Pradhan Mantri Jan Arogya Yojana Research Articles

Spanning care and comfort: examining Pradhan Mantri Jan Arogya Yojana's role in enhancing well-being of individuals in South Gujarat

Purpose This study aims to delve into the impact of the Pradhan Mantri Jan Arogya Yojana (PMJAY) on the well-being and quality of life of beneficiaries in Surat City of India. Employing correlation and regression analyses, the study uncovers significant correlations between Awareness, Healthcare Utilisation, and Financial Burden Reduction with well-being outcomes. Design/methodology/approach The investigation employs a structured questionnaire to gather data from 250 beneficiaries, exploring the relationships between Awareness, Healthcare Utilisation, Financial Burden Reduction, Well-Being and quality of Life. The data was collected using a structured questionnaire using a survey method. Findings The results highlighted the crucial role of Awareness in empowering beneficiaries to make informed healthcare decisions, positively influencing their well-being. Furthermore, the study underscores how active engagement with PMJAY's healthcare services enhances well-being. The mitigation of financial burdens emerges as a pivotal factor, signifying the program's efficacy in improving beneficiaries' quality of life. Originality/value The comprehensive model presented in this study reveals that PMJAY's multifaceted approach is pivotal in promoting enhanced well-being and quality of life among beneficiaries. These findings affect public health policies seeking to create holistic interventions that holistically address vulnerable populations' healthcare access, financial burdens, and overall well-being.

The Future of Health Insurance in India: A Case of Ayushman Bharat

Introduction: In 2017, the National Health Policy recommended the introduction of Ayushman Bharat to promote Universal Health Coverage (UHC), with the aim of providing comprehensive, need-based, and equitable healthcare services to the Indian population. The scheme comprises two primary components: the creation of 1,50,000 Health and Wellness Centres (HWCs) and the implementation of the Pradhan Mantri Jan Arogya Yojana (PM-JAY). These initiatives aim to enhance infrastructure related to comprehensive primary healthcare, maternal and child healthcare, non-communicable diseases, and improved drug delivery and diagnostic services. Out of 28 states and 8 Union territories in India, Delhi, Odisha, and West Bengal have not implemented the AB-PMJAY scheme. Telangana joined the scheme in May 2021, and each state has adopted different models to accommodate their healthcare requirements. Objective: The study elicits the various aspects of Ayushman Bharat, the scheme’s evolution throughout different timelines and its future prospects. Conclusion: The Ayushman Bharat scheme has played an enormous role in achieving comprehensive healthcare system by leveraging various technologies and digital health methods. During the pandemic, the rates of utilization have changed, and Ayushman Bharat is anticipated to contribute significantly to achieve UHC in the future.

IJCM_261A: Reaching the unreachable: An outreach based approach of IGMC Shimla to organise Ayushmann Health Melas/ Camps at Secondary level facilities in 03 districts of Shimla, Solan and Bilaspur in vicinity of the college

Background: Soul of India lives in its villages with >65% population living in rural settings. Saturation of all services especially Health services is at core of “leave no one behind” in line with principle of ‘Antyodaya’ reaching out at all. To build momentum with Pradhan Mantri Jan Arogya Yojana Ayushman Health Camps were organised by IGMC Shimla at secondary level facilities under flagship campaign Ayushman Bhavah Objective: Evaluation of health care services delivered by IGMC Shimla in Ayushmann Health Melas at secondary level facilities of 03 districts of Himachal Pradesh. Methodology: Ayushman Melas organised by IGMC Shimla at secondary level facilities from September 2023 to December 2023 in 03 districts Shimla (25); Solan (12) and Bilaspur (13) for providing clinical services to beneficiaries. Real time portal based reporting and analysis of same alongwith specialitywise footfallbifurcation is core. Results: As per Real time-based portal report analysis a footfall of 10379 registered out of which 9055 (87.24%) availed specialists services and 1324(12.74%) general physician services. A net of 2672 (29.5%) beneficiaries availed internal medicine specialist services, 458 (5.05%) surgical, 1619 (17.87%) orthopaedics, 772 (8.52%) obstetrics and gynaecology, 1460 (16.12%) Opthalmology, 698 (7.7%) Otorhinolaryngology, 152 (1.67%) psychiatry, 493 (5.44%) dermatology and 731 (8.07%) paediatric services respectively. 1012(9.75%) new diagnosed Hypertensives and 945 (9.10%) new diagnosed Diabetics, 1492 14.37%) beneficiaries screened for Oral Cancers, 804 (7.75%) for breast cancers and 468 (4.5%) for cervical Cancers. 299 (2.88%) new diagnosed cataract cases. 10379 beneficiaries were tested for 11102 tests (106.96%). Conclusion: Comprehensive health care service delivery by camps to unreachable for screening, diagnosis, one stop multi-speciality consultancy, referral and digitalisation of health vitals.

