health systems in India. Journal of Perinatology 36 (Suppl 3): S9–S12.
  5. Dasgupta, R., and I. Qadeer. 2005. The National Rural Health Mission (NRHM): a critical overview. Indian Journal of Public Health 49 (3): 138–140.Google Scholar
  6. Dash, U. and V. R. Muraleedharan. 2011. How equitable is employees’ state insurance scheme in India?: a case study of Tamil Nadu. London: Consortium for Research on Equitable Health Systems (CREHS). Available from: Accessed 29 Mar 2019.
  7. Devadasan, Narayanan, Tanya Seshadri, Mayur Trivedi, and Bart Criel. 2013. Promoting universal financial protection: evidence from the Rashtriya Swasthya Bima Yojana (RSBY) in Gujarat, India. Health Research Policy and Systems 11: 29. Scholar
  8. Evans, David B., Justine Hsu, and Ties Boerma. 2013. Universal health coverage and universal access. Bulletin of the World Health Organization 91 (8): 546–546A. Scholar
  9. Ghosh, Soumitra. 2018. Publicly financed health insurance schemes. Economic and Political Weekly 53 (23): 16–18.Google Scholar
  10. Griggs, David, Mark Stafford-Smith, Owen Gaffney, Johan Rockström, Marcus C. Öhman, Priya Shyamsundar, Will Steffen, Gisbert Glaser, Norichika Kanie, and Ian Noble. 2013. Policy: sustainable development goals for people and planet. Nature 495 (7441): 305–307. Scholar
  11. Guru, G. 2018. Ayushman Bharat—long live private healthcare. Economic and Political Weekly 53 (46): 8 Available from:—long-live-private.html%0A. Accessed 29 Mar 2019.Google Scholar
  12. Hou, Xiaohui, and Robert Palacios. 2011. Hospitalization patterns in RSBY: Preliminary evidence from the MIS. In India’s health insurance scheme for the poor: evidence from the early experience of the Rashtriya Swasthya Bima Yojana, ed. Robert Palacios, Jishnu Das, and Changqing Sun, 117–152. New Delhi: Centre for Policy Research.Google Scholar
  13. Jan Swasthya Abhiyan. 2018. Abandon Ayushman Bharat. Economic and Political Weekly 53 (39): 5.Google Scholar
  14. Karan, Anup, Arpita Chakraborty, Hema Matela, Swati Srivastava, Sakthivel Selvaraj, Elna James Kattoor, Lakshmi Ramakrishnan, Tirumaal Arumugam, Umakant Dash, V.R. Muraleedharan, and Girija Vaidyanathan. 2017. Process evaluation report of Chief Minister’s comprehensive health insurance scheme, Tamil Nadu. New Delhi: Public Health Foundation of India.Google Scholar
  15. Khanna, Renu. 2011. Universal health coverage in Thailand: what lessons can India learn? Medico Friend Circle Bulletin 342–344 (Aug2010-Jan2011): 34–42 Available at: Accessed 29 Mar 2019.Google Scholar
  16. Lahariya, Chandrakant. 2018. ‘Ayushman Bharat’ program and universal health coverage in India. Indian Pediatrics 55: 495–506 Available at: Accessed 29 Mar 2019.CrossRefGoogle Scholar
  17. Nandan, Deoki. 2010. National rural health mission: turning into reality. Indian Journal of Community Medicine 35 (4): 453. Scholar
  18. Nandi, Arindam, Ashvin Ashok, and Ramanan Laxminarayan. 2013. The socioeconomic and institutional determinants of participation in India’s health insurance scheme for the poor. PLoS One 8 (6): e66296. Scholar
  19. Nandi, Sulakshana, Helen Schneider, and Priyanka Dixit. 2017. Hospital utilization and out of pocket expenditure in public and private sectors under the universal government health insurance scheme in Chhattisgarh state, India: lessons for universal health coverage. PLoS One 12: e0187904. Scholar
