Understanding the extent of economic evidence usage for informing policy decisions in the context of India’s national health insurance scheme

Ayushman Bharat Pradhan Mantri Jan Aarogya Yojana (PM-JAY)

Datos Bibliográficos

ID21879639
AutoresDeepshikha Sharma (0009-0008-1803-4432, Post Graduate Institute of Medical Education and Research), Akashdeep Singh Chauhan (0000-0001-6791-2221, Post Graduate Institute of Medical Education and Research), Lorna Guinne (0000-0002-1013-4200, Center for Global Development, London, UK), Abha Mehndiratta (0000-0003-3045-1649, Center for Global Development, London, UK), Anamika Dhiman (Center for Global Development, London, UK), Malkeet Singh (0000-0002-0034-9726, Center for Global Development, London, UK), Shankar Prinja (0000-0001-7719-6986, Post Graduate Institute of Medical Education and Research, autor de correspondencia)
Año2024
Volumen9
Número6
Páginase015079
Fecha de publicación2024-06-01
Peer ReviewedSí
Open AccessSí
TipoARTICLE
RevistaBMJ Global Health (JOURNAL)
Identificadores de la revistaISSN: 2059-7908 • E-ISSN: 2059-7908
EditorialBMJ (PUBLISHER • GB)
DOI10.1136/bmjgh-2024-015079
PMID38857943
OpenAlexW4399487788
IdiomaEN
Citas recibidas1
Referencias citadas21

INTRODUCTION: Ayushman Bharat Pradhan Mantri Jan Aarogya Yojana (PM-JAY) is one of the world's largest tax-funded insurance schemes. The present study was conducted to understand the decision-making process around the evolution (and revision) of health benefit packages (HBPs) and reimbursement rates within PM-JAY, with a specific focus on assessing the extent of use of economic evidence and role of various stakeholders in shaping these policy decisions. METHODS: A mixed-methods study was adopted involving in-depth interviews with seven key stakeholders involved in HBP design and reimbursement rates decisions, and a survey of 80 government staff and other relevant stakeholders engaged in the implementation of PM-JAY. The data gathered were thematically analysed, and a coding framework was developed to explore specific themes. Additionally, publicly available documents were reviewed to ensure a comprehensive understanding of the decision-making processes. RESULTS: Findings reveal a progressive transition towards evidence-based practices for policy decisions within PM-JAY. The initial version of HBP relied heavily on key criteria like disease burden, utilisation rates, and out-of-pocket expenditures, along with clinical opinion in shaping decisions around the inclusion of services in the HBP and setting reimbursement rates. Revised HBPs were informed based on evidence from a national-level costing study and broader stakeholder consultations. The use of health economic evidence increased with each additional revision with consideration of health technology assessment (HTA) evidence for some packages and reimbursement rates based on empirical cost evidence in the most recent update. The establishment of the Health Financing and Technology Assessment unit further signifies the use of evidence-based policymaking within PM-JAY. However, challenges persist, notably with regard to staff capacity and understanding of HTA principles, necessitating ongoing education and training initiatives. CONCLUSION: While substantial progress has been made in transitioning towards evidence-based practices within PM-JAY, sustained efforts and political commitment are required for the ongoing systematisation of processes

Actuarial science · Economic growth · Economics · Environmental health · Geography · Health care · Health economics · Health insurance · National health insurance · Political science · Public economics · Health Systems, Economic Evaluations, Quality of Life · Healthcare Policy and Management · Healthcare Systems and Reforms · Medicine