Have a personal or library account? Click to login
Assessing Surgical Care under the Government‑Funded Health Insurance Scheme—Pradhan Mantri Jan Arogya Yojana in India Cover

Assessing Surgical Care under the Government‑Funded Health Insurance Scheme—Pradhan Mantri Jan Arogya Yojana in India

Annals of Global Health
Volume 91 (2025): Issue 1
By: Himanshu Iyer,  Uma Gupta,  Shreyas Patil,  Lokesh Krishna,  Sweta Dubey and  Siddhesh Zadey  
Open Access
|Dec 2025

References

  1. Shrime MG, Dare A, Alkire BC, Meara JG. A global country‑level comparison of the financial burden of surgery. Br J Surg. 2016;103(11):1453–1461. doi:10.1002/bjs.10249.
    Back to article
  2. World Health Organization. International Bank for Reconstruction and Development / The World Bank. Global Monitoring Report on Financial Protection in Health 2021. 2021.
    Back to article
  3. Shrime MG, Bickler SW, Alkire BC, Mock C. Global burden of surgical disease: An estimation from the provider perspective. Lancet Glob Health. 2015; 3(Suppl 2):S8–S9 doi:10.1016/S2214-109X(14)70384-5.
    Back to article
  4. Pandey A, Kumar GA, Dandona R, Dandona L. Variations in catastrophic health expenditure across the states of India: 2004 to 2014. PLoS One. 2018;13(10):e0205510. doi:10.1371/journal.pone.0205510.
    Back to article
  5. Selvaraj S, Farooqui HH, Karan A. Quantifying the financial burden of households’ out‑of‑pocket payments on medicines in India: A repeated cross‑sectional analysis of National Sample Survey data, 1994–2014. BMJ Open. 2018;8(5):e018020. doi:10.1136/bmjopen-2017-018020.
    Back to article
  6. Shetty R, Zadey S, Jindal A, et al. Prioritization of surgical, obstetric, trauma, and anesthesia care in India over seven decades: A systematic analysis of policy documents. PLOS Glob Public Health. 2023;3(7):e0002084. doi:10.1371/journal.pgph.0002084.
    Back to article
  7. Shetty R, Zadey S. New guidelines on non‑communicable diseases are welcome, but where is surgical care? The Wire Science. Published July 20, 2023. Accessed September 8, 2024. https://science.thewire.in/health/new-guidelines-non-communicable-diseases-surgical-care.
    Back to article
  8. Sonderman KA, Citron I, Mukhopadhyay S, et al. Framework for developing a national surgical, obstetric and anaesthesia plan. BJS Open. 2019;3(5):722–732. doi:10.1002/bjs5.50190.
    Back to article
  9. Angell BJ, Prinja S, Gupt A, Jha V, Jan S. The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana and the path to universal health coverage in India: Overcoming the challenges of stewardship and governance. PLoS Med. 2019;16(3):e1002759. doi:10.1371/journal.pmed.1002759.
    Back to article
  10. Dubey S, Deshpande S, Krishna L, Zadey S. Evolution of Government‑funded health insurance for universal health coverage in India. Lancet Reg Health Southeast Asia. 2023;13:100180. doi:10.1016/j.lansea.2023.100180.
    Back to article
  11. Iyer H, Gupta U, Patil S, Krishna L, Dubey S, Zadey S. Dataset for assessing surgical care under the government‑funded health insurance scheme – Pradhan Mantri Jan Arogya Yojana in India (Parts 1 and 2). Harvard Dataverse. 2024:1. doi:10.7910/DVN/4WQT2A.
    Back to article
  12. Lahariya C. “Ayushman Bharat” program and universal health coverage in India. Indian Pediatr. 2018;55(6):495–506. doi:10.1007/s13312-018-1341-1.
    Back to article
  13. Joseph J, Sankar D H, Nambiar D. Empanelment of health care facilities under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM‑JAY) in India. PLoS One. 2021;16(5):e0251814. doi:10.1371/journal.pone.0251814.
    Back to article
  14. National Health Authority. Ayushman Bharat PM‑JAY Annual Report 2020–21. 2021. Accessed March 24, 2022. https://nha.gov.in/img/resources/Annual-Report-2020-21.pdf.
    Back to article
  15. Aggarwal DV, Agarwal DA, Gautam K. National Health Benefit Package 2.2: User Guidelines. National Health Authority. 2021. Accessed September 12, 2022. https://pmjay.gov.in/resources/documents.
    Back to article
