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Background: India launched a national health insurance scheme named Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) in 2018 as a key policy for universal health coverage. The ambitious scheme covers 100 million poor households. None of the studies have examined its impact on the quality of care. The existing studies on the impact of AB-PMJAY on financial protection have been limited to early experiences of its implementation. Since then, the government has improved the scheme's design. The current study was aimed at evaluating the impact of AB-PMJAY on improving utilisation, quality, and financial protection for inpatient care after four years of its implementation. Methods: Two annual waves of household surveys were conducted for years 2021 and 2022 in Chhattisgarh state. The surveys had a sample representative of the state's population, covering around 15,000 individuals. Quality was measured in terms of patient satisfaction and length of stay. Financial protection was measured through indicators of catastrophic health expenditure at different thresholds. Multivariate adjusted models and propensity score matching were applied to examine the impacts of AB-PMJAY. In addition, the instrumental variable method was used to address the selection problem. Results: Enrollment under AB-PMJAY was not associated with increased utilisation of inpatient care. Among individuals enrolled under AB-PMJAY who utilised private hospitals, the proportion incurring catastrophic health expenditure at the threshold of 10% of annual consumption expenditure was 78.1% and 70.9% in 2021 and 2022, respectively. The utilisation of private hospitals was associated with greater catastrophic expenditure irrespective of AB-PMJAY coverage. Enrollment under AB-PMJAY was not associated with reduced out-of-pocket expenditure or catastrophic health expenditure. Conclusions: AB-PMJAY has achieved a large coverage of the population but after four years of implementation and an evidence-based increase in reimbursement prices for hospitals, it has not made an impact on improving utilisation, quality, or financial protection. The private hospitals contracted under the scheme continued to overcharge patients, and purchasing was ineffective in regulating provider behaviour. Further research is recommended to assess the impact of publicly funded health insurance schemes on financial protection in other low- and middle-income countries. [ABSTRACT FROM AUTHOR]

This article explores gender budgeting in Indian healthcare, emphasizing its role in addressing disparities. Examining trends, recent highlights, and implementation, it showcases impacts on maternal health, reproductive services, gender-based violence, and empowerment. Examples such as Ayushman Bharat and Mahila Samman Savings Certificate illustrate economic implications. Beyond healthcare, gender-responsive budgeting is seen as a versatile tool for broader equality. Challenges prompt a call for sustained efforts and a comprehensive framework.

Abstract Background India launched a national health insurance scheme named Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) in 2018 as a key policy for universal health coverage. The ambitious scheme covers 100 million poor households. None of the studies have examined its impact on the quality of care. The existing studies on the impact of AB-PMJAY on financial protection have been limited to early experiences of its implementation. Since then, the government has improved the scheme’s design. The current study was aimed at evaluating the impact of AB-PMJAY on improving utilisation, quality, and financial protection for inpatient care after four years of its implementation. Methods Two annual waves of household surveys were conducted for years 2021 and 2022 in Chhattisgarh state. The surveys had a sample representative of the state’s population, covering around 15,000 individuals. Quality was measured in terms of patient satisfaction and length of stay. Financial protection was measured through indicators of catastrophic health expenditure at different thresholds. Multivariate adjusted models and propensity score matching were applied to examine the impacts of AB-PMJAY. In addition, the instrumental variable method was used to address the selection problem. Results Enrollment under AB-PMJAY was not associated with increased utilisation of inpatient care. Among individuals enrolled under AB-PMJAY who utilised private hospitals, the proportion incurring catastrophic health expenditure at the threshold of 10% of annual consumption expenditure was 78.1% and 70.9% in 2021 and 2022, respectively. The utilisation of private hospitals was associated with greater catastrophic expenditure irrespective of AB-PMJAY coverage. Enrollment under AB-PMJAY was not associated with reduced out-of-pocket expenditure or catastrophic health expenditure. Conclusions AB-PMJAY has achieved a large coverage of the population but after four years of implementation and an evidence-based increase in reimbursement prices for hospitals, it has not made an impact on improving utilisation, quality, or financial protection. The private hospitals contracted under the scheme continued to overcharge patients, and purchasing was ineffective in regulating provider behaviour. Further research is recommended to assess the impact of publicly funded health insurance schemes on financial protection in other low- and middle-income countries.

Purpose: The aim was to analyse the knowledge and awareness regarding Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) within the operational districts of two high-volume non-profit eye organisations in Uttar Pradesh. Challenges faced by beneficiaries and non-beneficiaries are also examined. Methods: A prospective cross-sectional survey from November 2021 to April 2022 was conducted across operational districts of organisations A and B. Cluster sampling was used to select participants in randomly selected villages with 200 or more households, within 10–15 km of existing vision centres. A semi-structured interview schedule was used to collect data. The means of AB-PMJAY indicators were estimated. Awareness was estimated as a summed score. Multivariate logistic regression was applied to check the effects of the socio-economic and socio-demographic factors on the awareness of AB-PMJAY for both organisations separately and together. Results: A total of 1151 participants were interviewed: 52.9% from the catchment area of organisation A and 47.1% from that of organisation B. From the catchment of organisations A and B, 82.6% and 22.9% participants, respectively, had heard of the scheme, mostly from family and friends. Whereas 43% interviewees from the catchment area of organisation A and 8.5% from that of organisation B had knowledge about at least one topic, only 8.5% and 2.8%, respectively, were knowledgeable about all topics. Village effect was found to be significant for most of the knowledge and awareness indicators in both catchments. Only 37.8% and 20.2% of the catchment from organisations A and B, respectively, were AB-PMJAY cardholders. Of the services availed, 50% were cataract surgery. Almost 40% of the applicants faced some challenges while securing the AB-PMJAY card and 9% while using the AB-PMJAY card. Family income was found to be the only common predictor of knowledge at both locations. Conclusion: Varied awareness and limited knowledge in catchment villages put the onus on community eyecare organisations to spread awareness in their catchment, which may increase the uptake and utilisation of the scheme.

Background: The Pradhan Mantri Jan Arogya Yojana (PMJAY) program was created in line with the global goal of Universal Health Coverage (UHC), and aims to ensure everyone has access to quality healthcare services without suffering financial difficulties. In India, over 60% of healthcare spending is still borne by households, and a significant portion of the population lacks any form of health protection coverage. Discussion: The High-Level Expert Group (HLEG) recommended a shift from supply-side healthcare financing to demand-side financing, leading to the introduction of government-sponsored health insurance schemes. To achieve Universal Health Coverage (UHC), the Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (PMJAY) was launched following the recommendations of the National Health Policy 2017. The PMJAY program is the world's largest publicly sponsored social health insurance program, delivering comprehensive healthcare services covering primary, secondary, and tertiary care levels. The scheme covers approximately 12 crore households, including more than 50 crore beneficiaries, offering healthcare coverage of up to Rs. 5 lakh per family annually. PMJAY operates nationwide in India, covering all states and union territories except for a few.. Conclusion: To move forward, PMJAY can play a transformative role in the healthcare landscape, integrate with primary healthcare, contribute to economic development, and expand its scope to include more healthcare services.

