Reach of ‘Ayushman Bharat Scheme’ in Eight Aspirational Districts of Uttar Pradesh

The COVID-19 pandemic has brought to the fore the fragility of the government health care system and the stress on individuals in terms of out-of-pocket expenses for seeking health care. It also underscored the efforts of the frontline health workers and the schemes like Pradhan Mantri Jan Arogya Yojana (PMJAY), highlighting the need for a well-designed, comprehensive and shock-responsive health insurance scheme to become a critical element in the future for both meeting preventive and curative aspects of health care delivery.

This article examines the functioning of PMJAY from the perspective of beneficiaries, drawing on a 2019 GIDS–UNICEF study. The study gathered insights from PMJAY patients, empanelled hospitals and Arogya Mitras involved in scheme implementation. The article goes to focus to assess beneficiary satisfaction with healthcare services under Ayushman Bharat-PMJAY and the challenges they confront during hospitalisation in the eight aspirational districts of Uttar Pradesh. Based on a field survey of key stakeholders, it finds that many beneficiaries were nudged towards private hospitals for supposedly free specialised care but still incurred significant out-of-pocket expenses.