wl-6989-PM-JAY - Assessing Equity in Universal Health Coverage in Rural India

The Government of India launched its new health policy (NHP) in 2017 with the aim of universal health coverage and equity in financial protection. As a result, the Pradhan Mantri Jan Arogya Yojana was introduced in 2018. The PM-JAY is one of the most extensive non-contributory public health insurances (NPHI) schemes, with various inclusion criteria based on the 2011 Socioeconomic Caste Census (SECC). Evaluating the inclusion criteria is essential to assess its equitability in covering households. Therefore, this study aims to evaluate the equitability of PM-JAY by using the PROGRESS Equity Lens Pradhan Mantri-Jan Arogya Yojana in rural India. We will start by investigating the vulnerable households that are prone to incur catastrophic health expenditures (Socioeconomic determinants). Thereafter, the prevalence of catastrophic health expenditure (CHE) across different socioeconomic categories in rural India. We used a nationally representative data set from the 75th round of the social consumption health survey conducted by the NSSO. Logistic regression was used to determine CHE's determinants, which were defined at a threshold of 10%. Second, we evaluate the NPHI's coverage and socioeconomic variables that affect NPHI enrollment and, by extension, PM-JAY program enrollment in rural India. To do so, we used a nationally representative data set of NFHS-5 (2019–21) and a logistic regression. Anderson's behavioral model of healthcare utilization has served as the study's theoretical foundation. The findings show that while PM-JAY was launched to safeguard vulnerable households, lower-income households are doubly excluded from enrollment in PM-JAY and health care access. The study also identifies the drawbacks of the D7 and D6 criteria. The D7 criteria exclude households with self-employed members, whereas the D6 criteria may exclude households with educated heads of household.