Ayushman Bharat, But at What Cost?

Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is one of India's most ambitious efforts to protect vulnerable households from the financial burden of hospitalization. But how effectively does this promise translate into real protection for families living in rural India? The Ayushman Gap examines this question through a mixed-methods study of eligible rural households in Nawada district, Bihar. Drawing on household surveys and in-depth interviews, the book explores awareness of PM-JAY, possession and use of Ayushman cards, patterns of hospital utilization, barriers to accessing empanelled facilities, and the scheme's ability to reduce catastrophic health expenditure. The findings reveal a striking gap between policy design and lived experience. Limited awareness, knowledge gaps, hospital-level barriers, inadequate access to empanelled facilities, and indirect costs of healthcare continue to constrain the benefits of the scheme. While PM-JAY can substantially reduce direct medical expenditure for those who successfully access its benefits, transportation, food, lodging and other associated costs can continue to impose a serious financial burden. Grounded in evidence from rural Bihar, this book offers valuable insights for public health researchers, policymakers, healthcare professionals, students and anyone interested in universal health coverage, health financing and the implementation of publicly funded health insurance in India.