PGI Study: Ayushman Bharat increased spinal surgery access for the poor

Prof Vivek Lal, director, PGI, said the study highlights the transformative potential of publicly funded health insurance when aligned with institutional capacity. “This study clearly demonstrates how Ayushman Bharat is reshaping access to advanced surgical care by removing financial barriers that once excluded large sections of society. At PGI, we are witnessing a tangible shift where the ability to pay no longer determines the ability to receive complex, life-altering spine surgery. This is a powerful example of public policy translating into real, measurable health equity.”

A total of 410 spine surgeries were analysed during the study period. Of these, 67.3% (276 cases) were funded under PM-JAY, while 26.8 % (110 cases) were self-financed. Importantly, PM-JAY utilisation increased sharply from 58.7% in 2023 to 73.5 per cent in 2024, accompanied by a steep decline in self-paid procedures from 37.8% to 18.9%. Degenerative spinal disorders accounted for the largest proportion of cases (46.1%), followed by traumatic spinal injuries (33.4%), with surgeries spanning a wide spectrum, from decompression and stabilisation to complex instrumented fusion procedures. The utilisation of PM-JAY extended across trauma, deformity, tumour, infections, and revision spine surgeries, reflecting growing institutional confidence in delivering advanced spine care within fixed reimbursement frameworks.

The study was conducted by Dr Vishal Kumar, Professor, Department of Orthopaedic Surgery, PGI, along with Dr Sarvdeep Singh Dhatt and their team, under the mentorship and guidance of Prof Vijay G Goni, head, Department of Orthopedics, PGI. The team noted that spine surgery is among the most financially demanding areas of modern healthcare, making it a critical test case for the effectiveness of public health insurance.

Dr Vishal Kumar stated, “Spine surgery involves expensive implants, advanced imaging, and prolonged hospital care, which traditionally placed it beyond the reach of many patients. Our analysis shows that PM-JAY has significantly improved access across a broad range of spinal pathologies, while also reducing out-of-pocket expenditure. The year-on-year rise in PM-JAY-funded surgeries reflects growing patient awareness, administrative streamlining, and institutional adaptation to the scheme,” Dr Kumar said.

All PM-JAY-funded procedures in the study were performed using implants approved under predefined reimbursement packages, largely comprising domestically manufactured devices. While formal outcome comparisons were beyond the scope of the study, no gross differences in early postoperative outcomes were observed. Beyond individual patient benefit, the authors emphasise the broader socio-economic implications of improved access to timely spine surgery. Early intervention in spinal disorders can prevent permanent neurological deficits, reduce long-term disability, and enable patients to return to productive social and economic roles.

The study also warns that expanding coverage must be accompanied by robust clinical governance, continuous audit, and adherence to evidence-based surgical indications to prevent over-utilisation and ensure equitable implementation. Periodic revision of reimbursement packages improved digital integration, and inclusion of postoperative rehabilitation within insurance coverage were identified as key policy priorities.