A Systematic Review of the World’s Largest Government Sponsored Health Insurance Scheme for 500 Million Beneficiaries in India: Pradhan Mantri Jan Arogya Yojana
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Abstract
Background and Objective
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.
Methods
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.
Results
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.
Conclusions
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.
世界上最大的政府资助的印度5亿受益人健康保险计划的系统回顾：Pradhan Mantri Jan Arogya Yojana。
背景和目标：为了实现全民健康覆盖，印度于2018年推出了世界上最大的政府资助的健康保险计划Pradhan Mantri Jan Arogya Yojana（PM-JAY）。这项研究旨在对该计划自成立以来的影响进行全面审查。方法：我们回顾了2018年9月至2023年1月发表的研究（基于访谈或调查），这些研究从PubMed、Web of Science和Scopus数据库中检索。研究的主要结果是：（1）认识；（2） 方案利用；（3） 经验；（4） 金融保护；以及（5）受益人和医疗保健提供者所面临的挑战。结果：对印度14个邦和联邦直辖区共进行的18项研究进行了回顾。调查结果显示，尽管PM-JAY已经成为一个熟悉的名字，但人们对该计划的各个方面的认识仍然很低，如福利、医院和所涵盖的服务。该计划使贫困和弱势人群受益，使他们能够获得以前负担不起的医疗服务。然而，该计划提供的财政保护效果喜忧参半。发现了一些挑战，包括受益人在药物和诊断测试上的持续支出、受益人卡的延迟发放以及医疗保健提供者要求的共同支付。此外，私立医院对医疗套餐费率低和报销延迟表示不满。结论：协调一致的努力，如在全国范围内传播对该计划的清晰和完整的知识，为医疗保健提供者提供培训，解决基础设施缺口和医疗保健提供者的担忧，以及确保适当的管理，对于实现该计划的长期预期目标至关重要。
期刊介绍：
Applied Health Economics and Health Policy provides timely publication of cutting-edge research and expert opinion from this increasingly important field, making it a vital resource for payers, providers and researchers alike. The journal includes high quality economic research and reviews of all aspects of healthcare from various perspectives and countries, designed to communicate the latest applied information in health economics and health policy.
While emphasis is placed on information with practical applications, a strong basis of underlying scientific rigor is maintained.
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