CONVERGENCE OF NATIONAL AND STATE HEALTH INSURANCE SCHEMES: A CASE STUDY OF AB PM-JAY AND DR. NTR VAIDYA SEVA

Healthcare is essential for human development, improving productivity, and reducing the socio-economic burden of diseases. Despite progress in economic growth, India struggles with healthcare accessibility, particularly for vulnerable populations. The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) and Dr. NTR Vaidya Seva are two significant health insurance schemes designed to address this challenge. AB PM-JAY, the world’s largest publicly funded health insurance program, offers cashless coverage for secondary and tertiary care, aiming to reduce catastrophic health expenditure nationwide. Dr. NTR Vaidya Seva, specific to Andhra Pradesh, targets Below Poverty Line (BPL) families with comprehensive coverage for critical health conditions. This study evaluates the potential convergence of these two schemes to maximize healthcare delivery. It explores how the integration of PM-JAY and Dr. NTR Vaidya Seva can enhance accessibility, streamline administrative processes, and improve health outcomes by providing more comprehensive and coordinated services. The trust model underpinning both schemes ensures transparency, efficient fund allocation, and quality control while promoting sustainability and adaptability. Findings indicate that convergence can reduce overlapping administrative efforts, expand coverage, and foster collaboration among stakeholders. The unified approach supports equitable healthcare access, mitigates financial barriers, and ensures resource optimization. This study underscores the transformative impact of leveraging both national and state initiatives, offering a roadmap for achieving universal health coverage and addressing India's dual burden of communicable and non-communicable diseases. Enhanced synergy between PM-JAY and Dr. NTR Vaidya Seva can significantly uplift the health scenario for millions, particularly for those most vulnerable. KEY WORDS: Healthcare accessibility, Universal Health Coverage, AB PM-JAY, Dr. NTR Vaidya Seva, Health insurance, Vulnerable populations, Catastrophic health expenditure, Trust model, Administrative convergence, Comprehensive healthcare, Equity in healthcare.