Background: Universal health coverage targets that all individuals and communities receive the health services they need without suffering financial hardship. The PMJAY- Ayushman Bharat was launched on 23rd September 2018, to achieve the vision of Universal Health Coverage (UHC) to meet Sustainable Development Goals (SDGs) and its underlining commitment, which is to “leave no one behind.” This study was done to know about the impact and utilization of this scheme at the level of rural community. Material & Methods: Cross sectional study was done in rural area of Ayodhya. Computer generated random numbers were used to select households among people enlisted under Ayushman Bharat beneficiary list, 375 respondents were selected. A pretested semi structured questionnaire was used. Data was entered in Microsoft Excel sheet and analyzed using SPSS software version 20. Results: A total of 183 (48.8%) families had received the golden card and 74 (40.44%) families with golden card have utilized the card. Most common claims were in the range of Rs 10000-50000. Most common reason which emerged as barrier of card utilization was discrepancy in name on Aadhar & Golden card. Catastrophic health expenditure was incurred upon a total of 11(2.9%) families who had to self-pay for the health expenditure. Conclusion: AB PMJAY has targeted to address financial health security in a very elaborative manner but still the barriers exist due to which the utilization is less. Our study can provide a scoping base to make it more user friendly and useful by addressing the barriers of utilization and enhancing the spectrum of packages such as outpatient care expenditures so as to achieve the goal. [ABSTRACT FROM AUTHOR]

Ayushman Bharat (PMJAY), a flagship initiative of the Government of India and the world's largest government health insurance program, aims to transform India's healthcare landscape by providing comprehensive medical cover to a significant portion of the population. This article explores the potential of PMJAY in not only bridging the financial gap for accessing healthcare but also in fostering social inclusion within the healthcare system. The article examines how PMJAY's focus on primary care and preventive healthcare can contribute to overall wellness and empower individuals to take charge of their health. It further discusses the challenges associated with implementing such a large-scale program and suggests potential solutions to ensure its long-term success. [ABSTRACT FROM AUTHOR]

Resilient and high-performing health systems that can respond to the global polycrisis hinge upon the effectiveness of their primary healthcare (PHC) system. This requires adequate and sustainable financing for PHC, which should be predominantly government financed. The recent Ayushman Bharat health reforms in India aim to ensure comprehensive PHC services and enhance financial risk protection through increased government financing. The government has augmented investments to fortify the PHC system by establishing Health and Wellness Centers (HWCs), equipped with an expanded benefit package for PHC services & human resource capacity. Aligned with the National Health Mission's targeted and flexible financial mechanisms, this offers States the opportunity to contextualize solutions and offer incentives to healthcare workers. However, aligning public financing arrangements to service delivery complexities and health outcomes pose intricate challenges in shaping the required reforms. The economic growth and room for increased taxation on health products provide an avenue for increased funding. Smart and efficient payment mechanism with improved accountability should complement increased investment. [ABSTRACT FROM AUTHOR]

In India, rural–urban health disparities have been persisting over a period. Migration of patients from rural to urban is an integral part of population dynamics thereby creating an additional burden on urban hospitals. Over the decade, India has made significant advances in health in reducing the rural-urban gap. The article highlights how the strengthening of rural healthcare facilities has reduced the burden of urban hospitals. Secondary data on the usage of public and private healthcare facilities from two rounds of the National Family Health Survey (NFHS) conducted in 2016 and 2021 and the Rural Health Statistics 2021-2022 were analyzed. The proportion of beneficiaries seeking care from public health facilities has increased from 41.9% to 45.7% in rural areas and 31% to 35.3% in urban areas between 2014 to 2017. The institutional deliveries have increased from 56% to 69.2% in rural areas and from 42% to 48.3% in urban areas. The State and local level interventions such as the upgradation of existing physical infrastructure, human resources, regular supply of medicines and consumables, development of referral linkages, patient transportation, and enhancing community participation have strengthened the rural healthcare system. Adequate utilization of the resources is crucial to addressing the lag and alleviating the rural-urban divide.

In India, rural--urban health disparities have been persisting over a period. Migration of patients from rural to urban is an integral part of population dynamics thereby creating an additional burden on urban hospitals. Over the decade, India has made significant advances in health in reducing the rural-urban gap. The article highlights how the strengthening of rural healthcare facilities has reduced the burden of urban hospitals. Secondary data on the usage of public and private healthcare facilities from two rounds of the National Family Health Survey (NFHS) conducted in 2016 and 2021 and the Rural Health Statistics 2021-2022 were analyzed. The proportion of beneficiaries seeking care from public health facilities has increased from 41.9% to 45.7% in rural areas and 31% to 35.3% in urban areas between 2014 to 2017. The institutional deliveries have increased from 56% to 69.2% in rural areas and from 42% to 48.3% in urban areas. The State and local level interventions such as the upgradation of existing physical infrastructure, human resources, regular supply of medicines and consumables, development of referral linkages, patient transportation, and enhancing community participation have strengthened the rural healthcare system. Adequate utilization of the resources is crucial to addressing the lag and alleviating the rural-urban divide. [ABSTRACT FROM AUTHOR]

Schools provide a crucial platform for health and well-being interventions targeting children and adolescents. Early promotive and preventive initiatives are vital for enabling children and adolescents to reach their optimal potential, thereby adding to the country's social return-on-investment, creating a favourable demographic dividend. This review analyses the evolution of school health initiatives in India, including the current curriculum proposed under the Ayushman Bharat program. The manuscript highlights the challenges, and gaps in implementation of the current school health programs and proposes potential pathways for bridging these gaps for promotion of adolescent well-being. The review also discusses the concept of Health Promoting Schools and suggests adaptations and key recommendations to Indian context regarding 'how' to translate it into on-field reality based on the appraisal of successful case studies from other countries. Though India started school health services more than 100 y ago, the school health programmes in most Indian states are weak and fragmented, with piecemeal health screening with minimal focus on health promotion and well-being. The recently launched School Health and Wellness initiative under the Ayushman Bharat program has lots of promise. However, it needs to be translated into effective implementation to prevent it from meeting the fate of its forerunner programs. The school health program needs to move beyond the screening centric approach and be aspirational and holistic in nature focusing upon the overall well-being of the adolescents. Concerted efforts through intersectoral convergence are needed to optimally utilise the platforms of schools for promotion of adolescent well-being. [ABSTRACT FROM AUTHOR]

Health is crucial for personal happiness, productivity, and fulfillment. It impacts physical well-being, mental health, longevity, academic and professional success, and interpersonal relationships. It reduces healthcare costs, contributes to economic growth, and promotes community well-being. This paper explores the status of the healthcare system in rural India. Paper reviews available research and also collects data from rural hospitals. It also considers efforts by the Indian government and other organisations, such as Ayushman Bharat, which is acknowledged for its aim to strengthen primary healthcare and protect economically vulnerable populations. However, addressing these complex issues requires continuous efforts, adequate funding, and proactive measures in healthcare infrastructure, workforce development, and policy reforms. The presented data reflects rural areas' ongoing challenges, underscoring the pressing need for proper treatment and care. By prioritising the presented aspects, the healthcare landscape in rural India can witness positive transformations and ensure improved healthcare outcomes for its population. In this paper, the possible problems and solutions addressed which has been observed while visiting hospitals in rural areas of northeast India. Research findings emphasise the significance of implementing supply chain strategies in improving healthcare delivery. It concludes that the potential of Medical 4.0 applications with seven common effective findings can save numerous lives in rural areas by providing timely access to healthcare solutions. [ABSTRACT FROM AUTHOR]

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.

