Which feature best distinguishes Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) from the National Health Mission (NHM) in terms of target population and coverage model?

Explanation

## Distinguishing Features of AB-PMJAY and NHM ### AB-PMJAY (Ayushman Bharat – PMJAY) **Key Point:** AB-PMJAY is a **targeted, cashless health insurance scheme** launched in 2018 with a defined beneficiary population. - Covers **secondary and tertiary hospitalization** only (not outpatient or primary care) - Beneficiaries: **40 crore individuals** (approx. 10 crore families) from economically weaker sections - **Fixed annual coverage**: ₹5 lakh per family per year - Operates through **empaneled private and government hospitals** - **Cashless at point of service** (no out-of-pocket expense for covered procedures) - Focused on **reducing financial catastrophe** from hospitalization ### NHM (National Health Mission) **Key Point:** NHM is a **health system strengthening and outcome-focused program** with no fixed beneficiary list. - Launched in 2013; subsumed NRHM (2005) and NUHM - Covers **all population groups** — no income-based exclusion - Focuses on **maternal and child health, communicable and non-communicable disease prevention** - Strengthens **primary, secondary, and tertiary infrastructure** - Includes **outpatient, inpatient, and preventive services** - **No fixed annual coverage ceiling** — aims for universal health coverage - Emphasizes **health system capacity building** (workforce, equipment, surveillance) ### Comparison Table | Feature | AB-PMJAY | NHM | | --- | --- | --- | | **Model** | Cashless insurance | Health system strengthening | | **Target Population** | Defined (40 crore economically weaker) | Universal (all population) | | **Coverage Type** | Secondary/tertiary hospitalization only | Primary, secondary, tertiary + preventive | | **Annual Limit** | ₹5 lakh per family | No fixed ceiling | | **Beneficiary List** | Fixed and pre-identified | Entire population | | **Outpatient Coverage** | No | Yes | | **Primary Focus** | Financial protection from hospitalization | Health outcomes + system capacity | **High-Yield:** The **single best discriminator** is that AB-PMJAY has a **defined beneficiary list with a fixed annual ceiling**, whereas NHM is a **universal program with no beneficiary ceiling** aimed at comprehensive health system strengthening. **Clinical Pearl:** AB-PMJAY is a **safety net for catastrophic hospitalization costs**; NHM is the **backbone of India's public health infrastructure**. They are **complementary, not competing** — a patient covered under AB-PMJAY may also benefit from NHM-strengthened facilities.