Page 303 - ES 2020-21_Volume-1-2 [28-01-21]

JAY Ho: Ayushman Bharat's Jan 09

Arogya Yojana (JAY) and Health

Outcomes CHAPTER

Of all the forms of inequality, injustice in healthcare is the most shocking and
most inhuman.

—Martin Luther King Jr.

This chapter demonstrates strong positive effects on healthcare outcomes of the Pradhan
Mantri Jan Arogya Yojana (PM-JAY) – the ambitious program launched by Government
of India in 2018 to provide healthcare access to the most vulnerable sections. PM-JAY is
being used significantly for high frequency, low cost care such as dialysis and continued
to be utilised without disruption even during the Covid pandemic and the lockdown.
General medicine – the overwhelmingly major clinical specialty accounting for over half
the claims - exhibited a V-shaped recovery after falling during the lockdown and reached
pre-COVID-19 levels in December 2020. The final – but the most crucial – analysis in the
chapter attempts to estimate the impact of PM-JAY on health utcomes by undertaking a
difference-in-difference analysis. As PM-JAY was implemented in 2018, health indicators
measured by National Family Health Surveys 4 (in 2015-16) and 5 (in 2019-20) provide
before-after data to assess this impact. To mitigate the impact of various confounding
factors, we compute a difference-in-difference by comparing states that implemented PM-
JAY versus those that did not. We undertake this analysis in two parts. First, we use
West Bengal as the state that did not implement PM-JAY and compare its neighbouring
states that implemented PM-JAY – Bihar, Sikkim and Assam. Second, we repeat the same
analysis for all states that did not implement PM-JAY vis-à-vis all states that did.

PM-JAY enhanced health insurance coverage. Across all the states, the proportion of
households with health insurance increased by 54 per cent for the states that implemented
PM-JAY while falling by 10 per cent in states that did not. Similarly, the proportion of
households that had health insurance increased in Bihar, Assam and Sikkim from 2015-16
to 2019-20 by 89 per cent while it decreased by 12 per cent over the same period in West
Bengal. From 2015-16 to 2019-20, infant mortality rates declined by 12 per cent for states
that did not adopt PM-JAY and by 20 per cent for the states that adopted it. Similarly,
while states that did not adopt PM-JAY saw a fall of 14 per cent in its Under-5 mortality
rate, the states that adopted it witnessed a 19 per cent reduction. While states that did not
adopt PM-JAY witness 15 per cent decline in unmet need for spacing between consecutive
kids, the states that adopted it recorded a 31 per cent fall. Various metrics for mother and
child care improved more in the states that adopted PM-JAY as compared to those who
did not. Each of these health effects manifested similarly when we compare Bihar, Assam
and Sikkim that implemented PM-JAY versus West Bengal that did not. While some of