  20. Nandi, Sulakshana, Helen Schneider, and Samir Garg. 2018. Assessing geographical inequity in availability of hospital services under the state-funded universal health insurance scheme in Chhattisgarh state, India, using a composite vulnerability index. Global Health Action 11 (1): 1541220. Scholar
  21. National Health Authority (NHA). 2018. About Pradhan Mantri Jan Aarogya Yojna (PM-JAY). [cited 7 January 2019]. Available from: Accessed 29 Mar 2019.
  22. Prinja, Shankar, Akashdeep Singh Chauhan, Anup Karan, Gunjeet Kaur, and Rajesh Kumar. 2017. Impact of publicly financed health insurance schemes on healthcare utilization and financial risk protection in India: a systematic review. PLoS One 12: e0170996. Scholar
  23. Pulla, Venkat. 2018. Unwanted hysterectomies in India: paid by public insurance schemes. Space and Culture, India 6: 1–6.CrossRefGoogle Scholar
  24. Ramani, K.V., and Dileep Mavalankar. 2006. Health system in India: opportunities and challenges for improvements. Journal of Health Organization and Management 20: 560–572. Scholar
  25. Rao, M., S.S. Ramachandra, S. Bandyopadhyay, A. Chandran, R. Shidhaye, S. Tamisettynarayana, A. Thippaiah, M. Sitamma, M. Sunil George, V. Singh, S. Sivasankaran, and S.I. Bangdiwala. 2011a. Addressing healthcare needs of people living below the poverty line: a rapid assessment of the Andhra Pradesh Health Insurance Scheme. National Medical Journal of India 24 (6): 335–341.Google Scholar
  26. Rao, Mohan, Krishna D. Rao, A.K. Shiva Kumar, Mirai Chatterjee, and Thiagarajan Sundararaman. 2011b. Human resources for health in India. Lancet 377: 587–598. Scholar
  27. Selvaraj, Sakthivel, and Anup K. Karan. 2012. Why publicly-financed health insurance schemes are ineffective in providing financial risk protection. Economic and Political Weekly 47 (11): 60–68.Google Scholar
  28. Shahrawat, Renu, and Krishna D. Rao. 2012. Insured yet vulnerable: out-of-pocket payments and India’s poor. Health Policy Planning 27 (3): 213–221. Scholar
  29. Shaikh, Maaz, Sanne A.E. Peters, Mark Woodward, Robyn Norton, and Vivekanand Jha. 2018. Sex differences in utilisation of hospital care in a state-sponsored health insurance programme providing access to free services in South India. BMJ Global Health 3 (3): e000859. Scholar
  30. Sundararaman, Thiagarajan. 2017. National Health Policy 2017: a cautious welcome. Indian Journal of Medical Ethics 2 (2): 69. Scholar
  31. Sundararaman, Thiagarajan, V.R. Muraleedharan, and Indranil Mukhopadhyay. 2016. NSSO 71st round data on health and beyond: questioning frameworks of analysis. Economic and Political Weekly 51 (3): 85.Google Scholar
  32. Taneja, Pawan Kumar, and Shallini Taneja. 2016. Rashtriya Swasthya Bima Yojana (RSBY) for universal health coverage. Asian Journal of Management Cases 13 (2): 108–124. Scholar
  33. Trivedi, Mayur, and Deepak B. Saxena. 2013. Third angle of RSBY: service providers’ perspective to RSBY-operational issues in Gujarat. Journal of Family Medicine and Primary care 2 (2): 169–172. Scholar
  34. van Dijk, Christel E., Bernard van den Berg, Robert A. Verheij, Peter Spreeuwenberg, Peter P. Groenewegen, and Dinny H. de Bakker. 2013. Moral hazard and supplier-induced demand: Empirical evidence in general practice. Health Economics 22 (3): 340–352. Scholar

Copyright information

© National University of Singapore and Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Department of Community MedicineEmployees State Insurance Corporation Medical College and Post Graduate Institute of Medical Sciences and ResearchChennaiIndia

Personalised recommendations