Examining the factors contributing to a reduction in hardship financing among inpatient households in India

In India, the rising double burden of diseases and the low fiscal capacity of the government forces people to resort to hardship financing. This study aimed to examine the factors contributing to the reduction in hardship financing among inpatient households in India. The study relies on two rounds of National Sample Surveys with a sample of 34,478 households from the 71st round (2014) and 56,681 households from the 75th round (2018). We employed multivariable logistic regression and multivariate decomposition analyses to explore the factors associated with hardship financing in Indian households with hospitalized member(s) and assess the contributing factors to the reduction in hardship financing between 2014 and 2018. Notably, though hardship financing for inpatient households has decreased between 2014 and 2018, households with catastrophic health expenditure (CHE) had higher odds of hardship financing than those without CHE. While factors such as CHE, prolonged hospitalization, and private hospitals had impoverishing effects on hardship financing in 2014 and 2018, the decomposition model showed the potential of CHE (32%), length of hospitalization (32%), and private hospitals (24%) to slow down this negative impact over time. The findings showed the potential for further improvements in financial health protection for inpatient care over time, and underscore the need for continuing efforts to strengthen the implementation of public programs and schemes in India such as Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY).

Establishing a Health Technology Assessment Evidence Ecosystem in India’s Pradhan Mantri Jan Arogya Yojana

ABSTRACT The introduction of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) scheme in India was a significant step toward universal health coverage. The PM-JAY scheme has made notable progress since its inception, including increasing the number of people covered and expanding the range of services provided under the health benefit package (HBP). The creation of the Health Financing and Technology Assessment (HeFTA) unit within the National Health Authority (NHA) further enhanced evidence-based decision-making processes. We outline the journey of HeFTA and highlight significant cost savings to the PM-JAY as a result of health technology assessment (HTA). Our paper also discusses the application of HTA evidence for decisions related to inclusions or exclusions in HBP, framing standard treatment guidelines as well as other policies. We recommend that future financing reforms for strategic purchasing should strengthen strategic purchasing arrangements and adopt value-based pricing (VBP). Integrating HTA and VBP is a progressive approach toward health care financing reforms for large government-funded schemes like the PM-JAY.

A quasi-experimental study to assess the effectiveness of planned teaching program on knowledge regarding Ayushman Bharat Yojana among community people in Panchayatan village, Greater Noida, Uttar Pradesh

Background: The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is India’s government-funded health care program that benefits more than 10.74 million poor and vulnerable families. While Pradhan Mantri Jan Arogya Yojana (PMJAY) has helped to correct state imbalances in health care spending, it has not been sufficient to compensate for the inherent fiscal difficulties of poor states. Ayushman Bharat is a holistic need-based health care service which was developed to accomplish the sustainable development goals (SDGS). The purpose of conducting this research is to assess the knowledge regarding Ayushman Bharat Yojana to the people of Panchayatan village, Greater Noida. Methods: A quasi-experimental research design and convenience sampling technique was used to assess the effectiveness of planed teaching program on knowledge regarding Ayushman Bharat Yojana among 59 community people in Panchayatan village Greater Noida. Results: The study found that majority of the samples (64.4%) was between the ages of 16-35 years, (83.1%) were having no previous knowledge and (86.4%) were having no source of information. The findings show mean value of 11.7±4.16 knowledge level regarding Ayushman Bharat Yojana. The post-test mean score was 13.7 which was greater than the pre-test means score 9.6. Results show a significant association between the knowledge scores (post-test) with age (p=0.051) and monthly income (p=0.019). Conclusions: The findings concluded that the planned teaching program on knowledge regarding Ayushman Bharat Yojana among community people in Panchayatan village was effective in increasing the knowledge among community people.

