Institutional Architecture and Frozen Eligibility: Design Choices and Differentiated Outcomes in India’s Ayushman Bharat PM-JAY

Abstract:-
This paper examines the institutional architecture of India’s Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY), arguing that its design choices—rather than implementation deficits—shape the programme’s coverage patterns and governance outcomes. Using official documents, state-level reports, and comparative scheme histories, the analysis focuses on three dimensions: the creation of autonomous agencies operating parallel to existing health institutions; eligibility determination based on frozen foundational databases alongside selective categorical expansions; and the differentiated outcomes emerging from uneven state capacity. The paper shows how PM-JAY’s digital and fiscal infrastructure produces efficient claims processing within a fixed beneficiary universe while systematically excluding uninsured populations. It further demonstrates that performance-based financing reinforces pre-existing state inequalities. The findings contribute to debates on federalism, digital welfare platforms, and the political economy of health financing in India.

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