What is the common examiner trap about Social Issues in UPSC exams?

They may ask about the coverage amount (₹5 lakh per family per year) but trap you by asking 'per person' or 'per hospitalization'. Another trap is swapping the study conductor (IQVIA) with other agencies like NSSO or WHO.

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PMJAY Patients Pay ₹53,965 OOPE in Pvt Hospitals vs ₹21,827 in Public Facilities: NITI Aayog Study

Q: Which government body commissioned the evaluation study on PMJAY and other health sector schemes mentioned in the news?

NITI Aayog, The article clearly states that the evaluation study was commissioned by the NITI Aayog and submitted to its Development Monitoring and Evaluation Office (DEMO). The Ministry of Health is the implementing body, not the commissioning body for this specific study.

Q: Consider the following statements regarding the findings of the NITI Aayog study on PMJAY: 1. The average Out-of-Pocket Expenditure (OOPE) for PMJAY beneficiaries in private hospitals was more than double that in public hospitals. 2. The study found that transport costs are covered under the PMJAY scheme, reducing the financial burden. 3. The survey covered 2,283 households across 13 states and Union Territories. Which of the statements given above is/are correct?

Both 1 and 3, Statement 1 is correct as per the article: OOPE was ₹53,965 in private vs ₹21,827 in public facilities. Statement 2 is incorrect as the article explicitly notes 'transport cost is not covered under the scheme'. Statement 3 is correct as the survey sample was 2,283 households across 13 states/UTs.

Q: According to the NITI Aayog study, what was the average Out-of-Pocket Expenditure (OOPE) incurred per hospitalisation by PMJAY beneficiaries in public facilities?

₹21,827, The article provides the exact data: 'In public facilities, the patients incurred on an average OOPE of Rs 21,827 per hospitalisation.' ₹11,146 is the OOPE for non-insured patients in public facilities. ₹38,084 is the average OOPE for those not insured. ₹53,965 is the OOPE for PMJAY patients in private facilities.

Q: What is a key implication of the finding that PMJAY beneficiaries still incur significant Out-of-Pocket Expenditure (OOPE), as highlighted in the study?

It reveals a gap in coverage, potentially undermining the scheme's goal of financial protection., The core objective of PMJAY is to provide financial protection against catastrophic health expenditure. The persistence of high OOPE, especially for non-covered items like medicines and diagnostics, indicates a coverage gap that can leave families vulnerable, thus undermining the scheme's primary goal. The article does not suggest the other options.

Q: What should UPSC aspirants remember about Social Issues for Prelims?

1. Target this Data: ₹53,965 (Avg OOPE in Pvt Hosp under PMJAY) vs ₹21,827 (in Public Hosp). 2. Target this Nodal Body: NITI Aayog's Development Monitoring and Evaluation Office (DEMO). 3. Target this Legal Point: PMJAY launched on September 23, 2018, with an outlay of ₹40,112 crore for 2019-20 to 2024-25.

Social Issues PolityHIGH

Target:UPSC GS-IMPSCTeachingSSC GAPrelims HighMains HighStatic GK Link

07 Mar 2026

~2 min

Source: Indian Express

Key Data:₹53,965 OOPE in Pvt Hosp₹21,827 OOPE in Public Hosp₹40,112 crore outlay₹5 lakh coverage per family2,283 households surveyedLaunched Sept 23, 2018

Bodies:NITI AayogMinistry of Health and Family WelfareIQVIA Consulting

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~2 min · Quick mode

What This Article Covers

1.NITI Aayog's evaluation study finds PMJAY beneficiaries incur an average Out-of-Pocket Expenditure (OOPE) of ₹53,965 per hospitalisation in private facilities, versus ₹21,827 in public hospitals.

2.The study, by IQVIA Consulting, surveyed 2,283 households across 13 states/UTs; 65% of families had health insurance, with a majority covered under government-sponsored schemes like PMJAY.

3.Despite PMJAY's cashless coverage for 1,961 procedures, beneficiaries face OOPE for medicines, diagnostics, and transport, which are not covered, exposing a critical implementation gap.

The Big Picture

Prelims · HighMains · High

A NITI Aayog study reveals the significant out-of-pocket expenditure (OOPE) burden on patients, even under the Ayushman Bharat-PMJAY. Patients in private hospitals spend over double (₹53,965) compared to public facilities (₹21,827), highlighting gaps in coverage for medicines, diagnostics, and transport. This data is crucial for evaluating the scheme's effectiveness ahead of the 16th Finance Commission period.

Exam Lens

Quick Exam Facts From News

Avg OOPE Pvt Hosp (PMJAY)₹53,965 per hospitalisation

Avg OOPE Public Hosp (PMJAY)₹21,827 per hospitalisation

PMJAY Launch Date & OutlaySept 23, 2018; ₹40,112 Cr (2019-20 to 2024-25)

PMJAY Annual Coverage₹5 lakh per family per year

Study Agency for NITI AayogIQVIA Consulting and Information Services India Pvt. Ltd.

