The introduction of India’s largest social health insurance scheme, Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) has expanded healthcare access for millions of the country’s vulnerable population. The project has been marked by a key drive to increase healthcare access in different parts of the country across multiple specialties. Initiatives for inclusion of high-quality, innovative medical technologies within the reimbursement system is an established approach to improving short- and long-term patient outcomes.  

This includes the creation of a more inclusive reimbursement process that engages physicians and patient stakeholders at every step starting with prioritization, technical appraisal, and final decision. Complementing this approach, the introduction of quality-based incentives for implantable medical devices, in addition to existing service-based incentives within the reimbursement regime, will be the key to achieving a positive impact on patient outcomes. A move toward transparent, value-based pricing is expected to benefit public insurance beneficiaries as well as set positive benchmarks for private insurers to follow suit.

This special report presents the key recommendations aimed at improving access to high-quality healthcare through AB-PMJAY by introducing quality-based incentives.

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