A kid in rural India gets a high fever. The family's nearest clinic is hours away, they don't know how to get there, and by the time they get to the hospital, the bill is more than what they make in a month. This isn't a rare case; it's something that happens every day to millions of people. Ayushman Bharat, which started in 2018, was meant to help with this kind of problem.

The Pradhan Mantri Jan Arogya Yojana (PM-JAY) is the main part of this big program. It is a huge health insurance plan paid for by the government that promises Rs 5 lakh of coverage per family per year to more than 50 crore people. Since it started, it has helped more than 6.2 crore people get into hospitals, which is worth Rs 77,000 crore. It's important to note that more than 60% of these treatments have taken place in private hospitals. This makes it much easier for many people who used to only go to public hospitals to get the care they need.

PM-JAY is a big step towards universal health coverage, but it only solves one part of a much bigger problem. It helps with the costs of being in the hospital, but it doesn't do much to help with the more common and just as harmful costs of seeing a doctor, getting tests done and buying medicines. Almost 60% of India's healthcare spending goes towards these daily costs, which aren't covered by the current plan. Families with chronic illnesses or ongoing health needs are still under a lot of financial stress even though they have insurance because they don't have outpatient coverage.

Ayushman Bharat was never meant to be just about hospital insurance, but this is something that most people don't talk about. The first pillar was PM-JAY, and the second was Health and Wellness Centres (HWCs), which were meant to provide primary and preventive care. There are almost 1.4 lakh HWCs that are said to be working, but it's not clear how well they work. Many people are suffering because they don't have enough staff, diagnostic tools, or services. So, instead of treating illness early on, patients are sent to hospitals, which is a costly and unnecessary step in many cases. India could end up with a healthcare system that reacts instead of preventing problems if it doesn't have a strong base of primary care.

There is also a big gap in knowledge. A 2021 survey by the National Health Authority found that almost one in four eligible households did not know they could get help through PM-JAY. For a lot of migrant and seasonal workers, problems with portability and access across state lines make things even more complicated. If a lot of people don't know about PM-JAY or can't get to it because of red tape, the plan can't live up to its full potential. If you don't recognise insurance when you need it, it doesn't mean much on paper.

The digital backbone of Ayushman Bharat is a quiet but powerful enabler, which is a good thing. More than 50 crore people now have Ayushman Bharat Health Account (ABHA) IDs. This makes it possible for digital health records, e-prescriptions and claims processing to happen in real time. If done with care and fairness in mind, these efforts could make healthcare delivery much more efficient and open. But along with technology, there must also be important changes to policies that focus on both access and continuity of care.

This leads us to a bigger point. PM-JAY is a brave and necessary step, but it is not a complete answer and should not be seen as such. The plan needs to change in order to really deliver on its promise of "health without hardship". It is very important to expand coverage to include outpatient care, important medicines and care for people with chronic diseases. It's just as important to invest in the quality and reach of Health and Wellness Centres as it is to count them. Outreach and awareness campaigns need to be nonstop, tailored to different cultures, and based in the community. Digital infrastructure should be used not only for monitoring but also for providing care that is easy, smart and focused on the needs of the people.

Ayushman Bharat has started the process of making the health system more open to everyone, but the work is far from over. We need to be careful not to mix up coverage with care or success with scale. Health insurance is important, but it can't replace a strong, caring, and complete public health system. The real goal is not just to lower hospital bills, but to make sure that getting sick doesn't mean losing your job.

The idea of health without hardship is good, needed, and possible. But we need to do more than just give out health cards to get there. We need to trust each other. We have to fill in the gaps. And we, as a country, must promise to see this mission through. We have given out life jackets. It's time to make the lifeboat now.

Pandey is an independent researcher and consultant in the field of public health.