Health Insurance in India: A look into Ayushman Bharat- Pradhan Mantri Jan Arogya Yojana

India had experienced rapid economic growth over the years and has been overtaking other countries both in terms of GNP and GNP (PPP). However, on social front, India’s performance is poor and is probably behind most of the important developing economies. While India does have some world-class health infrastructure providing topnotch treatment facilities, but they are way out of reach of the common people. These anomalies in the health sector have been recognized and taken in charge by the government through financial and human investment and also through various schemes and policies. Health insurance is one of the most popular health policy taken by the government and Ayushman Bharat is the latest one. This paper therefore discusses critically the Ayushman Bharat Scheme.

Refining the provider payment system of India’s government-funded health insurance programme: an econometric analysis

ObjectivesReimbursement rates in national health insurance schemes are frequently weighted to account for differences in the costs of service provision. To determine weights for a differential case-based payment system under...

Neonatal, Infant, and Child Mortality in India: Progress and Future Directions.

In India, considerable progress has been made in reducing child mortality rates. Despite this achievement, wide disparities persist across and socio-economic strata, and persistent challenges, such as malnutrition, poor sanitation, and lack of clean water. This paper provides a comprehensive review of the state of child health in India, examining key risk factors and causes of child mortality, assessing the coverage of child health interventions, and highlighting critical public health programs and policies. The authors also discuss future directions and recommendations for bolstering ongoing efforts to improve child health. These include state- and region-specific interventions, prioritizing social determinants of health, strengthening data systems, leveraging existing programs like the National Health Mission (NHM) and Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY), and the proposed Public Health Management Cadre (PHMC). The authors argue that reducing child mortality requires not only scaled-up interventions but a comprehensive approach that addresses all dimensions of health, from social determinants to system strengthening.

An Investigation into the Implementation Approaches of the Pradhan Mantri Jan Arogya Yojana in Four South Indian States

The majority of India’s overall health expenses are incurred through out-of-pocket spending, and the country’s national health policies are aimed at reducing out-of-pocket expenditure in order to achieve universal health coverage and provide access to healthcare services for all. In such context, Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana, the largest health insurance programme, was launched in 2018 with theview of providinghealthcare coverage of Rs.5,00,000 per household per year. The financial support for secondary and tertiary healthcare services offered by both public and private empaneled providers is supplied to India’s underprivileged households. There are three different models used for implementing the scheme, and the states choose a model with their own state insurance schemes to execute PM-JAY. In order to monitor the implementation in each state, State Health Agencies (SHA) have been set up and have been assigned to monitor all the operations related to the scheme. Funds for the scheme are distributed to the SHAs jointly by the central and state governments. The present study aims to analyse the mode of implementation by the share of private and public hospitals empaneled in Andhra Pradesh, Karnataka, Kerala and Tamil Nadu by using secondary data sources from government websites, reports, and data repositories.

