Ayushman card (PM-JAY) as a tool for financial risk protection in orthopaedic trauma care: Evidence from a Level-1 trauma centre.

BACKGROUND

Orthopaedic trauma care is highly resource-intensive and often requires urgent surgical intervention, costly implants, and prolonged hospitalisation. In low- and middle-income settings, lack of financial protection can delay or prevent access to definitive care. Publicly funded insurance schemes such as Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) aim to improve access and reduce out-of-pocket expenditure. However, real-world evidence on utilization of these schemes in trauma surgery remains limited.

METHODS

A retrospective observational study was conducted at a tertiary care trauma centre, including orthopaedic trauma admissions from January 2024 to December 2025. Data were extracted from institutional electronic medical records and insurance claim databases. Key indicators included operative utilization rate, ward-based admission distribution, insurance coverage rate, scheme-wise distribution, and contribution of PM-JAY to total surgical volume.

RESULTS

During the study period, orthopaedic trauma workload increased substantially in 2025 compared with 2024. Total trauma admissions rose from 3378 in 2024 to 4085 in 2025, reflecting a 20.9% increase in inpatient volume. Similarly, the number of orthopaedic trauma surgeries increased from 2526 to 3,236, representing a 28.1% rise in operative workload. Insurance status was documented for 59% of patients, while the remaining 41% were managed through self-payment. Among patients with documented insurance coverage, PM-JAY was the predominant funding source, covering 80.7% of surgeries, followed by HIMCARE (9.3%), poor/free category (9.1%), and staff-free beneficiaries (0.9%). Notably, the contribution of PM-JAY to overall surgical volume increased from 31% in 2024 to 37.4% in 2025, highlighting its growing role in facilitating access to operative trauma care.

CONCLUSION

PM-JAY plays a major role in financing orthopaedic trauma surgery in economically vulnerable populations. Improved documentation and future outcome-based studies are needed to assess long-term effectiveness.