Assessing the implementation of India's new health reform program, Ayushman Bharat, in two Southern states: Kerala and Tamil Nadu

India's health indicators are negatively impacted by the high percentage of out-of-pocket expenditures, which leaves many unable to access health care or impoverishes them. To improve this situation, the Indian government in 2018, as part of health a reform program called Ayushman Bharat Initiative (AB), started the Pradhan Mantri Jan Arogya Yojana (PMJAY) as a scheme to provide financial access to secondary and tertiary healthcare services for people living in poverty. The AB-PMJAY is a publicly-funded insurance program that provides over $6,000 per indigent family per year for in-patient hospital care. We compare the rollout of the program in two Indian States, Kerala and Tamil Nadu, which have relatively better health indicators compared with other Indian States. Questionnaires were developed for the two states based on the separate programs they had ongoing before AB-PMJAY was introduced and the differing implementation strategy they undertook. We interviewed 21 health workers (10 from Kerala and 11 from Tamil Nadu), at the frontline of implementation and analyzed the narrative of the answers given for related themes. We found that low reimbursement rates may limit the number of private hospitals participating in the program, and that the classification criteria for eligibility may need to be updated. We also found that differing political alignment between the central government and subregional governments may affect how well the program is implemented. Overall, interview subjects felt that the program would lead to better health care access for the poor if well implemented and sustained.

Automated summary

India's health indicators are affected by high out-of-pocket expenditures, but the AB-PMJAY program aims to improve this by providing health insurance. The study highlights the limitations of low reimbursement rates and outdated eligibility criteria, as well as the impact of political alignment on implementation.