Driving the quality of care in publicly financed health insurance: a close look at the accreditation-based incentive policy of AB-PMJAY in India
Year: 2026
Type: article
Abstract: (AB PMJAY)-the world's largest publicly financed health insurance scheme in terms of the numbers of beneficiaries eligible for coverage-the government has undertaken several initiatives to integrate quality-related interventions into the services delivered by empaneled healthcare providers. Among these was the introduction of financial incentives to empaneled healthcare providers linked to the uptake of quality certifications and accreditations in 2019. This policy and practice review examines the design assumptions of the accreditation-linked incentive policy, its early implementation experience and the uptake of quality certification among healthcare providers. It draws on the findings of a mixed-methods study commissioned by the National Health Authority of India, conducted in 2021 and published as a technical report, and extends them with certification uptake data to September 2026. Uptake of certification has been low and concentrated among hospitals that were previously accredited through independent accreditation bodies; providers' responses to the incentive have been varied; and no clear relationship between certification tier and patient satisfaction has been demonstrated, although higher tiers corresponded to better-standardised structures and processes in the facilities observed. We examine the design assumptions that may explain this pattern and suggest the conditions under which the policy could achieve its intended effects. We submit that while the current design is largely an input-driven mechanism to motivate facilities to improve quality standards, it may serve only as a foundational step. For comprehensive quality improvement, we submit that the policy must evolve towards a suitable value-based incentive structure, aligning with international best practices, while providing a value proposition to empaneled hospitals vis-a-vis investments required for accreditation. We suggest actionable recommendations to strengthen the existing policy, spanning value-based incentive design, methods for improving provider value proposition and cross-scheme alignment.
Source: Frontiers in Public Health
Institutions: World Health Organization, World Health Organization - India
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
Funder: World Health Organization
OpenAlex ID: W7222980572