Study Protocol: A mixed method and multimethod study of implementation and impact of Ayushman Bharat- Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) scheme in Assam State

Abstract Introduction: Ayushman Bharat- Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), is an Indian Government initiated health insurance scheme, with the purpose to improve access and availability of secondary and tertiary inpatient care and reduce additional financial burden of out-of-pocket expenditure (OOPE) due to medical expenses from economical weaker sections of Indian population. AB-PMJAY was launched in the year 2018 and in the same year was implemented in Assam state. To obtain the evidence of impact and implementation of of AB-PMJAY in terms of healthcare services availability, accessibility, and affordability after the first 5 years of the scheme’s operations in Assam state. Methods and analysis: The study will follow a mixed methods approach using triangulation mixed methods design along with a multimethod approach. Primary data (qualitative and quantitative surveys) and secondary data (National Sample Survey (NSS) previous rounds – 60th (2004), 71st (2014) and 75th (2017) will be considered. 75th round of NSS of Assam will be considered as the baseline for the present study. The present protocol describes the methodological aspects adopted for evaluation of effectiveness and implementation strategies of AB-PMJAY in five districts viz. Kamrup Metropolitan, Sonitpur, Cachar, Sivasagar, and Kokrajhar of Assam. Quantitative data will be evaluated through descriptive statistical measures under quasi-experimental design and quantitative aspect will be explored through thematic analysis. The study protocol presented is the first attempt to collectively assess the early impacts and implementation procedures of the biggest government funded health insurance programme in Assam State.