A Critical Evaluation of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana in Bihar

Ayushman Bharat, by Lahariya, 2018, Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), launched in 2018, is India’s flagship health insurance scheme aimed at improving access to healthcare while protecting vulnerable families from financial distress due to medical expenses. This study takes a closer look at how the scheme is performing in Bihar—a state grappling with both economic and healthcare delivery challenges. Drawing on NFHS-5, by International Institute for Population Sciences (IIPS) & ICF, 2021, (2019–21), NSSO, Government of India, 2019, 75th round (2017–18), and primary data from 336 AB-PMJAY beneficiaries admitted to a tertiary hospital, the study explores changes in insurance awareness, healthcare usage, and out-of-pocket expenditure. Results show that average OOPE dropped from 76.1% to 30% of a family's monthly expenditure after admission under the scheme. Catastrophic health spending also fell sharply, from 65.5% to around 29%. While there has been visible progress in insurance coverage and financial risk protection, shown by Prinja et al., 2019, the benefits are not yet evenly distributed. Rural households, women, and marginalized communities still face gaps in awareness and access. The findings suggest that while AB-PMJAY has made a positive impact, more targeted efforts are needed to ensure its reach and effectiveness for every citizen