Ayushman Bharat and Universal Health Coverage in India: Is our approach ethical?

The Ayushman Bharat Mission with its two inter-linked components, namely Health and Wellness centres and the Pradhan Mantri Jan Arogya Yojana, has been proposed as India's prime instrument for achieving universal health coverage. The insurance component of the mission has received priority over the primary healthcare component. Apart from efficiency reasons, there are strong ethical grounds to prioritize the primary care component over its insurance counterpart. There is also a need to consider the ethical dimensions of publicly financed health insurance in India. A robust priority setting process should guide the roll-out of universal health coverage. This is particularly crucial since a large scale expansion of PMJAY to the non-poor population is being currently envisaged by the government.