Abstract Objective Institutional deliveries have been promoted in India to reduce maternal and neonatal mortality. While the institutional deliveries have increased, they tend to involve large out of pocket expenditure (OOPE) and distress financing for households. In order to protect the families from financial hardship, publicly funded health insurance (PFHI) schemes have been implemented in India. An expanded national health insurance scheme called the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) was launched in 2018. The current study was aimed at evaluating the performance of PFHI in reducing the OOPE and distress financing for the caesarean and non-caesarean institutional deliveries after the launch of PMJAY. This study analysed the nationally representative dataset of the National Family Health Survey (NFHS-5) conducted in 2019-21. Results Enrollment under PMJAY or other PFHI was not associated with any reduction in out of pocket expenditure or distress financing for caesarean or non-caesarean institutional deliveries across India. Irrespective of the PFHI coverage, the average OOPE in private hospitals was five times larger than public hospitals. Private hospitals showed an excessive rate of using caesarean-section. Utilization of private hospitals was significantly associated with incurring larger OOPE and occurrence of distress financing.

ABSTRACTThe 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.

Background: The National Health Policy 2017 has envisioned the integration of Health and Wellness Centers (HWCs) into India’s healthcare system as part of Ayushman Bharat. In February 2018, the Indian Government declared the transformation of 1,50,000 existing Sub Health Centers and Primary Health Centers into Health and Wellness Centers (HWCs) to provide Comprehensive Primary Health Care (CPHC). Health and Wellness Centres have an important role in the prevention of several diseases and health promotion and in undertaking public health functions in the community to strengthen the frontline workers and community platforms. Objective: To assess the availability of Infrastructure and 12 comprehensive primary health care services in study centres (HWC-SHC) in Raipur district Methodology: This is a cross-sectional observational study conducted in the 32 Health and wellness centre-sub centres of Raipur district, Chhattisgarh. In the Raipur district, there are 4 blocks and from each block, 25% of the study centres (HWC-SHC) are selected by simple random sampling. Semi- structured assessment tool with the reference of Government of India Operational Guidelines was used which consisted of checklist regarding Physical Infrastructure, Human Resource, Medicine, Diagnostic, IT component and 12 comprehensive primary health care services. The data was collected and analysis is being done by using SPSS software. Results: Out of 32 HWC-SHCs, 6 (18.75% ) were catering the services for the population as per the norms i.e. 3000- 5000. In the present study, 19 (59.4%) boundary wall, and 21 (65.6%) of SCs had wellness space. There were 31 (96.9%) of SCs had labor room, and 14 (43.8 %) had newborn care corner (NBCC). In this study, 21.9% Grievance board and 100% of IEC were present at the studied subcentres. It was observed that 31(96.9%) SCs had water, 27 (84.4%) had electricity supply and 1 (3.1%) of SCs had power backup. Separate public utilities for males and females were available in 2(6.3%) of the study centres. Out of the study sub-centre, 28 (87.5%) residential facilities were available, out of which 24 (85%) were occupied. For diagnostic services, 53.1 % of study centres have sickle- cell rapid tests and none of the centres have VIA for Screening of cervical cancer. Conclusion: The finding of the study shows that there is a scarcity in the physical infrastructure, Human resource and lab-diagnostic services at the studied centres. The major factor contributing to the non-utilization of health services at the SCs was the lack of adequate infrastructure, and logistics available at these centres.

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. [ABSTRACT FROM AUTHOR]

The present study explores district-level data associated with health insurance coverage (%) and the prevalence of hypertension (mildly, moderately, and severely elevated) observed across men and women as per NFHS 5. Coastal districts in the peninsular region of India and districts in parts of northeastern India have the highest prevalence of elevated blood pressure. Jammu and Kashmir, parts of Gujarat and parts of Rajasthan have a lower prevalence of elevated blood pressure. Intrastate heterogeneity in spatial patterns of elevated blood pressure is mainly seen in central India. The highest burden of elevated blood pressure is in the state of Kerala. Rajasthan is among the states with higher health insurance coverage and a lower prevalence of elevated blood pressure. There is a relatively low positive relationship between health insurance coverage and the prevalence of elevated blood pressure. Health insurance in India generally covers the cost of inpatient care to the exclusion of outpatient care. This might mean that health insurance has limited impact in improving the diagnosis of hypertension. Access to public health centers raises the probability of adults with hypertension receiving treatment with antihypertensives. Access to public health centers has been seen to be especially significant at the poorer end of the economic spectrum. The health and wellness center initiative under Ayushman Bharat will play a crucial role in hypertension control in India. [ABSTRACT FROM AUTHOR]

Objective: Institutional deliveries have been promoted in India to reduce maternal and neonatal mortality. While the institutional deliveries have increased, they tend to involve large out of pocket expenditure (OOPE) and distress financing for households. In order to protect the families from financial hardship, publicly funded health insurance (PFHI) schemes have been implemented in India. An expanded national health insurance scheme called the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) was launched in 2018. The current study was aimed at evaluating the performance of PFHI in reducing the OOPE and distress financing for the caesarean and non-caesarean institutional deliveries after the launch of PMJAY. This study analysed the nationally representative dataset of the National Family Health Survey (NFHS-5) conducted in 2019-21. Results: Enrollment under PMJAY or other PFHI was not associated with any reduction in out of pocket expenditure or distress financing for caesarean or non-caesarean institutional deliveries across India. Irrespective of the PFHI coverage, the average OOPE in private hospitals was five times larger than public hospitals. Private hospitals showed an excessive rate of using caesarean-section. Utilization of private hospitals was significantly associated with incurring larger OOPE and occurrence of distress financing. [ABSTRACT FROM AUTHOR]

