A groundbreaking study conducted by the Postgraduate Institute of Medical Education and Research (PGI) in Chandigarh has revealed that the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) has dramatically improved access to complex spine surgeries while simultaneously reducing out-of-pocket expenditure for patients across India. This comprehensive research, published in the prestigious Journal of Clinical Orthopaedics and Trauma (2026), provides compelling evidence of how public health insurance schemes are transforming high-cost specialty care in the country.
Detailed Analysis of 410 Spine Surgeries
The research team, led by Dr. Vishal Kumar and Dr. Sarvdeep Singh Dhatt, meticulously analyzed 410 spine surgeries performed between January 2023 and December 2024 at the institute. This extensive data collection period allowed researchers to track evolving trends in healthcare financing and access patterns for one of medicine's most expensive and complex procedures.
Remarkable Shift Toward Insurance-Supported Treatment
The study documented a significant transformation in how spine surgeries are financed. In 2023, PM-JAY funded 58.7% of all spine surgeries at PGI Chandigarh. This percentage increased substantially to 73.5% in 2024, demonstrating growing reliance on the public insurance scheme. Concurrently, self-financed procedures decreased from 37.8% to just 18.9% during the same period, indicating a clear shift away from out-of-pocket payments toward insurance-supported treatment at tertiary healthcare facilities.
Clinical Conditions and Surgical Impact
The research covered a broad spectrum of spinal conditions requiring surgical intervention. Degenerative spinal disorders represented the largest category at 46.1% of cases, followed by traumatic spinal injuries at 33.4%. The remaining cases involved various other spinal pathologies requiring specialized surgical care.
Spine surgery serves as an especially sensitive measure of healthcare affordability due to several factors: the procedures require expensive implants, involve prolonged hospitalization periods, and demand specialized surgical expertise. The study authors emphasized that timely intervention in spinal conditions is crucial for preventing permanent neurological deficits and long-term disability, making improved access through insurance schemes particularly valuable.
Standardized Implant Use and Quality Assurance
All surgeries covered under PM-JAY utilized implants approved within standard reimbursement packages, ensuring both quality control and cost-effectiveness. While the study primarily evaluated access and financing trends, the surgical team noted additional benefits of the insurance scheme, including standardized treatment protocols and predictable financial arrangements for both patients and healthcare providers.
Recommendations for Sustainable Implementation
The researchers underscored the importance of strong clinical governance and regular audits to ensure evidence-based use of surgical procedures and prevent potential overutilization. They emphasized that while increased access is beneficial, maintaining quality standards and appropriate utilization remains essential for the long-term sustainability of public health insurance programs.
The PGI Chandigarh study represents a significant contribution to understanding how India's flagship health insurance program is reshaping access to specialized surgical care. By documenting concrete improvements in both accessibility and affordability for complex spine surgeries, the research provides valuable insights for policymakers, healthcare administrators, and medical professionals working to strengthen India's healthcare system.
