PM-JAY Boosts Access to Complex Spine Surgeries, PGI Study Reveals

The research, published in the Journal of Clinical Orthopaedics and Trauma (2026), validates the role of India's flagship public health insurance scheme in reducing financial barriers for economically vulnerable patients.

Titled "Impact of Ayushman Bharat (PM-JAY) on access to spine surgery at a tertiary care centre in North India: A retrospective analysis", the study analysed 410 spine surgeries conducted at PGI between January 2023 and December 2024. The cohort included both elective and emergency procedures, covering a wide spectrum of spinal pathologies, including degenerative disorders, traumatic injuries, infections, deformities, tumours, and revision surgeries.

Of the total cases, 67.3% (276 surgeries) were funded under PM-JAY, while 26.8% (110 procedures) were self-financed. The study noted a sharp increase in PM-JAY utilisation from 58.7% in 2023 to 73.5% in 2024, alongside a decline in self-paid surgeries from 37.8% to 18.9%. Degenerative spinal disorders accounted for the largest proportion of surgeries (46.1%), followed by traumatic injuries (33.4%).

Prof Vivek Lal, director of PGI, said the findings highlight the transformative potential of public health insurance.

"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," he said.

Dr Vishal Kumar, Professor, Department of Orthopaedic Surgery, PGI, emphasised the significance of PM-JAY in reducing out-of-pocket expenditure for spine surgery, which typically involves costly implants, advanced imaging, and prolonged hospitalisation.

"Our analysis shows that PM-JAY has significantly improved access across a broad range of spinal pathologies. The year-on-year rise in funded surgeries reflects greater patient awareness, streamlined administrative processes, and institutional adaptation to the scheme," he said.

All PM-JAY-funded surgeries were performed using implants approved under predefined reimbursement packages, largely comprising domestically manufactured devices. While formal outcome comparisons were beyond the study's scope, early postoperative results showed no gross differences between funded and self-paid procedures.

The authors also noted the broader socio-economic impact of timely spine surgery, including prevention of permanent neurological deficits, reduction in long-term disability, and enabling patients to return to productive roles. They cautioned that expanding coverage must be accompanied by robust clinical governance, periodic audit, and adherence to evidence-based surgical indications, while recommending updates to reimbursement packages, better digital integration, and inclusion of postoperative rehabilitation in insurance coverage.

- ANI