Background: Comprehensive primary health care (CPHC) is an effective way to respond to the challenges of changing epidemiology, growing population expectations, and universal health coverage. A set of demand and supply improvement strategies was developed to support primary health center provision and pilot tested in three model health and wellness centers (HWCs) in Punjab. Objective: The study aimed to assess the early effects of interventions on the inputs, processes, and outputs for optimal implementation of the Ayushman Bharat-HWC (AB-HWC) program. Materials and Methods: Cross-sectional facility assessments were conducted using a standardized methodology at three time points to identify the changes in inputs and processes at subcenter-HWCs from 2019 to 2021. In addition, daily and month-wise service utilization data of model HWCs and nonmodel HWCs in the intervention block and control block in a district of Punjab from the AB-HWC portal were analyzed from May 2020 to April 2021. Results: The difference-in-difference analysis indicated that the CPHC strengthening interventions in the model HWCs improved the mean number of people screened for noncommunicable diseases, mean newly diagnosed patients with hypertension and diabetes, mean hypertensive and diabetic patients on treatment, mean outpatient attendance, and mean number of wellness sessions by 265.71, 21.31, 29.48, 102.17, and 4.88 units per month, compared to control HWCs. Conclusion: The success of the initiatives can be attributed to an integrated approach encompassing multistakeholder planning of interventions, community involvement, empowerment of service providers, and consistent supportive supervision. The long-term success will be contingent on the quality of training, team dynamics, community participation, social accountability, and supervision support.

Background: Launched in September 2018, the ABPMJAY is the world's largest publicly funded health insurance (PFHI) program with population coverage of 500 million. A systematic review was conducted. Methods: A comprehensive literature search was conducted in four databases: PubMed, Web of Science, Scopus, and Google Scholar. The literature search was conducted with the search terms: "Ayushman Bharat OR ABPMJAY OR modicare AND RSBY." The search was set to title and abstract. Gray literature and government websites were also searched for relevant documents. A total of 881 documents were identified (PubMed: 53, Web of Science: 46, Scopus: 97, Google Scholar: 681, government websites: two, and gray literature: two). Fifty-two duplicates were identified. After the elimination of the duplicates, 829 unique documents were identified. These 829 unique citations were then subjected to a review of title and abstract independently by 2 reviewers. Six-hundred and ninety-two articles were rejected after review of title and abstract. One-hundred and thirty-seven articles were screened for full text independently by two reviewers. Sixty-six articles were rejected after review of the full text. Disagreements were resolved by discussion. Seventy-one unique articles were included in the final review. To attain the objective of the study, which is to critically analyze and provide an overview of Ayushman Bharat, a narrative synthesis was performed. Results: Seven themes were identified from the review: (1) health and wellness centers (HWCs); (2) out-of-pocket health expenditure (OOPHE); (3) fraud; (4) upcoding and provision of unnecessary medical care; (5) moving focus away from primary care; (6) coverage; and (7) lop-sided access, exclusion at the periphery, and brain drain. There is very little impact evidence of the ABPMJAY available. Conclusions: The government could plan impact evaluation studies in every state that the ABPMJAY is functional in. Any high-quality feedback generated might enable the National Health Authority, the government body leading and coordinating the ABPMJAY, to take necessary steps operationally and advice the government on strategy. Another concern is that the ABPMJAY PFHI might negatively impact the ongoing process of continuous strengthening and development of the government health-care system at all levels-primary, secondary, and tertiary. Continual recalibration and course corrections on the basis of high-quality feedback might enable ABPMJAY reduce catastrophic OOPHE for 500 million Indians. This is more than 6% of humanity: the largest block of people served by a single PFHI in history. [ABSTRACT FROM AUTHOR]

Ayushman Bharat is a flagship programme of Government of India and has been much publicised; however, the extent of its translation to the ground level has not been documented. A study was conducted to assess the implementation and satisfaction of the AB-PMJAY scheme in the inpatient department of AIIMS, New Delhi. Data were collected from January 2019 to June 2019. The sample size was a universal sample, and therefore, all the beneficiaries who availed the services at AIIMS, New Delhi were enrolled. A total of 120 patients were enrolled in the study. The mean age of the participant was 36.37 years, about 45.83% of the participants were illiterate and 69.17% resided in the rural area. A total of 88% of patients did not face any problem in availing the scheme, while 18% of the patients were asked to purchase medications from outside. Patients were highly satisfied with the ease and benefits of availing the scheme. The government should examine the reasons why some medications are being purchased from outside, and a contingency fund may be given to the hospital to prevent people from purchasing the medications from outside. [ABSTRACT FROM AUTHOR]

A thriving healthcare system perfectly reflects economic development and contentment amongst the people of any region. With increasing anxiety concering health and growing medical needs, hospitals worldwide face substantial challenge to provide patients with adequate medical facilities under one roof. With a fragile state of the health industry in a developing country like India, there is a need for the hospitals to opt for international standards and comply with other premier health centers of the country. This paper aims to select the hospitals based on incongruous and conflicting criteria involving group decision-making using the Intuitionistic Fuzzy (IF) and Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) method. The criteria used are concomitant to an insured public health scheme named Ayushman Bharat-National Health Protection Scheme (AB-NHPS) of the Government of India. For each alternative Euclidean distance has been used to calculate the positive and negative separation measure from the ideal solution. The relative closeness to the ideal solution has been used to rank the hospitals. The result is a list of hospitals ranked from best to worst based on the laid criteria. It can aid governing bodies in decision-making under an uncertain environment with multiple complex criteria to analyze.

Abstract Background Government-sponsored health insurance schemes (GSHIS) aim to improve access to and utilization of healthcare services and offer financial protection to the population. India’s Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) is one such GSHIS. This paper aims to understand how the processes put in place to manage hospital-based transactions, from the time a beneficiary arrives at the hospital to discharge are being implemented in PM-JAY and how to improve them to strengthen the scheme’s operation. Methods Guidelines were reviewed for the processes associated with hospital-based transactions, namely, beneficiary authentication, treatment package selection, preauthorization, discharge, and claims payments. Across 14 hospitals in Gujarat and Madhya Pradesh states, the above-mentioned processes were observed, and using a semi-structured interview guide fifty-three respondents were interviewed. The study was carried out from March 2019 to August 2019. Results Average turn-around time for claim reimbursement is two to six times higher than that proposed in guidelines and tender. As opposed to the guidelines, beneficiaries are incurring out-of-pocket expenditure while availing healthcare services. The training provided to the front-line workers is software-centric. Hospital-based processes are relatively more efficient in hospitals where frontline workers have a medical/paramedical/managerial background. Conclusions There is a need to broaden capacity-building efforts from enabling frontline staff to operate the scheme’s IT platform to developing the technical, managerial, and leadership skills required for them. At the hospital level, an empowered frontline worker is the key to efficient hospital-based processes. There is a need to streamline back-end processes to eliminate the causes for delay in the processing of claim payment requests. For policymakers, the most important and urgent need is to reduce out-of-pocket expenses. To that end, there is a need to both revisit and streamline the existing guidelines and ensure adherence to the guidelines.

