Ayushman Bharat Transforms Access to High-Cost Spinal Surgeries: PGI Chandigarh Study
A groundbreaking study from the Post Graduate Institute of Medical Education and Research (PGI) in Chandigarh has provided compelling evidence of how India's flagship public health insurance scheme, Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY), is revolutionizing access to complex spinal surgeries for economically disadvantaged patients. The research, published in the Journal of Clinical Orthopaedics and Trauma in 2026, demonstrates a significant shift from self-financed to publicly funded care, marking a pivotal moment in healthcare equity.
Study Methodology and Key Findings
Conducted by the Department of Orthopaedic Surgery at PGI, the retrospective analysis examined 410 spine surgeries performed between January 2023 and December 2024. The findings reveal a dramatic transformation in funding patterns over the two-year period.
- Overall, 67.3% of surgeries (276 cases) were funded under PM-JAY, while 26.8% (110 cases) were self-financed.
- PM-JAY utilization surged from 58.7% in 2023 to 73.5% in 2024.
- Self-paid procedures declined sharply from 37.8% to 18.9% during the same period.
The study focused on a wide range of spinal conditions, with degenerative disorders accounting for 46.1% of cases and traumatic injuries making up 33.4%. Surgical procedures included decompression, stabilization, and complex instrumented fusion operations.
Expert Insights on Healthcare Transformation
Prof Vivek Lal, Director of PGI, emphasized the study's significance in demonstrating how public policy can translate into tangible health equity. "This research clearly shows how Ayushman Bharat is reshaping access to advanced surgical care by eliminating financial barriers that previously excluded large segments of society," he stated. "At PGI, we're witnessing a fundamental shift where the ability to pay no longer determines whether patients receive complex, life-changing spine surgery."
Dr Vishal Kumar, Professor in the Department of Orthopaedic Surgery and lead researcher, highlighted the particular importance of spinal surgery as a test case for public health insurance effectiveness. "Spine surgery involves expensive implants, advanced imaging, and prolonged hospital care that traditionally placed it beyond reach for many patients," he explained. "Our analysis demonstrates that PM-JAY has significantly improved access across various spinal pathologies while reducing out-of-pocket expenditure."
Broader Implications and Policy Recommendations
The research team, which included Dr Sarvdeep Singh Dhatt under the guidance of Prof Vijay G Goni, noted several critical implications beyond individual patient benefits:
- Early intervention in spinal disorders can prevent permanent neurological damage and reduce long-term disability.
- Improved access enables patients to return to productive social and economic roles more quickly.
- All PM-JAY-funded procedures used approved implants within predefined reimbursement packages, primarily comprising domestically manufactured devices.
The study also identified important policy priorities for sustaining and expanding this success:
- Periodic revision of reimbursement packages to reflect current costs
- Improved digital integration for smoother administrative processes
- Inclusion of postoperative rehabilitation within insurance coverage
- Robust clinical governance and continuous audit systems
- Adherence to evidence-based surgical indications to prevent over-utilization
Institutional Adaptation and Growing Confidence
The research revealed that PM-JAY utilization extended across diverse spinal surgery categories including trauma, deformity, tumor, infections, and revision procedures. This broad application reflects growing institutional confidence in delivering advanced spine care within fixed reimbursement frameworks.
Dr Kumar attributed the year-on-year increase in PM-JAY-funded surgeries to multiple factors: "The rising trend reflects growing patient awareness, administrative streamlining, and institutional adaptation to the scheme's requirements. While formal outcome comparisons weren't part of this study, we observed no gross differences in early postoperative outcomes between funding categories."
The PGI Chandigarh study stands as a powerful testament to how well-designed public health insurance can transform access to specialized medical care. By removing financial barriers to complex spinal surgeries, Ayushman Bharat PM-JAY is not only improving individual health outcomes but also contributing to broader socio-economic development through reduced catastrophic health expenditure and improved workforce participation.
