What are the key differences between Ayushman Bharat and the National Health Mission?
Of course. This is an excellent and frequently asked question that touches upon the evolution of India's public health strategy. Let's break down the differences between the National Health Mission (NHM) and Ayushman Bharat (AB) in a structured manner suitable for your UPSC preparation.
Opening
The National Health Mission (NHM) and Ayushman Bharat (AB) represent two distinct yet complementary pillars of India's public health architecture. While both aim to improve health outcomes, they differ fundamentally in their approach, scope, and financing mechanisms. NHM is a broad, systems-strengthening program focused on primary and secondary healthcare infrastructure and services, whereas Ayushman Bharat is a more targeted, insurance-based model aimed at providing financial protection for tertiary care and establishing a robust primary care network. Understanding their differences is crucial for analysing the shift in India's health policy from a supply-side, infrastructure-focused approach to a demand-side, entitlement-based one.
Comparison Table: NHM vs. Ayushman Bharat
| Feature | National Health Mission (NHM) | Ayushman Bharat (AB) |
|---|---|---|
| Launch Year | Launched as National Rural Health Mission (NRHM) in 2005. Subsumed National Urban Health Mission (NUHM) in 2013 to become NHM. | Launched on 23rd September 2018. |
| Core Objective | Strengthening the public health system, reducing Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR), and ensuring universal access to equitable, affordable, and quality healthcare services. | To achieve Universal Health Coverage (UHC) through financial protection for secondary and tertiary care hospitalisation and strengthening primary healthcare. |
| Components | 1. National Rural Health Mission (NRHM) 2. National Urban Health Mission (NUHM) 3. Tertiary Care Programmes 4. Human Resources for Health & Medical Education | 1. Health and Wellness Centres (HWCs) 2. Pradhan Mantri Jan Arogya Yojana (PM-JAY) |
| Approach | Supply-side intervention: Focuses on building and strengthening public health infrastructure (PHCs, CHCs), human resources (ASHAs), and service delivery. | Demand-side & Supply-side: PM-JAY is a demand-side, entitlement-based insurance scheme. HWCs are a supply-side strengthening of primary care. |
| Target Beneficiaries | Universal: Aims to serve the entire population through the public health system, with a special focus on women, children, and vulnerable groups in rural and urban areas. | Targeted (for PM-JAY): Bottom 40% of the population (over 12 crore families) identified based on Socio-Economic Caste Census (SECC) 2011 data for rural and urban areas. HWCs are universal. |
| Financial Protection | Indirect, through free or highly subsidised services at public facilities (e.g., Janani Shishu Suraksha Karyakram - JSSK). No fixed insurance cover. | Direct & Defined: PM-JAY provides a health cover of ₹5 lakh per family per year for secondary and tertiary care hospitalisation. |
| Financing Model | Programmatic funding from the Union Budget to states as grants-in-aid. States contribute a matching share (typically 60:40 for general states, 90:10 for NE/Himalayan states). | Insurance/Trust Model: States can implement PM-JAY through an insurance company (insurance model), a state-run trust (trust model), or a combination (hybrid model). HWCs are funded similarly to NHM. |
| Service Delivery | Primarily through government-owned public health facilities (Sub-Centres, PHCs, CHCs, District Hospitals). | Through a network of empanelled public and private hospitals for PM-JAY. HWCs upgrade existing Sub-Centres and PHCs. |
Key Differences Explained
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Philosophical Shift: NHM represents the traditional public health approach of strengthening government infrastructure and human resources. It is a classic supply-side intervention. Ayushman Bharat, particularly its PM-JAY component, marks a significant policy shift towards a demand-side, entitlement-based model. It empowers beneficiaries with a defined financial entitlement (the ₹5 lakh cover) to purchase services from both public and private providers, thereby creating demand.
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Focus of Care: While NHM has a broad mandate covering primary, secondary, and some tertiary care, its core strength and focus have been on Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCH+A) and controlling communicable diseases. Ayushman Bharat has a dual focus: its HWC component strengthens comprehensive primary care, while the PM-JAY component is exclusively for secondary and tertiary care hospitalisation, addressing catastrophic health expenditure.
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Beneficiary Identification: NHM's services are, in principle, universal for anyone visiting a public facility. Ayushman Bharat's PM-JAY component is strictly targeted. It uses the deprivation and occupational criteria from the SECC 2011 database to identify eligible families, making it one of the largest targeted welfare schemes globally.
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Role of the Private Sector: NHM's engagement with the private sector is limited, often restricted to public-private partnerships (PPPs) for specific services. In contrast, PM-JAY fundamentally integrates the private sector into public service delivery. It creates a large, government-funded market for healthcare, with private hospitals being major service providers. As per the PM-JAY Dashboard, a significant portion of empanelled hospitals are private.
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Financial Mechanism: NHM operates on a traditional budgetary allocation model where funds flow from the centre to State Health Societies. PM-JAY operates on a per-capita premium model. The central and state governments pay a premium (or contribute to a trust fund) for each enrolled family, creating a more predictable, insurance-like financial flow to cover hospitalisation claims.
UPSC Angle
For the Civil Services Examination, examiners are not just looking for a simple list of differences. They expect you to understand the implications of these differences.
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Continuum, Not Conflict: Frame your answer to show that Ayushman Bharat does not replace NHM but rather builds upon it. The Ayushman Bharat-HWCs are, in fact, an extension and strengthening of the primary care network that NHM painstakingly built. PM-JAY fills the critical gap of tertiary care financing that NHM did not explicitly cover.
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Health Economics: Link this topic to core economic concepts. Discuss the shift from supply-side to demand-side interventions. Analyse the problem of catastrophic health expenditure and how PM-JAY is designed to address it. As per the National Health Accounts Estimates 2019-20, Out-of-Pocket Expenditure (OOPE) as a share of Total Health Expenditure declined to 47.1%, a trend that schemes like PM-JAY aim to accelerate.
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Federalism: Highlight the aspect of cooperative federalism. Both schemes are Centrally Sponsored, requiring state participation and funding. However, PM-JAY offers states flexibility in implementation (insurance vs. trust model), which is a key feature to mention in questions related to Centre-State relations.
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Challenges and Way Forward: A high-scoring answer will critically analyse the challenges. For NHM, this includes workforce shortages and infrastructure gaps. For PM-JAY, challenges include regional disparities in