Background: The Government of India launched the Ayushman Bharat (AB) program in 2018 which aims to transform 150,000 existing Sub Health Centres and Primary Health Centres into Ayushman Bharat Health and Wellness Centres (HWCs). In this study, we assessed health system readiness for establishment of HWCs. Methods: The assessment comprised of a cross sectional facility assessment and a knowledge assessment of community health officers (CHOs) and female multipurpose health workers also known as auxiliary nurse midwives (ANMs), in 26 HWCs in one community development block of Punjab state. HWCs were assessed for key input and process parameters such as a human resource, physical infrastructure, supplies, capacity building etc., and processes including health promotion, community participation, digitization of management information system, and service delivery. Results: It was observed that only 7 of the 26 HWCs had all human resources as per guidelines. The median knowledge score of CHOs and ANMs was 54% and 51% respectively. 11 of the 26 HWCs were co-located with Zila Parishad SHCs. Out of the 15 standalone HWCs, while 9 had independent buildings, 5 were located in buildings of other community level institutions. 50 percent of the HWCs were not able to perform diabetes screening due to lack of glucometers or testing supplies. While services for non-communicable diseases were available, a two-way referral tracking system for patients was missing. The mean job satisfaction rated by the newly appointed CHOs was 3.12 on a scale of 1 to 5, where 5 represented very high job satisfaction. Conclusion: The operationalization of HWCs requires State and local level interventions for strengthening of existing physical infrastructure, ensuring a regular supply of medicines and consumables, development of referral mechanisms for patients and enhancing community participation.

Introduction: Since the Government of India has decided to continue with the publicly funded health insurance (PFHI) strategy, it is now pertinent to attempt to determine the factors that drive health insurance coverage in India. The NITI (National Institute for Transforming India) Aayog (i.e. Commission) is the apex public policy think tank of the Government of India. The NITI Aayog assesses the health status of the states through its acclaimed health index consisting of 24 indicators for health outcomes, governance and infrastructure. All states and Union Territories (UTs) are ranked on the index. This study aims to assess associations between NITI Aayog health index scores and health insurance coverage across India through a state-level lens. Methods: Health insurance coverage data has been extracted from the National Family Health Survey (NFHS) 4 and NFHS-5 data. NFHS-4 was conducted during 2015–16. NFHS-5 was interrupted by the COVID-19 pandemic and conducted in two phases from 2019 to 2021. This change in health insurance coverage is mapped to the NITI Aayog health index scores for the states and UTs. The NITI Aayog has classified states into two categories: Larger states and smaller states. Based on performance in health indices, NITI Aayog also classifies the states and UTs as Aspirants, Achievers and Front runners. Results and discussion: There is a positive linear relationship between the health index scores of front-runners (Pearson's r = 0.6037, p = 0.029) and the total insurance coverage. We observe poor linear relationship between the health index scores of achievers (Pearson's r = 0.2822, p = 0.498) and the total insurance coverage. There is no linear relationship between the NFHS-5 Total Insurance Coverage and the NITI Health Index Scores (Pearson's r = 0.2766, p = 0.125). Also, we observe a moderate positive linear relationship between the health index scores and the total insurance coverage among the Union Territories which is not statistically significant (Pearson's r = 0.4343, p = 0.465). A similar conclusion is made in the context of smaller states (Pearson's r = 0.3692, p = 0.368) and larger states (Pearson's r = 0.2103, p = 0.387). At the same time, we observe a decrease in insurance coverage across NFHS-4 and NFHS-5 in some states and UTs. Further research is needed to identify the determinants of these spatial changes across a span of five years, from a temporal lens.

Introduction: Brands for services and health-care services for that matter can permeate unique meanings to consumers. Objective: The main objective of this study was to understand the perception and experiences of service providers about the health and wellness enter (HWC) branding. Materials and Methods: The study adopted a qualitative research method in which in-depth interviews of health-care service providers were carried out to capture their perceptions and experiences on HWC branding. Results: Two thematic areas emerged after the analysis of the collected data. Bada Hospital (Big Hospital): the service providers stated that the local inhabitants ask about the six thematic circles portrayed on the wall of HWCs and their role in this newly renovated building. After knowing the six priority service packages available, the locals perceived that this facility has now become a Bada hospital that can cater to their wider health-care needs. Incremental Trust: the service providers stated that the local tribal inhabitants, after perceiving this as a Bada Hospital, have started accessing health services in HWCs with less trust in faith healers. The locals also knew that the HWCs can provide them with medications including the injectables that they prefer the most and can also conduct some procedures, both medical and surgical, with adequate drugs, instruments, and consumables, thereby creating an incremental trust of the locals with 3–4 times more outpatient department footfall. Conclusion: The service providers perceive that the branding has created trust for the HWCs and improved the health-seeking behavior in the catchment areas. [ABSTRACT FROM AUTHOR]

INTRODUCTION- The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PMJAY) was launched on 23rd September 2018 asa flagship program of the Government of India with the aim ofachieving Universal Health Coverage in our country. Under this scheme, each under-privileged family was provided with annual health insurance coverage of Rs. 5 lakh for hospital-based treatments, including 1,669 procedures in 24 specilties. In this article, we present the 3-year experience of implementing this scheme at our tertiary care center in New Delhi. MATERIAL AND METHODS- A dedicated Ayushman Bharat section was created in our center, comprising of specialist doctors, staffand Ayushman Mitras (AMs). Kiosks were establishedto screen all in-patient admissions via Beneficiary Identification (BIS) portal. The patient treatment wasinitiated,and the necessary implants/stents/medications/consumables were provided by Amrit Pharmacy. Treatment records were obtained for initiating the claims process via Transaction Management System (TMS) portal at the time of discharge. This data was collected and analyzed based on the medical specialty and the state of origin of patients. RESULTS- During the 3-year period, a total of 1,775 beneficiaries were identified in our center and1,255 claims were initiated, of which 1,210 claims have been settled. Beneficiaries from across 12 states availed of benefits under this scheme, the highest number being from Uttar Pradesh (38.8%), Bihar (32.9%), and Haryana (8.7%). Most claims were initiated for the specialty of Neurosurgery (28.9%), followed by Orthopedics (20.8%) and then Cardiology (17.1%). Cross-subsidization was done for 21 packages whose cost exceeded the ceiling of package rates prescribed by the National Health Authority (NHA). A total of 32 unspecified surgical procedures were also performed under the scheme after taking due permission from the authorities. There was no denial of services to beneficiaries. CONCLUSION- The AB PMJAY scheme is a boon for vulnerable families who cannot afford costly medicines & specialized surgical procedures. Though it possesses the potential to mitigate India`s healthcare woes, the greatest challenge lies in its smooth implementation via the dedicated IT platform, training healthcare staff and constant rationalization of &updation of treatment packages based on expert views and standard treatment guidelines. [ABSTRACT FROM AUTHOR]

