Spatial Analysis of Healthcare Vulnerability and Accessibility under PMJAY in Uttar Pradesh

Abstract

This study investigates spatial disparities in healthcare access under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) across the districts in Uttar Pradesh, India. Despite being the highest contributor to Ayushman card distribution and hospital empanelment under PMJAY, Uttar Pradesh ranks low in the hospital admissions. This reflects a gap between coverage and utilization. Using district-level data from the District Wise Development Indicators (2021), National Family Health Survey-5 and the PMJAY Dashboard (2024), the study constructed a composite vulnerability index. Spatial analysis techniques, including Local Indicators of Spatial Association (LISA), percentile mapping, and spatial regression models were employed. This paper analyzes district variations in utilization of PMJAY and examine that how the social, economic and health infrastructure of the districts shape the utilization pattern. The results reveal that educational disadvantage, rural location, and infrastructure gaps are significantly associated with lower healthcare utilization. The Spatial Error Model (SEM) provided the best model fit, indicating that unobserved spatial factors play a critical role in shaping healthcare outcomes. The findings highlight the need for geographically targeted health policies that address structural inequalities to enhance the effectiveness of public health insurance programs like PMJAY.