Presentation (CTI)

OBJECTIVES: To develop a district-level investment prioritisation framework to identify high-need districts for public super-speciality capacity expansion of AB-PMJAY sustainability in India.
METHODS: A district-level prioritisation model was developed in India for Gujarat using AB-PMJAY claims data for Policy Period 8 (June 2023-July 2024). A composite priority score was calculated using four normalized indicators: (i) speciality-specific claim volume; (ii) enrolled beneficiary population; (iii) government expenditure on private-sector super-speciality claims; and (iv) availability of public super-speciality facilities. Equal weighting was assigned to each parameter. Analysis focused on high-utilisation packages representing the top 55% of claim amount. Districts with the highest PS values should be prioritized for investment in a super-specialty hospital.
RESULTS: Demand for super-speciality care was highly variable across districts in Gujarat, India and reflected geographic inequities and high dependency on the private sector. High investment priority was identified for PTCA, PET imaging, radiotherapy, total joint replacement, CABG, haemodialysis, neonatal intensive care, urology, orthopaedic and advanced cardiac services. These results show a high degree of unmet public sector capacity, both in urban and underserved areas, suggesting opportunities for strategic expansion of infrastructure to improve access and reduce dependence on the private sector.
CONCLUSIONS: This claims-based prioritisation framework offers a scalable, evidence-informed approach to optimise public super-speciality infrastructure investment under publicly funded health assurance schemes. Strategic expansion of high priority districts may improve equitable access, reduce dependence on the private sector and improve long-term financial sustainability of AB-PMJAY in Gujarat.