Impact of India's publicly financed health insurance scheme on public sector district hospitals: a health financing perspective

Prinja, Shankar; Singh, Maninder Pal; Aggarwal, Vipul; Rajsekar, Kavitha; Gedam, Praveen; Goyal, Aarti; Bahuguna, Pankaj

doi:10.1016/j.lansea.2022.100123

Cited by 7 publications

(7 citation statements)

References 16 publications

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“…PM-JAY reimbursed Rs283 billion of medical expenses arising from 24 million admissions to over 24 000 empanelled hospitals up to July 2021 (online supplemental table S1). 25 However, the volume and value of claims varied markedly between states and specialties 26. Empanelled hospitals are mostly (56%) public and are disproportionately located in states that had NPHI prior to PM-JAY 27.…”

Section: Introductionmentioning

confidence: 99%

“…25 However, the volume and value of claims varied markedly between states and specialties. 26 Empanelled hospitals are mostly (56%) public and are disproportionately located in states that had NPHI prior to PM-JAY. 27 There have been reports of delays in claim reimbursement, lack of front-line worker capacity and variable access to treatment and satisfaction.…”

Section: Introductionmentioning

confidence: 99%

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Public health insurance coverage in India before and after PM-JAY: repeated cross-sectional analysis of nationally representative survey data

Mohanty,

Upadhyay,

Maiti

et al. 2023

BMJ Glob Health

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IntroductionThe provision of non-contributory public health insurance (NPHI) to marginalised populations is a critical step along the path to universal health coverage. We aimed to assess the extent to which Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (PM-JAY)—potentially, the world’s largest NPHI programme—has succeeded in raising health insurance coverage of the poorest two-fifths of the population of India.MethodsWe used nationally representative data from the National Family Health Survey on 633 699 and 601 509 households in 2015–2016 (pre-PM-JAY) and 2019–2021 (mostly, post PM-JAY), respectively. We stratified by urban/rural and estimated NPHI coverage nationally, and by state, district and socioeconomic categories. We decomposed coverage variance between states, districts, and households and measured socioeconomic inequality in coverage. For Uttar Pradesh, we tested whether coverage increased most in districts where PM-JAY had been implemented before the second survey and whether coverage increased most for targeted poorer households in these districts.ResultsWe estimated that NPHI coverage increased by 11.7 percentage points (pp) (95% CI 11.0% to 12.4%) and 8.0 pp (95% CI 7.3% to 8.7%) in rural and urban India, respectively. In rural areas, coverage increased most for targeted households and pro-rich inequality decreased. Geographical inequalities in coverage narrowed. Coverage did not increase more in states that implemented PM-JAY. In Uttar Pradesh, the coverage increase was larger by 3.4 pp (95% CI 0.9% to 6.0%) and 4.2 pp (95% CI 1.2% to 7.1%) in rural and urban areas, respectively, in districts exposed to PM-JAY and the increase was 3.5 pp (95% CI 0.9% to 6.1%) larger for targeted households in these districts.ConclusionThe introduction of PM-JAY coincided with increased public health insurance coverage and decreased inequality in coverage. But the gains cannot all be plausibly attributed to PM-JAY, and they are insufficient to reach the goal of universal coverage of the poor.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Public health insurance coverage in India before and after PM-JAY: repeated cross-sectional analysis of nationally representative survey data

Mohanty,

Upadhyay,

Maiti

et al. 2023

BMJ Glob Health

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show abstract

“…Prinja and colleagues 2 assessed the impact of India's publicly financed health insurance scheme on public sector district hospitals in Dec 2022 issue of the Journal. Therein they calculate State- and speciality-wise percent share of Pradhan Mantri Jan Arogya Yojana (PMJAY) claims (number and value) at district hospitals across the country along with net financial gain at district hospitals in cost efficient scenario.…”

mentioning

confidence: 99%

“…Therein they calculate State- and speciality-wise percent share of Pradhan Mantri Jan Arogya Yojana (PMJAY) claims (number and value) at district hospitals across the country along with net financial gain at district hospitals in cost efficient scenario. 2 The authors—which also included the Executive Director of National Health Authority—investigated funds transferred to government run hospitals under claims made by the staff and the difference it had with its actual expenditure. The authors found that as the former amount was higher, the health care service providers got monetary benefits which they might utilise under various heads to upgrade their infrastructure.…”

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confidence: 99%

“…When one visits the website of the Commission, it shows minimum standard requirements of teaching and non-teaching staff, medical equipments, infrastructure, land requirement etc. 4 But the study by Prinja and colleagues 2 avoids this point. During the study period, as the conversion from district hospitals to Medical Colleges had been going on, readers would like to know whether few or many hospitals under the observation underwent the transition and what were the cost implications.…”

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confidence: 99%

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