ArticleApplied health economics and health policy2021
Translating Research to Policy: Setting Provider Payment Rates for Strategic Purchasing under India's National Publicly Financed Health Insurance Scheme.
Article in Applied health economics and health policy, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 26 papers, 2 of them syntheses that pooled it.
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26 citing papers in PubMed, 2 syntheses or guidelines pooled it, 34 citations in OpenAlex.
- A Systematic Review of the World's Largest Government Sponsored Health Insurance Scheme for 500 Million Beneficiaries in India: Pradhan Mantri Jan Arogya Yojana.Applied health economics and health policy · 2024Pooled it
- National Methodological Guidelines to Conduct Budget Impact Analysis for Health Technology Assessment in India.Applied health economics and health policy · 2021Pooled it
- Trial
- Beyond coverage: why Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana struggles to deliver healthcare in Jammu and Kashmir.Frontiers in public health · 2026Article
- An Introduction to Costing and the Types of Costs Used within Health Economic Studies.PharmacoEconomics - open · 2025Review
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- Financial Viability of Private Hospitals Operating Under India's National Health Insurance Scheme Ayushman Bharat Pradhan Mantri-Jan Arogya Yojana (AB PM-JAY).Applied health economics and health policy · 2025Article
- Impact of Government-Funded Health Insurance on Out-of-Pocket Expenditure and Quality of Hospital-Based Care in Indian States of Madhya Pradesh and Maharashtra.Applied health economics and health policy · 2024Article
- Impact of health benefit package policy interventions on service utilisation under government-funded health insurance in Punjab, India: analysis ofThe Lancet regional health. Southeast Asia · 2024Article
- The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) after four years of implementation - is it making an impact on quality of inpatient care and financial protection in India?BMC health services research · 2024Article
- Health care cost accounting in the Indian hospital sector.Health policy and planning · 2024Article
- Cost of Care for Non-communicable Diseases: Which Types of Healthcare Providers are the Most Economical in India's Chhattisgarh State?PharmacoEconomics - open · 2024Article
- 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).BMJ global health · 2024Article
- Framework for responsive financing of district hospitals of India.Frontiers in public health · 2024Article
- National hospital costing systems matter for universal healthcare: the India PM-JAY experience.BMJ global health · 2023Article
- Refining the provider payment system of India's government-funded health insurance programme: an econometric analysis.BMJ open · 2023Article
- Article
- Impact of India's publicly financed health insurance scheme on public sector district hospitals: a health financing perspective.The Lancet regional health. Southeast Asia · 2023Article
- Cost of hospital services in India: a multi-site study to inform provider payment rates and Health Technology Assessment.BMC health services research · 2022Article
- Role of healthcare cost accounting in pricing and reimbursement in low-income and middle-income countries: a scoping review.BMJ open · 2022Article
Corrections and comments
- Erratum issued
Authors and funding
8 authors at 11 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIn 2018, the Government of India launched Ayushman Bharat Pradhan Mantri-Jan Aarogya Yojana (AB PM-JAY), a large tax-funded health insurance scheme. In this paper, we present findings of the Costing of Health Services in India (CHSI) study, describe the process of use of cost evidence for price-setting under AB PM-JAY, and estimate its fiscal impact.
methodsReference costs were generated from the first phase of CHSI study, which sampled 11 tertiary public hospitals from 11 Indian states. Cost for Health Benefit Packages (HBPs) was estimated using mixed (top-down and bottom-up) micro-costing methods. The process adopted for price-setting under AB PM-JAY was observed. The cost of each HBP was compared with AB PM-JAY prices before and after the revision, and the budgetary impact of this revision in prices was estimated.
findingsFollowing the CHSI study evidence and price consultations, 61% of AB PM-JAY HBP prices were increased while 18% saw a decline in the prices. In absolute terms, the mean increase in HBP price was ₹14,000 (₹450-₹1,65,000) and a mean decline of ₹6,356 (₹200-₹74,500) was observed. Nearly 42% of the total HBPs, in 2018, had a price that was less than 50% of the true cost, which declined to 20% in 2019. The evidence-informed revision of HBP prices is estimated to have a minimal fiscal impact (0.7%) on the AB PM-JAY claims pay-out.
interpretationEvidence-informed price-setting helped to reduce wide disparities in cost and price, as well as aligning incentives towards broader health system goals. Such strategic purchasing and price-setting requires the creation of systems of generating evidence on the cost of health services. Further research is recommended to develop a cost-function to study changes in cost with variations in time, region, prices, skill-mix and other factors.
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