Quality health care is the essential need for all the citizens of the country. It forms the basis for equitable and sustainable economic development. India has made significant progress in basic health care over the past few decades. However, still most people do not have access to essential health care services. Health insurance is very important for every citizen, especially in India, where there is a large rural population. As everyone cannot afford private Health insurance coverage, so government must take initiatives to provide health insurance coverage to poor people. Government of India has been taking initiatives to provide financial assistance for health care costs for vulnerable and needy families. Rastriya Swasthya Bima Yojana (RSBY) was launched in the year 2008, but was not very successful. Prime Recently, Ayushman Bharat Jana Arogya Yojana (PMJAY) was launched on 23rd September 2018. It provides health insurance cover of Rs. 5 lakhs per year, per family for secondary and tertiary care hospitalization to more than 10.74 crore poor and vulnerable families. Ayushman Bharat PMJAY card holders can claim cashless services at all the empanelled hospitals or at the private hospitals (approximately 20,000 plus) those have registered to offer PMJAY. The total number of Ayushman Bharat Cards issued till 21st March 2022 are 17,86,97,235 and Hospital admissions under PMJAY as of 21st March 2022 since launch are 3,11,27,750. Ayushman Bharat PMJAY has shown a good progress since its launch. It is a successful health insurance scheme till now. This paper studies about reasons of perceived failure of Rastriya Swasthya Bima Yojana (RSBY), Introduction of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY), its features, coverages and benefits, the factors behind the success of Ayushman Bharat PMJAY scheme, its challenges and about the future of the scheme. [ABSTRACT FROM AUTHOR]

Purpose: The aim was to analyse the knowledge and awareness regarding Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) within the operational districts of two high-volume non-profit eye organisations in Uttar Pradesh. Challenges faced by beneficiaries and non-beneficiaries are also examined., Methods: A prospective cross-sectional survey from November 2021 to April 2022 was conducted across operational districts of organisations A and B. Cluster sampling was used to select participants in randomly selected villages with 200 or more households, within 10-15 km of existing vision centres. A semi-structured interview schedule was used to collect data. The means of AB-PMJAY indicators were estimated. Awareness was estimated as a summed score. Multivariate logistic regression was applied to check the effects of the socio-economic and socio-demographic factors on the awareness of AB-PMJAY for both organisations separately and together., Results: A total of 1151 participants were interviewed: 52.9% from the catchment area of organisation A and 47.1% from that of organisation B. From the catchment of organisations A and B, 82.6% and 22.9% participants, respectively, had heard of the scheme, mostly from family and friends. Whereas 43% interviewees from the catchment area of organisation A and 8.5% from that of organisation B had knowledge about at least one topic, only 8.5% and 2.8%, respectively, were knowledgeable about all topics. Village effect was found to be significant for most of the knowledge and awareness indicators in both catchments. Only 37.8% and 20.2% of the catchment from organisations A and B, respectively, were AB-PMJAY cardholders. Of the services availed, 50% were cataract surgery. Almost 40% of the applicants faced some challenges while securing the AB-PMJAY card and 9% while using the AB-PMJAY card. Family income was found to be the only common predictor of knowledge at both locations., Conclusion: Varied awareness and limited knowledge in catchment villages put the onus on community eyecare organisations to spread awareness in their catchment, which may increase the uptake and utilisation of the scheme., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Family Medicine and Primary Care.)

The present study explores district-level data associated with health insurance coverage (%) and the prevalence of hypertension (mildly, moderately, and severely elevated) observed across men and women as per NFHS 5. Coastal districts in the peninsular region of India and districts in parts of northeastern India have the highest prevalence of elevated blood pressure. Jammu and Kashmir, parts of Gujarat and parts of Rajasthan have a lower prevalence of elevated blood pressure. Intrastate heterogeneity in spatial patterns of elevated blood pressure is mainly seen in central India. The highest burden of elevated blood pressure is in the state of Kerala. Rajasthan is among the states with higher health insurance coverage and a lower prevalence of elevated blood pressure. There is a relatively low positive relationship between health insurance coverage and the prevalence of elevated blood pressure. Health insurance in India generally covers the cost of inpatient care to the exclusion of outpatient care. This might mean that health insurance has limited impact in improving the diagnosis of hypertension. Access to public health centers raises the probability of adults with hypertension receiving treatment with antihypertensives. Access to public health centers has been seen to be especially significant at the poorer end of the economic spectrum. The health and wellness center initiative under Ayushman Bharat will play a crucial role in hypertension control in India.

Background: Launched in September 2018, the ABPMJAY is the world's largest publicly funded health insurance (PFHI) program with population coverage of 500 million. A systematic review was conducted. Methods: A comprehensive literature search was conducted in four databases: PubMed, Web of Science, Scopus, and Google Scholar. The literature search was conducted with the search terms: “Ayushman Bharat OR ABPMJAY OR modicare AND RSBY.” The search was set to title and abstract. Gray literature and government websites were also searched for relevant documents. A total of 881 documents were identified (PubMed: 53, Web of Science: 46, Scopus: 97, Google Scholar: 681, government websites: two, and gray literature: two). Fifty-two duplicates were identified. After the elimination of the duplicates, 829 unique documents were identified. These 829 unique citations were then subjected to a review of title and abstract independently by 2 reviewers. Six-hundred and ninety-two articles were rejected after review of title and abstract. One-hundred and thirty-seven articles were screened for full text independently by two reviewers. Sixty-six articles were rejected after review of the full text. Disagreements were resolved by discussion. Seventy-one unique articles were included in the final review. To attain the objective of the study, which is to critically analyze and provide an overview of Ayushman Bharat, a narrative synthesis was performed. Results: Seven themes were identified from the review: (1) health and wellness centers (HWCs); (2) out-of-pocket health expenditure (OOPHE); (3) fraud; (4) upcoding and provision of unnecessary medical care; (5) moving focus away from primary care; (6) coverage; and (7) lop-sided access, exclusion at the periphery, and brain drain. There is very little impact evidence of the ABPMJAY available. Conclusions: The government could plan impact evaluation studies in every state that the ABPMJAY is functional in. Any high-quality feedback generated might enable the National Health Authority, the government body leading and coordinating the ABPMJAY, to take necessary steps operationally and advice the government on strategy. Another concern is that the ABPMJAY PFHI might negatively impact the ongoing process of continuous strengthening and development of the government health-care system at all levels—primary, secondary, and tertiary. Continual recalibration and course corrections on the basis of high-quality feedback might enable ABPMJAY reduce catastrophic OOPHE for 500 million Indians. This is more than 6% of humanity: the largest block of people served by a single PFHI in history.