Key drivers of reversal of trend in childhood anaemia in India: evidence from Indian demographic and health surveys, 2016–21

AimRecent National Family Health Survey results portray striking improvements in most population and health indicators, including fertility, family planning, maternal and child health, gender treatment, household environments, and health insurance coverage of the Pradhan Mantri Jan Arogya Yojana (PM-JAY), with all India resonance. However, the prevalence of any anaemia (< 11 g/dl) among children under age five has exhibited a reversed trajectory in recent years. Therefore, the present study explores key drivers of the reversal of the trend in the prevalence of childhood anaemia between 2015 and2021.MethodsData of four rounds of the National Family Health Survey (NFHS) were used to show the overall trend of anaemia among children. However, for the analysis of key drivers of the reversal trend of childhood anaemia, only the recent two rounds (NFHS-4 & NFHS-5) were used. Descriptive, bivariate multivariable analysis and Fairlie decomposition model were used to explore the drivers of the reversal of the trend in childhood anaemia.ResultsDuring the past two decades, India has seen a decline in the prevalence of childhood anaemia (NFHS-2 to NFHS-4). However, a reversal of trend was observed recently. The prevalence of anaemia among children aged 6–59 months increased from 59 percent in NFHS-4 to 67 percent in NFHS-5. In addition, the prevalence of mild anaemia increased from 23.3 percent in NFHS-2 to 28.7 percent in NFHS-5. However, the prevalence of moderate and severe anaemia declined considerably from NFHS-2 (40 percent and 4.1 percent) to NFHS-4 (28.7 percent and 1.6 percent), but showed an increase in the prevalence in NFHS-5 (36.3 percent and 2.2 percent). Among others, mothers’ educational attainment, anaemia status and socio-economic status emerge as the key drivers of the change in the prevalence of childhood anaemia.ConclusionThese findings may have vital implications for the ongoing Anaemia Mukt Bharat Programme, one of the government's dream projects in India.

Effects of the Indian National Health Insurance Scheme (PM-JAY) on Hospitalizations, Out-of-pocket Expenditures and Catastrophic Expenditures

ABSTRACT India launched one of the world’s largest health insurance programs, the Pradhan Mantri Jan Arogya Yojana (PM-JAY), targeting more than 500 million economically and socially disadvantaged Indians. PM-JAY is publicly funded and covers hospitalization costs in public and private facilities. We examine how PM-JAY has affected hospitalizations and out-of-pocket expenditures (OOPE), and given the high use of private health care in India, we compare these outcomes across public and private facilities. We conducted a household survey to collect data on socioeconomic and demographic information, health status and hospitalizations for more than 57,000 PM-JAY eligible individuals in six Indian states. Using multivariate regression models, we estimated whether PM-JAY was associated with any changes in hospitalizations, OOPE and catastrophic health expenditures (CHE) and whether these differed across public and private facilities. We found that PM-JAY was not associated with an increase in hospitalizations, but it increased the probability of visiting a private facility by 4.6% points (p < .05). PM-JAY was associated with a relative reduction of 13% in OOPE (p < .1) and 21% in CHE (p < .01). This was entirely driven by private facilities, where relative OOPE was reduced by 17% (p < .01) and CHE by 19% (p < .01). This implied that PM-JAY has shifted use from public to private hospitalizations. Given the complex healthcare system with the presence of parallel public and private systems in India, our study concludes that for economically and socially disadvantaged groups, PM-JAY contributes to improved access to secondary and tertiary care services from private providers.

Healthier mind builds healthier nation under ABArK

Background: The State of Karnataka launched a scheme called “Arogya Karnataka” as a part of universal health coverage following the Karnataka Integrated Public Health Policy 2017 and Karnataka Vision 2025 document. With the goal of achieving universal health coverage (UHC), Karnataka, a national leader in healthcare, launched the Arogya Karnataka scheme in March 2018. It was later integrated with the government of India's national health protection scheme Ayushman Bharat Pradhan Mantri Jan Arogya Yojana(AB-PMJAY) to help with financial protection. Mental health, as defined by the World Health Organization (WHO), refers to “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community”. Methods: A cross-sectional analysis of data collected from the State Health Agency, Suvarna Arogya Suraksha Trust (SAST) portal. The study was conducted for a period 12 months from January to December 2022. Results: The study included 7292 mental disorder patients, majority of were male (70.95%), having age group of 31-45 years (45.41%), and belonged to the Below poverty line (BPL) (94.54%). Majority of cases were psychoactive substance use (64%) followed by Schizophrenia (22%) and Mental Retardation (14%). Conclusions: Ayushman Bharat –PM-JAY Arogya Karnataka (AB-PMJAY ArK) has potential to reduce the out of pocket expenditure, distress financing and reduce catastrophic health expenditure which will lead to significant impact on health indices.

