University School of Management and Entrepreneurship, Delhi Technological University, New Delhi, India.
Department of Humanities and Social Sciences, National Institute of Technology Kurukshetra, Kurukshetra, 136119, Haryana, India.
Appl Health Econ Health Policy. 2024 Jan;22(1):17-32. doi: 10.1007/s40258-023-00838-0. Epub 2023 Oct 6.
In pursuit of universal health coverage, India has launched the world's largest government-sponsored health insurance scheme, Pradhan Mantri Jan Arogya Yojana (PM-JAY) in 2018. This study aims to provide a holistic review of the scheme's impact since its inception.
We reviewed studies (based on interviews or surveys) published from September 2018 to January 2023, which were retrieved from PubMed, Web of Science, and Scopus database. The main outcomes studied were: (1) awareness; (2) utilization of scheme; (3) experiences; (4) financial protection; and (5) challenges encountered by both beneficiaries and healthcare providers.
A total of 18 studies conducted across 14 states and union territories of India were reviewed. The findings revealed that although PM-JAY has become a familiar name, there remains a low level of awareness regarding various facets of the scheme such as benefits entitled, hospitals empanelled, and services covered. The scheme is benefitting the poor and vulnerable population to access healthcare services that were previously unaffordable to them. However, financial protection provided by the scheme exhibited mixed results. Several challenges were identified, including continued spending by beneficiaries on drugs and diagnostic tests, delays in issuance of beneficiary cards, and co-payments demanded by healthcare providers. Additionally, private hospitals expressed dissatisfaction with low health package rates and delays in claims reimbursement.
Concerted efforts such as population-wide dissemination of clear and complete knowledge of the scheme, providing training to healthcare providers, addressing infrastructural gaps and concerns of healthcare providers, and ensuring appropriate stewardship are imperative to achieve the desired objectives of the scheme in the long-run.
为追求全民健康覆盖，印度于 2018 年推出了世界上最大的政府资助的医疗保险计划——总理医疗保险计划（PM-JAY）。本研究旨在全面评估该计划自启动以来的影响。
我们检索了 2018 年 9 月至 2023 年 1 月期间在 PubMed、Web of Science 和 Scopus 数据库中发表的基于访谈或调查的研究，主要研究结果包括：（1）知晓率；（2）计划利用情况；（3）体验；（4）财务保护；以及（5）受益人和医疗服务提供者遇到的挑战。
共审查了印度 14 个邦和联邦属地开展的 18 项研究。结果表明，尽管 PM-JAY 已广为人知，但人们对该计划的诸多方面，如应享权益、指定医院和涵盖服务，仍缺乏了解。该计划使贫困和弱势群体能够获得以前负担不起的医疗服务。然而，该计划提供的财务保护效果参差不齐。研究发现了一些挑战，包括受益人在药品和诊断测试上继续支出、受益人卡发放延迟以及医疗服务提供者要求共付额。此外，私立医院对低健康套餐费率和理赔报销延迟表示不满。
必须做出一致努力，如在广大人群中广泛传播对该计划的清晰和完整的了解，为医疗服务提供者提供培训，解决基础设施差距和医疗服务提供者的关切，并确保适当的管理，以实现该计划的长期目标。
