ACCESS TO HEALTH INSURANCE UNDER AYUSHMAN BHARAT (PM-JAY): COVERAGE VERSUS ACTUAL UTILISATION — AN ECONOMIC ANALYSIS

Abstract

India a large part Of its health bill straight out Of the s own pocket, and for households a single hospital stay can wipe out years of savings. Ayushman Bharat (PM-JAY) was launched in 2018 to soften that blow by giving more than 50 crore a Of {5 lakh per Elmily each year for hospital treatment. On this is one of the biggest health schemes in the world. But having a card and actually using it are two different things. Illis dissertation asks a simple question: when the govemment gives a family insurance cover, does that cover turn into real treatment, and if not, why not? I study the distance (how many people hold an Ayushrnan card) and utilisation (how many actually use it) using mainly state-level data from the PM-JAY dashboard, the National Family Health Survey (NFHS-5), the NSS 75th Round, and the National Health Authority's annual rem)rts. The work is built around objectives and uses ordinary least squares (OLS) regression with robust standard errors, sup1Mted by a qualitative reading of how different run the scheme. Three findings stand out. First, PM-JAY coverage is somewhat higher in lxmer states, which suggests the scheme is reaching the people it was meant for, but rural and hilly areas still lag l*hind. Second, the coverage—utilisation gap grows åstest exactly where enrolment grows fastest — in other words, handing out mre cards does not by itself mean n»re treatnrnt. Third, the single factor that most reliably tums a card into actual hospital care is the density of empanelled hospitals: where there are n»re PM-JAY hospitals near Ikople, utilisation rises. Interestingly, a state having large general health infrastructure does not high PM-JAY use, that infrastnrture is not always plugged into the scheme. The clear is that the success of PM-JAY should not judged by how many cards are printed, but by how many cards are used. Expanding and prolRrly paying empanelled hospitals, cutting administrative friction, and pushing awareness through frontline workers are likely to do more for the than enrolment alone.