The Politics of Health Policy Agenda Setting in India: The Case of the PMJAY Program

ABSTRACT In 2018, India’s Prime Minister announced a new health insurance program, Pradhan Mantri Jan Arogya Yojana (PMJAY), aiming to cover over 500 million people. This paper seeks to document and explain the emergence of PMJAY on India’s political and policy agendas. We analyze media, election manifestos, legislative debates, and health budgets to compare PMJAY’s presence on India’s policy agenda to previous health programs. We then apply Kingdon’s Multiple Streams Framework to explain the program’s emergence and adoption, validating our data and interpretations through consultations with Indian health policy experts. Comparing respective launch years, PMJAY was covered in national newspapers 37 to 212 times more than previous flagship health programs, although it was not more prominent in parliamentary debates or in the health budget. Events in the problem, politics, and policy streams converged to enable its prominence. Health policy elites who favored insurance as a policy to address out-of-pocket health expenditures gained influence after the 2014 election victory of the Bharatiya Janata Party (BJP). PMJAY’s naming and branding, scale, timing, implementation style, and design aligned with both the BJP’s ideology and political strategy. PMJAY represents the increased prominence of health programs in Indian politics, although primarily on the political and media agenda, rather than on the budgetary and legislative agenda during this period. The political forces that facilitated its emergence also shaped its design in ways that are likely to affect the Indian health system’s ability to provide comprehensive financial protection in the future.

Study of awareness, enrolment, and utilization of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana in Gujarat, India

Background: Ayushman Bharat-Pradhanmantri Jan Arogya Yojana (AB-PMJAY) envisages complete financial protection for around 50 crores of identified poor and vulnerable Indian beneficiaries against their catastrophic health care needs. Awareness is a pre-requisite that ensures enrolment and utilization of any health insurance program. Being a newly implemented scheme, very few studies are reported on the level of awareness, enrolment, and utilization of the AB-PMJAY scheme as well as the sources of information and support to the beneficiaries from Gujarat. So, this study aims to assess the current status of awareness, enrolment, and utilization of AB-PMJAY in Gujarat. Methods: A multi-stage sampling method was used in this cross-sectional study in both rural and urban areas and altogether 1152 households were randomly selected from three districts of Gujarat. Ten trained field investigators collected data with the help of a structured interview schedule. Results: AB-PMJAY is popular in Gujarat, with 24% high-level awareness and 47.8% moderate-level awareness. Out of 1152 households, 82.9% had AB-PMJAY cards, with a 43.3% utilization rate. Factors affecting awareness include area of living, religion, and caste. While 22.9% reported out-of-pocket (OOP) expenditure with AB-PMJAY benefits, 15.1% reported non-utilization of their AB-PMJAY cards, despite needed. ASHA workers and Ayushman Mitras were the major sources of information. Conclusions: The reported utilization rate in this study was only 43.3%, despite having impressive awareness and enrolment rates. The OOP costs must be reduced, and the issues that prevented households from using the AB-PMJAY benefits despite their need must be addressed.

The genesis ofthe PM-JAY health insurance scheme inIndia: technical andpolitical elements influencing a national reform towards universal health coverage.