  16. Sethi SD, Gedam DP, Thakkar D, Arora L, Agrawal R. Unspecified package utilization under AB PM‑JAY. National Health Authority. 2021. Accessed December 10, 2021. https://pmjay.gov.in/sites/default/files/2021-05/Policy_Brief_Unspecified_Package_Utilization_under_AB_PM-JAY.pdf.
    Back to article
  17. National Health Authority. Health Benefit Packages 2.0: Frequently Asked Questions. Published online December 2019. Accessed July 6, 2024. https://ayushmanup.in/assets/doc/FAQ-English.pdf.
    Back to article
  18. National Health Authority. Health Benefit Package 2.0. Published online June 1, 2021. Accessed March 25, 2022. https://pmjay.gov.in/sites/default/files/2021-06/National-Master-for-Website_0.pdf.
    Back to article
  19. Dong D, Sehgal P, Chhabra S, Naib P, Smith O. PM‑JAY: The role of private hospitals. National Health Authority. 2020. Accessed December 10, 2021. https://pmjay.gov.in/sites/default/files/2020-11/Policy_Brief_9_Private_PM-JAY_201123_WB_NHA_R.pdf.
    Back to article
  20. Naib P, Nigam DR, Gautam K, Goel H. Cataract Management under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM‑JAY). National Health Authority. 2021:9.
    Back to article
  21. Kaur S, Jain N, Desai S. Patterns of utilization for hysterectomy: An analysis of early trends from Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM‑JAY). National Health Authority. 2021. Accessed December 10, 2021. https://www.pmjay.gov.in/sites/default/files/2019-08/NHA%20Working%20paper%20series%20001%20.pdf.
    Back to article
  22. Kumar S, Aggarwal DrV, Rao DrK, Agarwal DrR. Pattern of utilization of appendicectomy and cholecystectomy under Pradhan Mantri Jan Arogya Yojana (PM‑JAY) in India‑ Sept 2018‑March 2021. National Health Authority. 2022:32. Accessed October 24, 2023. https://pmjay.gov.in/sites/default/files/2022-08/Pattern-of-utilization-of-Appendicectomy-and-Cholecystectomy-under-Pradhan-Mantri-Jan-Arogya-Yojana.pdf.
    Back to article
  23. Mohpal A, Smith O, Chhabra S. Quality of care in PM‑JAY: A first look at unplanned readmissions and mortality. National Health Authority. 2020. Accessed December 9, 2021. https://pmjay.gov.in/sites/default/files/2020-06/Policy-Brief-7_PMJAY-Readmissions_30-05-20_NHA.pdf.
    Back to article
  24. Dong D, Naib P, Smith O, Chhabra S. Raising the bar: Analysis of PM‑JAY high‑value claims. National Health Authority. 2019. Accessed December 9, 2021. https://www.pmjay.gov.in/sites/default/files/2019-10/Policy%20Brief_Raising%20the%20Bar_High%20Value%20Claims_10-10-19_WB.pdf.
    Back to article
  25. Sehgal PK, Chandrashekhar S, Naib P. Trends in cardiac care utilisation under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM‑JAY). National Health Authority. 2021. Accessed December 10, 2021. https://pmjay.gov.in/sites/default/files/2021-06/Analysis-of-Cardiac-Packages-Utilization-Under-PMJAY_Final.pdf.
    Back to article
  26. Kaur S, Jain N, Bhatnagar PC. Early trends from utilization of oncology services: Insights from Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY). National Health Authority. 2021. Accessed December 10, 2021. https://www.pmjay.gov.in/sites/default/files/2019-11/Working%20paper-4%20%281%29.pdf.
    Back to article
  27. Kaur S, Jain N, Kumar S. Addressing gender issues under Ayushman Bharat Pradhan Mantri Jan ArogyaYojana (AB PM‑JAY) in India – Implications for equity. National Health Authority. 2021. Accessed December 10, 2021. https://pmjay.gov.in/sites/default/files/2020-03/Working%20paper.pdf.
    Back to article
  28. Arora A, Bhutani P, Chhabra S, Smith O. PM‑JAY without borders: Analysis of portability services. National Health Authority. 2020. Accessed December 9, 2021. https://pmjay.gov.in/sites/default/files/2020-02/Policy%20Brief%205_Analysis%20of%20Portability%20Services.pdf.
    Back to article
  29. Naib P, Nigam R, Gautam K, Goel H. Cataract management under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM‑JAY). National Health Authority. 2021. Accessed December 10, 2021. https://www.pmjay.gov.in/sites/default/files/2019-10/Cataract_Final_Paper.pdf.
    Back to article