Survey Sample Size2,283 households across 13 states/UTs

1-Minute Revision

›Avg OOPE Pvt Hosp (PMJAY): ₹53,965 per hospitalisation
›Avg OOPE Public Hosp (PMJAY): ₹21,827 per hospitalisation
›Target this Data: ₹53,965 (Avg OOPE in Pvt Hosp under PMJAY) vs ₹21,827 (in Public Hosp).
›Target this Nodal Body: NITI Aayog's Development Monitoring and Evaluation Office (DEMO).
›Target this Legal Point: PMJAY launched on September 23, 2018, with an outlay of ₹40,112 crore for 2019-20 to 2024-25.

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News Snapshot

💰

High Out-of-Pocket Cost

PMJAY patients pay ₹53,965 on average for medicines, transport, and diagnostics in private hospitals, over double the cost in public hospitals.

🏛️

NITI Aayog Evaluation

A study commissioned by NITI Aayog's Development Monitoring and Evaluation Office (DEMO) assesses all centrally sponsored health schemes.

🎯

Coverage Gap Exposed

Despite being a cashless scheme, 65% of PMJAY beneficiaries incurred OOPE as transport, medicines, and diagnostics are not fully covered.

Detailed Analysis & Strategic Depth

Context / Background

Ayushman Bharat-PMJAY, launched in 2018, is the world's largest health assurance scheme aiming for universal health coverage. The scheme provides cashless coverage of ₹5 lakh per family per year for secondary and tertiary care. This evaluation comes ahead of the 16th Finance Commission period (starting April 1, 2026) to appraise its functioning and inform future funding and policy decisions.

Core Analysis & Implications

The study reveals a critical flaw in PMJAY's design: while hospitalisation costs are covered, ancillary expenses are not. This leads to significant financial strain, especially for those using private facilities where OOPE is 2.5 times higher. The gap between insured and uninsured patients' OOPE is only ₹3,294 on average, questioning the scheme's effectiveness in reducing catastrophic health expenditure. The finding that 35% of PMJAY beneficiaries incurred zero OOPE shows partial success, but the majority still pay, indicating implementation and coverage deficiencies.

Future Outlook / Way Forward

The findings will be crucial for the government's appraisal before the 16th Finance Commission. Potential reforms include expanding the package to cover diagnostics, medicines, and possibly transport subsidies. The recent expansion to cover all senior citizens (70+) needs a review to ensure it doesn't exacerbate OOPE. The study underscores the need for stronger price regulation in private healthcare and better integration of PMJAY with primary care to reduce the need for hospitalisation.

Key Facts at a Glance

Avg OOPE Pvt Hosp (PMJAY)₹53,965 per hospitalisation

Avg OOPE Public Hosp (PMJAY)₹21,827 per hospitalisation

PMJAY Launch Date & OutlaySept 23, 2018; ₹40,112 Cr (2019-20 to 2024-25)

PMJAY Annual Coverage₹5 lakh per family per year

Study Agency for NITI AayogIQVIA Consulting and Information Services India Pvt. Ltd.

Survey Sample Size2,283 households across 13 states/UTs

You've read the full analysis. Now test your understanding.

Practice exam-style questions based on this article.

Q1Static LinkageEasyUPSC, SSC, State PSC

Which government body commissioned the evaluation study on PMJAY and other health sector schemes mentioned in the news?

Q2Statement-basedMediumUPSC, SSC

Consider the following statements regarding the findings of the NITI Aayog study on PMJAY:

1. The average Out-of-Pocket Expenditure (OOPE) for PMJAY beneficiaries in private hospitals was more than double that in public hospitals.

2. The study found that transport costs are covered under the PMJAY scheme, reducing the financial burden.

3. The survey covered 2,283 households across 13 states and Union Territories.

Which of the statements given above is/are correct?

Q3Data-centricMediumUPSC, Banking, SSC

According to the NITI Aayog study, what was the average Out-of-Pocket Expenditure (OOPE) incurred per hospitalisation by PMJAY beneficiaries in public facilities?

Q4Application/ImpactMediumUPSC, SSC

What is a key implication of the finding that PMJAY beneficiaries still incur significant Out-of-Pocket Expenditure (OOPE), as highlighted in the study?

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PMJAY Patients Pay ₹53,965 OOPE in Pvt Hospitals vs ₹21,827 in Public Facilities: NITI Aayog Study

Exam Lens

Quick Exam Facts From News

1-Minute Revision

News Snapshot

High Out-of-Pocket Cost

NITI Aayog Evaluation

Coverage Gap Exposed

Detailed Analysis & Strategic Depth

Context / Background

Core Analysis & Implications

Future Outlook / Way Forward

Prelims Flashpoints

Key Facts at a Glance