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Empanelment of health care facilities under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) in India

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  • Jaison Joseph
  • Hari Sankar D.
  • Devaki Nambiar

Abstract

Introduction: India’s Pradhan Mantri Jan Arogya Yojana (PM-JAY) is the world’s largest health assurance scheme providing health cover of 500,000 INR (about USD 6,800) per family per year. It provides financial support for secondary and tertiary care hospitalization expenses to about 500 million of India’s poorest households through various insurance models with care delivered by public and private empanelled providers. This study undertook to describe the provider empanelment of PM-JAY, a key element of its functioning and determinant of its impact. Methods: We carried out secondary analysis of cross-sectional administrative program data publicly available in PM-JAY portal for 30 Indian states and 06 UTs. We analysed the state wise distribution, type and sector of empanelled hospitals and services offered through PM-JAY scheme across all the states and UTs. Results: We found that out of the total facilities empanelled (N = 20,257) under the scheme in 2020, more than half (N = 11,367, 56%) were in the public sector, while 8,157 (40%) facilities were private for profit, and 733 (4%) were private not for profit entities. State wise distribution of hospitals showed that five states (Karnataka (N = 2,996, 14.9%), Gujarat (N = 2,672, 13.3%), Uttar Pradesh (N = 2,627, 13%), Tamil Nadu (N = 2315, 11.5%) and Rajasthan (N = 2,093 facilities, 10.4%) contributed to more than 60% of empanelled PMJAY facilities: We also observed that 40% of facilities were offering between two and five specialties while 14% of empanelled hospitals provided 21–24 specialties. Conclusion: A majority of the hospital empanelled under the scheme are in states with previous experience of implementing publicly funded health insurance schemes, with the exception of Uttar Pradesh. Reasons underlying these patterns of empanelment as well as the impact of empanelment on service access, utilisation, population health and financial risk protection warrant further study. While the inclusion and regulation of the private sector is a goal that may be served by empanelment, the role of public sector remains critical, particularly in underserved areas of India.

Suggested Citation

  • Jaison Joseph & Hari Sankar D. & Devaki Nambiar, 2021. "Empanelment of health care facilities under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) in India," PLOS ONE, Public Library of Science, vol. 16(5), pages 1-16, May.
    • Handle: RePEc:plo:pone00:0251814
    DOI: 10.1371/journal.pone.0251814
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    References listed on IDEAS

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    1. Mita Choudhury & Pritam Datta, 2019. "Private Hospitals in Health Insurance Network in India: A Reflection for Implementation of Ayushman Bharat," Working Papers id:13009, eSocialSciences.
    2. Choudhury, Mita & Datta, Pritam, 2019. "Private Hospitals in Health Insurance Network in India: A Reflection for Implementation of Ayushman Bharat," Working Papers 19/254, National Institute of Public Finance and Policy.
    3. Government of India, 2017. "National Health Policy 2017," Working Papers id:11664, eSocialSciences.
    4. Gerard La Forgia & Somil Nagpal, 2012. "Government-Sponsored Health Insurance in India : Are You Covered?," World Bank Publications - Books, The World Bank Group, number 11957, December.
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    1. S S Ramya & Rebecca Devaprasad, 2023. "An Investigation into the Implementation Approaches of the Pradhan Mantri Jan Arogya Yojana in Four South Indian States," Shanlax International Journal of Economics, Shanlax Journals, vol. 11(4), pages 1-9, September.

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