PM-JAY Boost Access To Complex Spine Surgeries, Reduce Out-Of-Pocket Costs: Study

The government's flagship Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) has significantly improved access to complex spine surgeries and eliminated out-of-pocket costs, reducing the financial burden on patients from a lower economic background, according to a new study. The study conducted by the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, demonstrated a substantial increase in the utilisation of PMJAY for spine surgery, with a concurrent decline in self-financed procedures. The retrospective, single-centre observational study was conducted, analysing all spine surgeries performed from January 2023 to December 2024. A total of 410 patients (249 males and 161 females) underwent spine surgery during the study period.

The majority of cases included degenerative spinal disorders (46.1 per cent) and traumatic injuries (33.4 per cent).

Overall, 276 procedures (67.3 per cent) were funded under PM-JAY, while 110 (26.8 per cent) were self-financed.

“PM-JAY utilisation increased from 58.7 per cent (101/172) in 2023 to 73.5 per cent (175/238) in 2024. Correspondingly, self-financed procedures declined from 37.8 per cent in 2023 to 18.9 per cent in 2024,” said the team from the Department of Orthopaedic Surgery, PGIMER.

“By eliminating out-of-pocket costs for 73.5 per cent of our 2024 cohort, the scheme has engaged the economically disadvantaged population that was previously excluded,” they added.

The findings, published in the Journal of Clinical Orthopaedics and Trauma, suggest that “publicly funded insurance is effectively improving financial access to implant-intensive spine care across a broad spectrum of pathologies. However, robust clinical governance remains essential to ensure equitable implementation and prevent overutilisation”.

ABPMJAY, launched in 2018, represents the world's largest publicly funded health insurance programme, providing coverage of up to Rs 5 lakh per family per year for secondary and tertiary care to eligible households.

The scheme aims to reduce catastrophic health expenditure and improve access to essential healthcare services by empanelling both public and private hospitals across the country. Since its inception, PM-JAY has been increasingly utilised for high-cost surgical interventions, including orthopaedic and spine procedures.

“Expansion of coverage to include postoperative rehabilitation and essential orthotic devices could improve continuity of care and long-term functional outcomes. Additionally, standardised data capture and reporting across empanelled institutions would facilitate ongoing evaluation of utilisation patterns, outcomes, and cost-effectiveness,” the researchers said.

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