Which is the most common cause of out-of-pocket expenditure (OOP) in Indian households under the Ayushman Bharat scheme?

Explanation

## Out-of-Pocket Expenditure Under Ayushman Bharat **Key Point:** Despite Ayushman Bharat's comprehensive inpatient coverage, outpatient care and medicines remain the largest driver of OOP expenditure in Indian households. ### Why Outpatient Care & Medicines Dominate OOP Costs Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) provides: - ₹5 lakh annual coverage per family for **inpatient care only** - Covers 1,393 procedures across 27 specialties - **Does NOT cover** outpatient department (OPD) visits, consultations, or retail medicines ### Coverage Gaps Leading to OOP | Expense Category | AB-PMJAY Coverage | OOP Burden | |---|---|---| | Inpatient hospitalization | ✓ Covered (₹5 lakh) | Minimal | | OPD consultations | ✗ Not covered | **High** | | Retail medicines | ✗ Not covered | **Very high** | | Diagnostic tests (OPD) | ✗ Not covered | **High** | | Preventive care | ✗ Minimal | **Moderate** | **High-Yield:** The scheme's focus on **inpatient catastrophic care** leaves chronic disease management (diabetes, hypertension, COPD) and routine OPD medications as out-of-pocket expenses—the most frequent healthcare touchpoints for poor households. **Clinical Pearl:** A diabetic patient in an AB-PMJAY beneficiary household may access free hospitalization for diabetic ketoacidosis but must pay out-of-pocket for daily insulin and glucose monitoring—driving cumulative OOP costs far above inpatient expenses. ### Policy Implication Ayushman Bharat addresses **financial catastrophe** from acute hospitalization but does not solve the **chronic disease burden** that consumes household income over time. This remains a key gap in achieving universal health coverage (UHC). [cite:Park 26e Ch 3]