Stages of Exclusion in Rajasthan’s Mukhyamantri Ayushman Aarogya Yojana: Findings from a Citizen Survey

In 2021, the government of Rajasthan launched the Mukhyamantri Ayushman Arogya Yojana (MAAY), a health insurance scheme designed to provide affordable healthcare to all citizens, with a particular focus on low-income households. MAAY promises all families in the state cashless medical treatment up to Rs. 25 lakh, with an additional accident cover of Rs. 10 lakh. Official records indicate that a total of 1.4 crore families in the state have registered for the scheme as of 2024, with the state covering the premium for nearly 92% of these families. A total of 42.66 lakh individuals (~37.67 lakh families) have received care under the scheme (Government of Rajasthan, 2024).

State-sponsored health insurance schemes, such as Rajasthan’s MAAY, are instituted with the primary objective of ensuring citizen access to healthcare. However, early reports (Government of Rajasthan, 2024) on MAAY indicate that the scheme is falling short of meeting this objective, meaning that citizens are experiencing exclusion at various points that prevent them from accessing the scheme’s benefits as intended.

In a previous brief, we introduced a citizen-centric framework to study the factors that limit the effectiveness of state-sponsored health insurance schemes such as MAAY. The framework has two components: a) stages of exclusion- a user journey map, which allows us to identify points at which citizens experience exclusion, and b) dimensions of exclusion a multi-dimensional lens, which allows us to understand citizens’ broader social contexts that might help explain such exclusion.

Here we present findings from a survey we conducted in Rajasthan to unpack the first component of the framework—identifying points along a citizen’s journey with MAAY at which they experience exclusion. The survey was conducted between March and April of this year in partnership with Gram Vaani, a social technology company, in seven districts of Rajasthan: Ajmer, Alwar, Bharatpur, Bundi, Dausa, Deeg, and Jaipur. The sample size across seven districts is as shown in Table 1.

Table 1

To garner responses from citizens, we administered a short IVR-based survey in Hindi, which allowed respondents to share their experiences with the scheme. As a first step in the data collection exercise, we conducted community outreach programs in the selected districts to raise awareness about the survey, the IVR platform and the manner of recording responses in IVR mode. These programs resulted in responses to our surveys through self-initiated calls from citizens. To prompt additional responses, outbound calls were also placed. The outbound calls were made to individuals already in the implementation partner’s database.

The findings from this preliminary survey can be accessed here. It should be noted that the findings are based entirely on our sample and may not be representative of the state of exclusion in the identified districts or the state.