To improve access to healthcare, most states in India offer health insurance schemes with fully or partially discounted premiums, primarily targeting low-income households. One such scheme is the Mukhyamantri Ayushman Arogya Yojana (MAAY), launched by the government of Rajasthan in 2021 which aimed to provide cashless, affordable healthcare to all families in the state. Yet early evidence shows that many people still struggle to benefit from the scheme. The project examines why these exclusions persist, despite MAAY’s promise of universal access.
Using a citizen-centric framework, we examine exclusion at five critical stages: becoming aware of the scheme, enrolling successfully, using benefits at hospitals, raising grievances, and renewing membership. Breakdowns at any of these touchpoints, such as lack of information, documentation mismatches, denial of care, technical issues, or inaccessible grievance channels can leave families without timely treatment. These obstacles prevent citizens from obtaining timely treatment and undermine the scheme’s core objective of protecting households from health-related financial shocks.
Building on our earlier work on exclusion in social protection, this project explores how broader economic, social and political exclusions shape people’s ability to access health insurance. Economic constraints, weak social networks, and limited political voice can interact to heighten vulnerability and reduce a citizen’s ability to navigate the system. By documenting these mechanisms of exclusion, the project aims to inform policymakers and support the design of more inclusive health insurance systems that ensure every individual can obtain care when they need it without friction.