Many countries are using health insurance to advance progress towards universal health coverage (UHC). India launched the Pradhan Mantri Jan Arogya Yojana (PM-JAY) health insurance scheme in 2018. We examine the political economy context around PM-JAY policy formulation, by examining the perspectives of policy stakeholders shaping decisions around the reform. More specifically, we focus on early policy design at the central (national) level. We use a framework on the politics of UHC reform proposed by Fox and Reich (The politics of universal health coverage in low- and middle-income countries: A framework for evaluation and action. J. Health Polit. Policy Law 2015;40:1023-1060), to categorize the reform into phases and examine the interactions between actors, institutions, interests, ideas and ideology which shaped reform decisions. We interviewed 15 respondents in Delhi between February and April 2019, who were either closely associated with the reform process or subject experts. The ruling centre-right government introduced PM-JAY shortly before national elections, drawing upon policy legacies from prior and state insurance schemes. Empowered policy entrepreneurs within the government focused discourse around ideas of UHC and strategic purchasing, and engaged in institution building leading to the creation of the National Health Authority and State Health Agencies through policy directives, thereby expanding state infrastructural and institutional power for insurance implementation. Indian state inputs were incorporated in scheme design features like mode of implementation, benefit package and provider network, while features like the coverage amount, portability of benefits and branding strategy were more centrally driven. These balanced negotiations opened up political space for a cohesive, central narrative of the reform and facilitated adoption. Our analysis shows that the PM-JAY reform focused on bureaucratic rather than ideological elements and that technical compromises and adjustments accommodating the interests of states enabled the political success of policy formulation. Appreciating these politics, power and structural issues shaping PM-JAY institutional design will be important to understand how PM-JAY is implemented and how it advances UHC in India.

Implementation of PM-JAY in India: a qualitative study exploring the role of competency, organizational and leadership drivers shaping early roll-out of publicly funded health insurance in three Indian states

BackgroundThe Pradhan Mantri Jan Arogya Yojana (PM-JAY), a publicly funded health insurance scheme, was launched in India in September 2018 to provide financial access to health services for poor Indians. PM-JAY design enables state-level program adaptations to facilitate implementation in a decentralized health implementation space. This study examines the competency, organizational, and leadership approaches affecting PM-JAY implementation in three contextually different Indian states.MethodsWe used a framework on implementation drivers (competency, organizational, and leadership) to understand factors facilitating or hampering implementation experiences in three PM-JAY models: third-party administrator in Uttar Pradesh, insurance in Chhattisgarh, and hybrid in Tamil Nadu. We adopted a qualitative exploratory approach and conducted 92 interviews with national, state, district, and hospital stakeholders involved in program design and implementation in Delhi, three state capitals, and two anonymized districts in each state, between February and April 2019. We used a deductive approach to content analysis and interpreted coded material to identify linkages between organizational features, drivers, and contextual elements affecting implementation.Results and conclusionPM-JAY guideline flexibilities enabled implementation in very different states through state-adapted implementation models. These models utilized contextually relevant adaptations for staff and facility competencies and organizational and facilitative administration, which had considerable scope for improvement in terms of recruitment, competency development, programmatic implementation support, and rationalizing the joint needs of the program and implementers. Adaptations also created structural barriers in staff interactions and challenged implicit power asymmetries and organizational culture, indicating a need for aligning staff hierarchies and incentive structures. At the same time, specific adaptations such as decentralizing staff selection and task shifting (all models); sharing of claims processing between the insurer and state agency (insurance and hybrid model); and using stringent empanelment, accreditation, monitoring, and benchmarking criteria for performance assessment, and reserving secondary care benefit packages for public hospitals (both in the hybrid model) contributed to successful implementation. Contextual elements such as institutional memory of previous schemes and underlying state capacities influenced all aspects of implementation, including leadership styles and autonomy. These variations make comparisons across models difficult, yet highlight constraints and opportunities for cross-learning and optimizing implementation to achieve universal health coverage in decentralized contexts.

KNOWLEDGE AND UTILIZATION OF “PRADHAN MANTRI JAN AROGYAYOJANA-AYUSHMAN BHARAT” (PMJAY-AB) SCHEME AMONG THE ELIGIBLE FAMILIES IN SELECTED RURAL COMMUNITY LUCKNOW

