Financial barriers that once excluded large sections of society are being removed
At a research institute in Chandigarh, a two-year study of 410 spine surgeries has offered something rare in public health: measurable evidence that a policy is working as intended. India's Ayushman Bharat PM-JAY scheme, designed to extend surgical care to those who could not otherwise afford it, has shifted the financial architecture of complex spinal procedures — with publicly funded cases rising from 58.7 to 73.5 percent between 2023 and 2024. The findings invite a deeper question that every society must eventually answer: when the cost of healing is removed as a barrier, who finally gets to be healed?
- For patients with degenerative spinal disorders or traumatic injuries, the cost of surgery has long been the quiet verdict that determined whether they recovered or simply endured.
- Self-financed procedures — the kind that empty family savings and accumulate debt — fell by nearly half in a single year, from 37.8 to 18.9 percent of all cases.
- The shift was not statistical noise: researchers confirmed it as a real and significant redistribution of who gains access to some of modern medicine's most expensive interventions.
- Crucially, early postoperative outcomes showed no meaningful difference between publicly funded and privately financed patients, suggesting quality did not erode as access widened.
- Researchers and clinicians caution that the data marks a beginning, not a resolution — sustained policy evaluation will determine whether this expansion holds or quietly contracts under systemic pressure.
At PGIMER in Chandigarh, researchers tracked 410 spine surgeries over two years and found something worth pausing over: the financial landscape of who receives complex surgical care in India is shifting in a measurable direction. The Ayushman Bharat PM-JAY scheme — a publicly funded health insurance program aimed at those who cannot afford major procedures — covered 58.7 percent of spine surgeries at the institute in 2023. By 2024, that figure had risen to 73.5 percent. In the same period, self-financed procedures fell from 37.8 to 18.9 percent. Statisticians confirmed the change was real, not random.
The surgeries in question were not minor interventions. The 410 cases included spinal decompression, complex instrumented fusion, and operations for trauma, tumors, deformity, and infection. Nearly half the patients had degenerative spinal disorders; a third had suffered traumatic injuries. These are procedures that have historically sorted patients by wealth as much as by medical need.
Professor Vivek Lal, PGIMER's director, described the scheme as dismantling financial obstacles that once excluded large portions of society from advanced care. Dr. Vishal Kumar noted that rising PM-JAY uptake reflected both greater patient awareness and the institution's own growing fluency with the scheme's requirements. Implants used were domestically manufactured and approved under reimbursement packages — and early outcomes showed no significant difference between funded and self-paying patients.
The study, published in 2026, stops short of declaring success. Its authors call for continued evaluation and policy refinement, recognizing that spine surgery remains one of healthcare's most expensive frontiers. What the data demonstrates is a principle as old as medicine itself: when the price of care is removed, more people seek it. Whether the system can sustain that openness — in quality, in capacity, and in commitment — is the question that follows.
At a medical institute in Chandigarh, researchers have been watching a quiet shift unfold in who gets access to the most expensive surgeries. Over two years, they tracked 410 spine operations at the Postgraduate Institute of Medical Education and Research. What they found matters: the way India pays for complex surgical care is changing, and the change is measurable.
The Ayushman Bharat scheme—formally the Pradhan Mantri Jan Arogya Yojana, or PM-JAY—is a publicly funded health insurance program designed to reach people who cannot afford major medical procedures. Between January 2023 and December 2024, spine surgeries at PGIMER became increasingly funded through this scheme rather than out of patients' own pockets. In 2023, 58.7 percent of spine surgeries were covered by PM-JAY. By 2024, that figure had climbed to 73.5 percent. Meanwhile, self-financed procedures—the kind that require families to drain savings or borrow money—fell from 37.8 percent to 18.9 percent. The shift was statistically significant, meaning it was not random variation but a real change in how surgical access was being distributed.
Spine surgery is not routine work. The 410 cases analyzed included decompression procedures, spinal stabilization, complex instrumented fusion, and operations for trauma, deformity, tumors, and infections. Nearly half the patients (46.1 percent) had degenerative spinal disorders—the slow wear and tear that comes with age and use. Another third (33.4 percent) had suffered traumatic spinal injuries. These are expensive interventions, often requiring specialized implants and extended hospital stays. Historically, cost has been the barrier that determines who receives treatment and who does not.
Professor Vivek Lal, the director of PGIMER, framed the findings plainly: the scheme is removing financial obstacles that once kept large sections of society from accessing advanced surgical care. Dr. Vishal Kumar, from the Department of Orthopaedic Surgery, noted that the year-on-year rise in PM-JAY-funded cases reflects both growing awareness among patients and the institution's own adaptation to the scheme's requirements. The surgeries used implants approved under the scheme's reimbursement packages, most of them domestically manufactured devices. Early postoperative outcomes showed no significant differences between the publicly funded and privately financed cases.
The study, published in the Journal of Clinical Orthopaedics and Trauma in 2026, does not claim the problem is solved. The researchers emphasize that sustained evaluation and policy refinement will be necessary to maximize long-term impact. Spine surgery remains among the most expensive areas of modern healthcare, making it a crucial test case for whether public insurance can truly democratize access to complex care. What the data shows is that when the financial barrier is removed, more people use the service. What remains to be seen is whether the quality holds, whether patients recover well, and whether the system can sustain this expansion without strain.
Notable Quotes
Ayushman Bharat is reshaping access to advanced surgical care by removing financial barriers that once excluded large sections of society— Professor Vivek Lal, PGIMER Director
PM-JAY has improved access across a broad range of spinal pathologies while reducing out-of-pocket expenditure— Dr. Vishal Kumar, Department of Orthopaedic Surgery, PGIMER
The Hearth Conversation Another angle on the story
Why does spine surgery matter as a test case for public health insurance?
Because it's expensive, specialized, and historically available only to those who could pay. If a public scheme can make spine surgery accessible, it suggests the model might work for other complex procedures too.
The numbers show PM-JAY funding jumped from 58.7 to 73.5 percent. That's significant, but what about the patients who still paid out of pocket?
That's the right question. Nearly one in five spine surgeries in 2024 were still self-financed. The scheme expanded access, but didn't eliminate the financial divide entirely. Some patients still chose private funding, or couldn't access the scheme for other reasons.
The study mentions no gross differences in early postoperative outcomes. Does that mean the publicly funded surgeries were just as good?
The data suggests yes, at least in the short term. But early outcomes are only part of the story. Long-term recovery, complications, and quality of life matter too. That's why the researchers call for sustained evaluation.
What does institutional adaptation mean in this context?
It means PGIMER had to learn how to work within the scheme's rules—which implants are approved, how reimbursement works, how to process patients efficiently. The hospital didn't just passively receive PM-JAY patients; it actively adjusted its systems to accommodate them.
If the scheme is working, what's the concern about policy refinement?
Expansion creates new pressures. More patients means more demand on hospital resources, more need for trained surgeons, more implant supply chains. The scheme needs to evolve to handle scale without compromising quality or access.