Background: The Government of India launched the Ayushman Bharat (AB) program in 2018 which aims to transform 150,000 existing Sub Health Centres and Primary Health Centres into Ayushman Bharat Health and Wellness Centres (HWCs). In this study, we assessed health system readiness for establishment of HWCs. Methods: The assessment comprised of a cross sectional facility assessment and a knowledge assessment of community health officers (CHOs) and female multipurpose health workers also known as auxiliary nurse midwives (ANMs), in 26 HWCs in one community development block of Punjab state. HWCs were assessed for key input and process parameters such as a human resource, physical infrastructure, supplies, capacity building etc., and processes including health promotion, community participation, digitization of management information system, and service delivery. Results: It was observed that only 7 of the 26 HWCs had all human resources as per guidelines. The median knowledge score of CHOs and ANMs was 54% and 51% respectively. 11 of the 26 HWCs were co-located with Zila Parishad SHCs. Out of the 15 standalone HWCs, while 9 had independent buildings, 5 were located in buildings of other community level institutions. 50 percent of the HWCs were not able to perform diabetes screening due to lack of glucometers or testing supplies. While services for non-communicable diseases were available, a two-way referral tracking system for patients was missing. The mean job satisfaction rated by the newly appointed CHOs was 3.12 on a scale of 1 to 5, where 5 represented very high job satisfaction. Conclusion: The operationalization of HWCs requires State and local level interventions for strengthening of existing physical infrastructure, ensuring a regular supply of medicines and consumables, development of referral mechanisms for patients and enhancing community participation. [ABSTRACT FROM AUTHOR]

There are multiple small health insurance schemes throughout India. However, high out-of-pocket (OOP) expenditures, unaffordable and inequitable access to healthcare services still persist. In an attempt to address these pressing issues and achieve universal health coverage (UHC), a national health initiative named Ayushman Bharat (AB) was launched in September 2018, as a part of India's National Health Policy 2017. AB has two main components, first, the health insurance scheme named the National Health Protection Mission (NHPM), which is also branded as 'Pradhan Mantri Jan Arogya Yojana' (PMJAY) and second, transforming the existing primary healthcare centers (PHC) under the control of State Governments. AB aims to transform nearly 150,000 PHCs to deliver comprehensive primary healthcare services across the country by 2022. PMJAY is designed to cover the costs of almost all secondary and many tertiary care procedures of about 40% of the total Indian population. For the first time, attempts have been made to provide affordable healthcare services to the population under a single common initiative in a big, democratic and diverse country like India. This paper provides an overview of the healthcare scheme. We have also analyzed some of its salient features and summarized them for an international audience which is inclusive of academics and public policy researchers. [ABSTRACT FROM AUTHOR]

Background: The Government of India introduced a new cadre of Community Health Officers (CHOs) in the primary health-care system through the Ayushman Bharat Health and Wellness Centres (HWCs) program. Objectives: The study aimed to assess the activities performed and time spent by the existing and new primary health-care team members at the HWC level. Methods: A time and motion study was undertaken in four HWCs in Punjab over a period of 3 months, to assess the time spent by auxiliary nurse midwives (ANMs) and CHOs on different services and activities. Data were collected through direct continuous observation of four CHOs and four ANMs during working hours for a period of 6 consecutive days of a week, along with structured time allocation interviews of all participants. Results: The CHOs spent 5.7 (5.6–5.9) hours per day on duty of which 57% was productively involved in service delivery. The average time spent by ANMs was 4.9 (4.5–5.3) hours per day, with nearly 62% productive time. While the CHOs spent nearly 40% of their time on services for non-communicable diseases (NCDs), the ANMs spent 51% of their time on maternal, infant, child, and adolescent health services. Conclusion: The introduction of HWCs and CHOs has nudged the health system toward comprehensive primary health care by placing a renewed emphasis on NCDs. The study provides useful evidence for staff, program implementers, and policymakers, to aid informed decision-making for human resource management.

Abstract Background Integrated care is a people-centered health delivery approach that ensures the comprehensiveness, quality, and continuity of service across the settings and levels of health systems. The World Health Organization (WHO) recommends integration across levels and building-blocks of health systems as a prerequisite of Universal Health Coverage (UHC). While health systems of low- and middle-income countries (LMICs) are often fragmented and led by siloed service delivery structure, several LMICs—including India—have attempted health system integration. Several systematic reviews of evidence on healthcare integration from developed countries exist, but no synthesis from LMICs was reported to date. This review will overview the existing evidence of primary-secondary care integration (PSI) in the context of LMICs, aiming to support policy decisions for the effective integration of health delivery systems in India. Methods The review will be conducted following the six steps recommend by Arksey and O'Malley. Scientific and grey literature will be systematically selected from PubMed, Embase, Scopus, Web of Science, Global Index Medicus, and electronic repositories (such as WHO, World Bank, Health Policy Plus, and OpenGrey). Using a comprehensive search strategy, literature written in English and published between 2000 and 2020 will be selected, and two independent authors will screen their titles and abstracts. The result will be charted using a data extraction form and reported using tables, figures, and narrative forms. Discussion No ethical approval is necessary for the review. The final report will be developed with the consultation of other stakeholders and disseminated through workshops, conference papers, and peer review articles. The review will serve as a guiding tool to approach, implement, and test the PSI models in India and other LMICs. Scoping review registration https://osf.io/kjhzt .

Background: Government-sponsored health insurance schemes (GSHIS) aim to improve access to and utilization of healthcare services and offer financial protection to the population. India's Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) is one such GSHIS. This paper aims to understand how the processes put in place to manage hospital-based transactions, from the time a beneficiary arrives at the hospital to discharge are being implemented in PM-JAY and how to improve them to strengthen the scheme's operation.Methods: Guidelines were reviewed for the processes associated with hospital-based transactions, namely, beneficiary authentication, treatment package selection, preauthorization, discharge, and claims payments. Across 14 hospitals in Gujarat and Madhya Pradesh states, the above-mentioned processes were observed, and using a semi-structured interview guide fifty-three respondents were interviewed. The study was carried out from March 2019 to August 2019.Results: Average turn-around time for claim reimbursement is two to six times higher than that proposed in guidelines and tender. As opposed to the guidelines, beneficiaries are incurring out-of-pocket expenditure while availing healthcare services. The training provided to the front-line workers is software-centric. Hospital-based processes are relatively more efficient in hospitals where frontline workers have a medical/paramedical/managerial background.Conclusions: There is a need to broaden capacity-building efforts from enabling frontline staff to operate the scheme's IT platform to developing the technical, managerial, and leadership skills required for them. At the hospital level, an empowered frontline worker is the key to efficient hospital-based processes. There is a need to streamline back-end processes to eliminate the causes for delay in the processing of claim payment requests. For policymakers, the most important and urgent need is to reduce out-of-pocket expenses. To that end, there is a need to both revisit and streamline the existing guidelines and ensure adherence to the guidelines. [ABSTRACT FROM AUTHOR]

Poverty and healthcare issues are the most debatable topics today. Developing countries like India have as much as 45% of its population trapped in poverty because of various urgent healthcare needs. Universal health coverage (UHC) is a unique insurance system to provide financial protection to the marginalized groups of the country. It facilitates appropriate and immediate health needs, including required diagnostic, therapeutic and operational costs. However, UHC, a unique plan which focuses on the disadvantaged sections of the society, has some serious lacunae when it comes to its implementation in real life. This includes finances and human resources. Experts are reallocating adequate budgetary expenditure on healthcare issues, and in the meantime, a shortage of skilled health manpower is hunting down the UHC scheme in India. In recent times, different state governments are increasing budget allocation for the health sector. UHC is targeting low-income and poor families, forgetting the affordable and timely healthcare by way of improving services offered at the primary health centers and rapid expansion of the skilled health manpower across the country. UHC needs to focus on health paradigm systems, including improved healthcare-seeking behavior, nutrition, sanitation, potable water, reducing maternal and infant mortality, and dissemination of information of current technology to provide quality health services to the underserved and marginalized population of the country. These changes would symbolize a real way forward toward the immediate fulfillment of UHC goals for India.