Ayushman Bharat yojana have two inter-related components, which are Health and wellness center (HWCs) and Pradhan Mantri Jan Arogya Yojana (PM-JAY). Pradhan Mantri Jan Arogya Yojana is the National health protection scheme introduced on 23 September 2018 by the government of India targeting poor, socioeconomically weaker and disadvantaged families. It is a centrally sponsored scheme funded by both the union government and the state. This scheme is offering services to 50 crore re people with world's largest government sponsored healthcare program. The study was initiated to assess the knowledge and utilization of “Pradhan Mantri Jan Arogya YojanaAyushman Bharat” (PMJAY-AB) scheme among the eligible families of selected rural community Lucknow. The objective of the study was to assess the knowledge and utilization of PMJAY-AB scheme among the eligible families of selected rural community in Lucknow and to correlate the knowledge with the utilization of PMJAY-AB scheme. Non experimental descriptive survey research design was used by using convenience sampling technique to collect the data from 150 samples through structured questionnaires. Finding of the study reveals that the majority of people 58 (38.67%) had moderate adequate knowledge, 49 (32.67%) had an inadequate knowledge and, only 43(28.67%) people had an adequate knowledge regarding PMJAY-AB scheme. Utilization rates reveals the majority of people 90.67% are poorly utilizating the scheme while 6.67% had average utilization and only 2.67% people are utilizing the full services covered under the PMJAY-AB scheme. Hence the study concludes that the community people needs awareness regarding the Pradhan Mantri Jan ArogyaYojana-Ayushman Bharat” (PMJAY-AB) scheme to ensure full coverage.

Evolution of Government-funded health insurance for universal health coverage in India.

India has run multiple Government-Funded Health Insurance schemes (GFHIS) over the past decades to ensure affordable healthcare. We assessed GFHIS evolution with a special focus on two national schemes - Rashtriya Swasthya Bima Yojana (RSBY) and Pradhan Mantri Jan Arogya Yojana (PMJAY). RSBY suffered from a static financial coverage cap, low enrollment, inequitable service supply, utilization, etc. PMJAY expanded coverage and mitigated some of RSBY's drawbacks. Investigating equity in PMJAY's supply and utilization across geography, sex, age, social groups, and healthcare sectors depicts several systemic skews. Kerala and Himachal Pradesh with low poverty and disease burden use more services. Males are more likely to seek care under PMJAY than females. Mid-age population (19-50 years) is a common group availing services. Scheduled Caste and Scheduled Tribe people have low service utilization. Most hospitals providing services are private. Such inequities can lead the most vulnerable populations further into deprivation due to healthcare inaccessibility.

Facilitating Cancer Care Through Ayushman Bharat Scheme (PMJAY) in Rural Places of India: A Narrative Review

&#x0D; Pradhan Mantri Jan Arogya Yojana (PMJAY) also known as Ayushman Bharat or flagship National Health Protection Scheme is funded by the Government of India. The scheme takes into account not only the poor but rural families also, and that is why it is economically beneficial to the poor households in rural and urban areas. Either due to lack of funds or due to paucity of health care facilities at adjacent centres, cancer care in rural areas has always been suboptimal. Poor people are almost always on the verge of facing economic toxicities during cancer diagnosis, treatment or rehabilitation. Despite various available regional and national programs for healthcare in India, lack of insurance scheme was an inseparable problem. Ayushman Bharat scheme provides financial protection for access curative care at secondary and tertiary levels through engagement with both public and private sector. Pradhan Mantri Jan Arogya Yojana (PM-JAY) and Health and Wellness Centres (HWCs) are the two major components. Ayushman Bharat provides India with a great opportunity to improve the quality of health-care delivery by linking reimbursements directly to adherence to evidence-based management guidelines. Newer modalities of radiotherapy, chemotherapy and other biological therapies have been included under this scheme. Removes the burden of out of pocket expenditures. In Spite of multiple benefits PMJAY is not out of fallacies. Paucity of health care services, difficulties with implementation, failure in compensating associated indirect costs are the major drawbacks. Opportunities like delivering affordable and equitable cancer care in India, digitalization, removing heterogeneity across rural and urban India are the future perspectives. To conclude, if PMJAY can overcome these shortcomings, and also incorporate a hospital cash component, it could genuinely claim to be the world’s largest and most successful national health protection scheme.&#x0D;