Performance of India’s national publicly funded health insurance scheme, Pradhan Mantri Jan Arogaya Yojana (PMJAY), in improving access and financial protection for hospital care: findings from household surveys in Chhattisgarh state

Abstract

Background: A national Publicly Funded Health Insurance (PFHI) scheme called Pradhan Mantri Jan Arogaya Yojana (PMJAY) was launched by government of India in 2018. PMJAY seeks to cover 500 million persons with an annual cover of around 7000 USD per household. PMJAY claims to be the largest government funded health scheme globally and has attracted an international debate as a policy for Universal Health Coverage. India's decade-long experience of the earlier national and state-specific PFHI schemes had shown poor effectiveness in financial protection. Most states in India have completed a year of implementation of PMJAY but no evaluations are available of this important scheme. Methods: The study was designed to find out the effect of enrolment under PMJAY in improving utilisation of hospital services and financial protection in Chhattisgarh which has been a leading state in implementing PFHI in terms of enrolment and claims. The study analyses three repeated cross-sections. Two of the cross-sections are from National Sample Survey (NSS) health roundsyear 2004 when there was no PFHI and 2014 when the older PFHI scheme was in operation. Primary data was collected in 2019-end to cover the first year of PMJAY implementation and it formed the third cross-section. Multivariate analysis was carried out. In addition, Propensity Score Matching and Instrumental Variable method were applied to address the selection problem in insurance. Results: Enrollment under PMJAY or other PFHI schemes did not increase utilisation of hospital-care in Chhattisgarh. Out of Pocket Expenditure (OOPE) and incidence of Catastrophic Health Expenditure did not decrease with enrollment under PMJAY or other PFHI schemes. The size of OOPE was significantly greater for utilisation in private sector, irrespective of enrollment under PMJAY.

Is Indonesia achieving universal health coverage? Secondary analysis of national data on insurance coverage, health spending and service availability

“…Studies in other low and middle income countries report similar findings. [26][27][28][29] Our study is also in line with earlier work in Indonesia, showing that JKN claims per capita for noncommunicable diseases are consistently higher in Jakarta province (the national capital) than in largely rural NTT, 30 31 a difference attributed to differences in supply. 30 Table 5 Use of health services and out-of-pocket (OOP) spending-regression model including district health needs index and access to services, personal insurance status and household wealth…”

“… 36–38 This ‘gateway effect’ has been seen in other countries embarking on scale-up of insurance, including China, Ghana, Kenya and India. 28 39–41 In addition, patients may prefer to pay OOP for outpatient services, in particular, since they are relatively affordable, perceived as higher quality, and less burdensome in terms of queuing and paperwork. 41–44 …”

Impact of COVID-19 and containment measures on burn care: A qualitative exploratory study

“…The program covers hospitalisation costs for around 40% of country’s population and cost of burns management is covered under the scheme [30] . But, the early evidence on the implementation of PMJAY indicates skewed distribution of empanelled hospitals and limited results in reducing financial risk protection for hospitalised patients [31] , [32] . Decentralised burn care service with a three-tiered structure, first aid at primary health facilities, hospitalised treatment of minor non-complicated at district hospitals, and referral linkage to specialised tertiary level burn centres emerged as preferred long-term solution to improve health systems responsiveness to burns.…”

Health insurance awareness and its uptake in India: a systematic review protocol

“…The main aim of the PMJAY is to lessen the economic burden experienced by poor and vulnerable groups for access to healthcare facility. 13 Despite the availability of multiple health insurance schemes, evidence suggests that the uptake of health insurance in India is poor. As per the recently concluded National Sample Survey Office data, there were as low as 14% rural and 18% urban residents of India having some form of health insurance.…”

“…'Ayushman Bharat Scheme-PMJAY' is implemented to ensure increased utilisation of the healthcare facilities with financial protection of the beneficiaries. The evidence available on the effectiveness of the PMJAY scheme states no effect of the scheme on utilisation of healthcare and financial protection of enrolled beneficiaries, 13 however, this evidence is limited. Therefore, in the Indian context, it is important to understand if awareness is a factor that has led to decreased utilisation of PMJAY or failure of the other schemes (viz.…”