Abstract
In September 2018, India launched Pradhan Mantri Jan Arogya Yojana (PM-JAY), a nationally implemented government-funded health insurance scheme to improve access to quality inpatient care, increase financial protection, and reduce unmet need for the most vulnerable population groups. This protocol describes the methodology adopted to evaluate implementation processes and early effects of PM-JAY in seven Indian states. The study adopts a mixed and multi-methods concurrent triangulation design including three components: 1. demand-side household study, including a structured survey and qualitative elements, to quantify and understand PM-JAY reach and its effect on insurance awareness, health service utilization, and financial protection; 2. supply-side hospital-based survey encompassing both quantitative and qualitative elements to assess the effect of PM-JAY on quality of service delivery and to explore healthcare providers’ experiences with scheme implementation; and 3. process documentation to examine implementation processes in selected states transitioning from either no or prior health insurance to PM-JAY. Descriptive statistics and quasi-experimental methods will be used to analyze quantitative data, while thematic analysis will be used to analyze qualitative data. The study design presented represents the first effort to jointly evaluate implementation processes and early effects of the largest government-funded health insurance scheme ever launched in India.
Highlights
In line with global efforts aimed at leaving no one behind while advancing universal health coverage (UHC), recent health sector reforms in India have strived to expand social health protection for the most vulnerable segments of society while simultaneously strengthening delivery of quality healthcare services
We identified a non-random sample of 6 empaneled and 6 non-empaneled hospitals in each of 14 of the abovementioned 16 districts (the supply-side hospital evaluation was not conducted in two districts: Gaya (Bihar) and Rampur
In each of the three guides, we explore the fidelity of implementation to the original design and related adaptations; changes to administrative structures and authority within governing institutions; changes in implementation processes; how stakeholders responded to implementation; and any unintended consequences arising from implementation processes
Summary
In line with global efforts aimed at leaving no one behind while advancing universal health coverage (UHC), recent health sector reforms in India have strived to expand social health protection for the most vulnerable segments of society while simultaneously strengthening delivery of quality healthcare services This strategy has largely been pursued through the implementation of government-funded health insurance (GFHI) schemes implemented at either federal or state levels [1], aimed at improving access to quality health care while offering financial protection to end users. A review of numerous impact studies on one specific Indian scheme, Rashtriya Swasthya Bima Yojana (RSBY), highlights methodological weaknesses in existing studies and calls for more rigorous evaluations [18] This paucity of evidence is surprising considering that the scope of GFHI implementation in the Indian context can offer numerous opportunities for learning at the global level
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