A review of India's AB-PM-JAY including strategic purchasing, decentralized regulation and financial risk protection

Abstract

India's Universal Health Coverage (UHC) mission is one of the most ambitious policy efforts in global health governance. It aims to give everyone equal access to quality health care without putting a strain on their finances.  The Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana (AB-PM-JAY), which started in 2018, is the main part of this project.  It is a big step towards making healthcare financing more accessible because it offers health insurance coverage of up to ₹500,000 per family per year to almost 500 million people.  This review brings together the most recent evidence on how well AB-PM-JAY works and how it is run, focussing on strategic purchasing, cost monitoring, state-level implementation models, and the changing structure of "decentred regulation."  Empirical evidence consistently shows that AB-PM-JAY significantly lowers out-of-pocket costs (OOPE) for tertiary procedures like heart surgeries. However, there are still big differences between states in how long it takes to process claims, how efficiently the government runs, and how well costs are covered.  This study finds big gaps in research in areas like integrating dynamic cost surveillance, comparing the performance of different state models, regulatory pluralism, and the area of oral healthcare financing that hasn't been investigated enough.  It sets research goals and hypotheses based on theoretical and real-world evidence, and it suggests a statistical framework that includes descriptive, correlational, and inferential analyses to help with real-world testing.  The discussion includes important measures like the average decrease in OOPE, the relationship between cost monitoring and claim turnaround time, and the use of regression to predict OOPE.  The synthesis results show that for sustainable UHC, it is very important to include cost surveillance in digital health infrastructure, improve hybrid purchasing models, and set up clear regulatory coordination mechanisms.  The paper ends by saying that AB-PM-JAY is a huge step forward in protecting people from financial risk, but its long-term success depends on pricing that is based on evidence, strong governance, and making sure that all health areas, including oral care and preventive services, are included fairly.