  30. Mathur P, R S, Vaitheeshwaran K, H D, Koli RR. Patterns of stroke care in ABPM‑JAY beneficiaries inempaneled hospitals of PM‑JAY scheme. National Health Authority. 2022.
    Back to article
  31. Aggarwal V, Malik S, Arora L, Agrawal R. Analyzing variation in breast cancer service utilization, supply and underlying causes under PM‑JAY. National Health Authority. 2021. Accessed December 10, 2021. https://pmjay.gov.in/sites/default/files/2021-05/WP12_Working-paper.pdf.
    Back to article
  32. Smith O, Dong D, Chhabra S. PM‑JAY across India’s States: Need and utilization. National Health Authority. 2019.
    Back to article
  33. Smith O, Dong D, Chhabra S. PM‑JAY and India’s aspirational districts. National Health Authority. 2019.
    Back to article
  34. Goodair B, Reeves A. The effect of health‑care privatisation on the quality of care. Lancet Public Health. 2024;9(3):e199–e206. doi:10.1016/S2468-2667(24)00003-3.
    Back to article
  35. Mohanty SK, Upadhyay AK, Maiti S, et al. Public health insurance coverage in India before and after PM‑JAY: Repeated cross‑sectional analysis of nationally representative survey data. BMJ Glob Health. 2023;8(8):e012725. doi:10.1136/bmjgh-2023-012725.
    Back to article
  36. Achungura G, Raza A, Katre V, Anand JS, Ravishankar N, Kelkar R. Data integration of health financing systems as a critical enabler for objective‑oriented health system reform: A scoping review from India. Health Syst Reform. 2024;10(3):2401190. doi:10.1080/23288604.2024.2401190.
    Back to article
  37. Sabherwal S, Sood I, Khurana A, et al. Awareness, knowledge and challenges faced by beneficiaries and non‑beneficiaries of Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana with special reference to eyecare in three districts of Uttar Pradesh state: A cross‑sectional study. J Family Med Prim Care. 2024;13(8):2892–2899. doi:10.4103/jfmpc.jfmpc_1678_23.
    Back to article
  38. Parisi D, Srivastava S, Parmar D, et al. Awareness of India’s national health insurance scheme (PM‑JAY): A cross‑sectional study across six states. Health Policy Plan. 2023;38(3):289–300. doi:10.1093/heapol/czac106.
    Back to article
  39. Reddy NKK, Bahurupi Y, Kishore S, Singh M, Aggarwal P, Jain B. Awareness and readiness of health care workers in implementing Pradhan Mantri Jan Arogya Yojana in a tertiary care hospital at Rishikesh. Nepal J Epidemiol. 2020;10(2):865–870. doi:10.3126/nje.v10i2.27941.
    Back to article
  40. Reddy CL, Peters AW, Jumbam DT, et al. Innovative financing to fund surgical systems and expand surgical care in low‑income and middle‑income countries. BMJ Glob Health. 2020;5(6):e002375. doi:10.1136/bmjgh-2020-002375.
    Back to article
  41. National Health Authority, India. About Pradhan Mantri Jan Arogya Yojana (PM‑JAY). February 8, 2021. Accessed June 22, 2022. https://pmjay.gov.in/about/pmjay.
    Back to article
  42. Prinja S, Singh MP, Aggarwal V, et al. Impact of India’s publicly financed health insurance scheme on public sector district hospitals: A health financing perspective. Lancet Reg Health Southeast Asia. 2023;9:100123. doi:10.1016/j.lansea.2022.100123.
    Back to article
  43. Seyi‑Olajide JO, Ameh EA, Anyanwu SN. Expanding access to surgical care toward universal health coverage: Leveraging sustainable financing strategies for sub‑saharan Africa. Niger J Clin Pract. 2021;24(2):148–155. doi:10.4103/njcp.njcp_505_20.
    Back to article
DOI: https://doi.org/10.5334/aogh.4908 | Journal eISSN: 2214-9996
Journal RSS Feed
Language: English
Submitted on: Aug 4, 2025
Accepted on: Nov 20, 2025
Published on: Dec 12, 2025
Published by: Ubiquity Press
In partnership with: Paradigm Publishing Services
Publication frequency: 1 issue per year
Keywords:
Global surgery,
India,
Pradhan Mantri Jan Arogya Yojana (PMJAY),
surgical planning,
low- and middle-income countries,
health equity

© 2025 Himanshu Iyer, Uma Gupta, Shreyas Patil, Lokesh Krishna, Sweta Dubey, Siddhesh Zadey, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.

Previous articleVolume 91 (2025): Issue 1