PM-JAY Expands Access To Complex Spine Surgeries, Cuts Out-of-Pocket Costs: Study

The Government’s flagship Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) has significantly expanded access to complex spine surgeries while sharply reducing out-of-pocket expenditure for patients from economically weaker sections, according to a new study from the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh.

Titled Impact of Ayushman Bharat (PM-JAY) on Access to Spine Surgery at a Tertiary Care Centre in North India: A Retrospective Analysis, the study documents a marked rise in the utilisation of PM-JAY for spine procedures, accompanied by a steady decline in self-financed surgeries. The findings highlight the scheme’s growing role in improving financial access to implant-intensive, high-cost orthopaedic care.

The single-centre, retrospective observational study analysed all spine surgeries performed at PGIMER between January 2023 and December 2024. During this period, 410 patients—249 men and 161 women—underwent surgical intervention for various spinal conditions. Degenerative spinal disorders accounted for the largest share of cases (46.1 per cent), followed by traumatic spinal injuries (33.4 per cent). Other indications included infectious and neoplastic conditions.

Overall, 276 procedures, or 67.3 per cent of the total, were funded under PM-JAY, while 110 cases (26.8 per cent) were self-financed. The remaining procedures were supported through other funding mechanisms. Importantly, the study noted a sharp year-on-year increase in reliance on the public insurance scheme.

“PM-JAY utilisation increased from 58.7 per cent (101 of 172 procedures) in 2023 to 73.5 per cent (175 of 238 procedures) in 2024. At the same time, self-financed surgeries declined from 37.8 per cent to 18.9 per cent,” the PGIMER orthopaedic team reported. “By eliminating out-of-pocket costs for nearly three-quarters of patients in 2024, the scheme has enabled access for economically disadvantaged groups who were previously excluded from advanced spine care.”

The findings, published in the Journal of Clinical Orthopaedics and Trauma, suggest that publicly funded health insurance is playing a decisive role in bridging financial barriers to specialised spine treatment across a wide range of pathologies. However, the authors cautioned that strong clinical governance and monitoring mechanisms are essential to ensure equitable implementation and prevent unnecessary or inappropriate utilisation.

Launched in 2018, AB-PMJAY is the world’s largest publicly funded health insurance programme, offering coverage of up to Rs 5 lakh per family per year for secondary and tertiary care to eligible households. By empanelling both public and private hospitals nationwide, the scheme aims to reduce catastrophic health expenditure and improve access to essential healthcare services. In recent years, its use for high-cost surgical procedures—particularly in orthopaedics and neurosurgery—has steadily increased, noted the authors.

Spinal disorders often require advanced imaging, specialised implants, prolonged hospitalisation, and intensive post-operative care, making them financially daunting for many families. Historically, these costs have restricted access to timely surgery for patients from lower socio-economic backgrounds, frequently leading to disability or long-term loss of livelihood.

Commenting on the findings, Dr. Rahul Khare, Professor and Head of the Orthopaedic Department at the central-run Ram Manohar Lohia Hospital, Delhi, who was not associated with the study, said the scheme has been transformative for poor patients. “Several complex spine surgeries, joint replacements, and arthroscopic surgeries, apart from trauma, that were once out of reach are now possible because of PM-JAY,” he said. He added that the availability of post-operative medicines through Jan Aushadhi and Amrit Kendras under the scheme has further reduced out-of-pocket spending, especially when certain drugs are not stocked by hospitals.

The study’s authors—Dr. Vishal Kumar, Dr. Tharun Teja Aduri, Dr. Aditya Gupta, and Dr. Sarvdeep Singh Dhatt—also pointed to areas for improvement. They recommended expanding coverage to include post-operative rehabilitation and essential orthotic devices to strengthen continuity of care and long-term functional outcomes. Standardised data collection and reporting across empanelled hospitals, they noted, would help policymakers better assess utilisation patterns, outcomes, and cost-effectiveness.

As India grapples with the dual challenge of rising non-communicable diseases and healthcare affordability—and India’s health budget has remained less than 2 per cent—the study underscores the potential of publicly funded insurance to improve access to complex, life-altering procedures.