The development in the country's health status has not kept pace with its economic development. Although India along with most countries of the world was a signatory to the Alma Ata Declaration of 1978, its performance particularly on health equity and quality issues, so far, has been far from satisfactory. There are vast variations in health-care status by states, by ethnic groups, gender, and urban-rural difference. Till recently, government policies and people's perceptions also seemed to be on the wrong track. Our priorities seemed to be all wrong – we seemed to prefer setting up of high-cost tertiary health institutions at the expense of the primary health centers. The recently launched Swachh Bharat and Ayushman Bharat schemes offer hope of addressing these asymmetries. This paper briefly dwells on these issues.

To review the importance of evidence-based methods in health insurance reimbursement for achieving universal health coverage in India. A narrative literature review was performed. The out-of-pocket (OOP) healthcare expenditure in India is among the highest in the world. This situation is despite the implementation of numerous government health schemes and the availability of a large number of health insurance programs, both public and private. Compromised quality of care in many public healthcare facilities is a major factor driving the average Indian citizen to increasingly depend upon private healthcare facilities, further escalating OOP spending. The low awareness and poor uptake of insurance policies among Indians is one of the biggest challenges in the implementation of universal health coverage (UHC) in India. The catastrophic burden of high OOP expenses on individual households could be reduced by taking steps to enhance health insurance uptake, which can be in turn achieved by strengthening the healthcare reimbursement system in India. The application of the principles of evidence-based healthcare for reimbursement requires the systematic assessment of all health technologies, which is already being done in developed countries. The enactment of health schemes such as Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana and setting up of Health Technology Assessment in India are steps toward reducing OOP expenditure and achieving UHC in India. We review the importance and challenges of evidence-based reimbursement and health technology assessment toward achieving UHC in India. • Indian households bear a high out-of-pocket expenditure on healthcare in India. • Introducing evidence-based reimbursement and health technology assessment would encourage the insurance uptake. • This would reduce the expenditure and improve the access to quality healthcare. • By launching the Ayushman Bharat public health insurance and assurance scheme, and by setting up Health Technology Assessment in India, the country is taking bold steps for providing universal health coverage to its citizens. [ABSTRACT FROM AUTHOR]

Background: In India, policymakers are in an opined that expansion of public-funded health insurance is the key to achieve Universal Health Coverage (UHC). Despite untapped potential to be part of such government-run public-funded health scheme, many private service providers are reluctant to join in such scheme due to various reasons. This paper aims to evaluate facilitators, barriers and perception to participation of the private sector health facilities in Health Insurance & government-led schemes. Methods: Present study was conducted in 83 private hospitals of Vadodara city. Sampling frame was formed & with the use of random number table, 83 hospitals were selected randomly. Data collection was done in pre tested, pre formed questionnaire & respondents were the medical superintendent or the person in-charge of the hospital. Results: In the present study 30% & 26% of hospitals were enrolled for cashless private health insurance facility & government health schemes respectively. Social service, competition and increase clientele were the common reason sought for enrolment in government health schemes. Low & delayed reimbursement, bribe to clear payment, limited services covered, administrative issues were the common problems identified for non-enrolment. There was an association between a number of beds in the hospital & enrolment to government health scheme (p

The Ayushman Bharat, the universal healthcare scheme in India, faced service adoption challenges after its launch in 2018. It was an enigma for the top management in Ayushman Bharat regarding slower service adoption of a free mass healthcare coverage scheme by the target population. The case focuses on the service adoption challenges from patient and physician perspectives while implementing a universal healthcare system. It provides insights to policymakers, physicians, service operations managers, and healthcare administrators regarding managing the universal healthcare system's implementation challenges in a developing country context. Research questions/Objective: This study aims to understand service adoption challenges in a universal healthcare system setting. The study explores the following research questions: How is service adoption theory applied in a universal health coverage program? What should be the integrated marketing communication plan to improve the awareness about a universal healthcare program? Links to theory: The study uses service adoption theory. It analyzes service adoption challenges for the universal healthcare system in India called Ayushman Bharat. It also uses literature on the Unified Theory of Acceptance and Use of Technology (UTAUT) model. Phenomenon studied: The case study uses pan India patient and physician data to explore service adoption issues in Ayushman Bharat - a universal healthcare scheme in India. Case context: The primary data collected through the field (hospital) visits and interaction with patients and physicians of Ayushman Bharat form the basis of this case study. Findings: The study emphasizes on performance expectancy, ease in availing of the service, positive social influence, and facilitating conditions for service delivery of Ayushman Bharat. The Ayushman Bharat scheme's performance expectancy means how being a healthy individual would contribute to better performance at the workplace. The effort expectancy is the level of ease an eligible Ayushman Bharat scheme can avail the service at the empanelled hospital. The social acceptance of the Ayushman Bharat scheme by friends, peers, and people in the vicinity would create a positive social influence. The facilitating conditions in the Ayushman Bharat scheme are the government's capacity to provide organizational and technological infrastructure to support this universal healthcare program. Discussions: The use of service adoption theory and the UTAUT model to enhance the adoption of the universal healthcare system in India have been discussed in the case study. [ABSTRACT FROM AUTHOR]

Compared to its peers, India has always spent far less on health. This is slowly changing as are the drivers that are forcing some of these changes. Demographical and epidemiological changes have moved the disease burden away from communicable and maternal and childhood diseases to non-communicable diseases. More people are city dwellers and achieving UHC is one of Sustainable Development Goals. To tackle these commitments and shifting demands, in 2017, there was a committed move towards improving primary health care by introducing comprehensive PHC through health and wellness centres. These centres are close to the community and by improving the quality of care given and increasing the range of services that they provide, there should be an increase in access to health. However, much needs to be done to ensure that these centres will provide high quality care to the local populations. Training the healthcare workers needed to staff these HWCs will take time. Keeping the required funding to expand the programme will be challenging in the current fiscal space. There is a need to integrate care and flow of funds between primary and secondary care and empowering local populations to engage in governance of the HWCs will take time. [ABSTRACT FROM AUTHOR]