Evidence mapPaperPMID 40976675Full record

ArticleBMJ open2025

Impact of India's publicly funded health insurance scheme on financial risk protection: a case-control study from Haryana state in India.

Amneet P Kumar, Aditi Yerram, Yashika Chugh, Saroj Rana, Deepanjali Mudgal, Shankar Prinja, Muraleedharan V R

Abstract read
In one paragraph

Article in BMJ open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Amneet P KumarCommissioner and Secretary, Government of Haryana, Haryana, India amneetpkumarias@gmail.com.ORCID http://orcid.org/0000-0003-3455-1110
Aditi YerramUniversity of California San Diego, La Jolla, California, USA.
Yashika ChughCommunity Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, Haryana, India.
Saroj RanaCommunity Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, Haryana, India.
Deepanjali MudgalState Health Authority, Government of Haryana, Chandigarh, Haryana, India.
Shankar PrinjaCommunity Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, Haryana, India.ORCID http://orcid.org/0000-0001-7719-6986
Muraleedharan V RDepartment of Humanities and Social Sciences, IIT Madras, Chennai, Tamil Nadu, India.ORCID http://orcid.org/0000-0002-6698-7958

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveThis paper examines the impact of India's National Publicly Funded Health Assurance Scheme, Ayushman Bharat Pradhan Mantri Jan Aarogya Yojana (PM-JAY), in Haryana on out-of-pocket (OOP) expenses and catastrophic health expenditure (CHE).

designWe conducted a case-control study using a stratified random sampling approach. SETTINGS: Six districts in Haryana, based on utilisation, were selected: Mewat, Faridabad, Sonipat, Ambala, Kurukshetra and Karnal.

participantsA total sample size of 772 individuals, that is, 386 PM-JAY beneficiaries (cases) and non-beneficiaries (controls) each.

interventionData were collected using a semistructured questionnaire covering household demographics and expenditure details. The interview gathered information on hospitalisation within the past year, types of ailments, the type of empanelled facility visited, expenditure details and borrowing/selling of assets for treatment. PRIMARY AND SECONDARY OUTCOMES: Mean OOP expenditure was calculated for beneficiaries and non-beneficiaries based on the type of healthcare provider. The impact of PM-JAY on OOP expenditure was analysed using a generalised linear model controlling for religion, caste, type of house, type of family, morbidity patterns, type of disease, type of health facility, hospital stay duration, average distance to the facility and travel time. CHE was defined as OOP payments ≥30% of household income. Logistic regression was used to assess the determinants of CHE.

resultsWe found that direct medical expenses incurred for hospitalisations were 65% lower for beneficiaries (11 131 rupees) compared with non-beneficiaries (31 675 rupees). While OOP expenditures are similar for both groups in public empanelled hospitals, non-beneficiaries incur OOP costs three times higher than PM-JAY beneficiaries in private empanelled hospitals. Factors, including the disease type, average distance from home to the facility, average travel time and type of hospital, significantly influence these expenses. Furthermore, the prevalence of CHE is significantly lower among PM-JAY beneficiaries (13.3%) compared with non-beneficiaries (45.9%), with an OR of 7.15 (95% CI: 4.74 to 10.80; p<0.01).

conclusionsOur analysis shows the scheme's impact on decreasing OOP expenditure and CHE. To enhance the scheme's effectiveness, the study highlights the necessity of addressing non-medical expenses and expanding coverage for indirect costs, such as food, accommodation and transportation. Additionally, strengthening the supply side through improved drug availability at healthcare facilities is crucial for enhancing financial protection and access to care.

Indexed as

Catastrophic IllnessFinancing, GovernmentFinancing, PersonalHealth ExpendituresInsurance, HealthNational Health ProgramsAdolescentAdultCase-Control StudiesFemaleHospitalizationHumansIndiaMaleMiddle AgedYoung AdultHealth Care CostsHEALTH ECONOMICSHealth policyHealth Services AccessibilityPUBLIC HEALTH

Identifiers

PMID40976675
PMCPMC12458760

What Socratic holds

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LicenceCC BY-NC
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.