Globally, the health systems are facing several constraints for achieving Universal Health Coverage (UHC). One of the major barriers in achieving UHC has been low financial protection to people and the proportion of population with out-of-pocket expenditure exceeding 10% of household budget. Further, percentage of population impoverished due to OOP increased from 1.8 to 2.5% in 2015. This suggests financial protection is deteriorating across the globe. 

In order to address ‘financing gap’, the country has introduced several publicly financed insurance/assurance schemes and many states launched their own schemes to provide financial risk protection against hospitalization cost. Most recently, in 2018, the union government introduced Ayushman Bharath Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) that intends to provide financial coverage up to five lakhs against secondary and tertiary care hospitalization to 40% of vulnerable households. Although, PM-JAY is a national scheme, there are certain states which have not joined the scheme but have introduced their own scheme. Odisha an eastern Indian, launched - Biju Swasthya Kalyan Yojana (BSKY) in August, 2018 without joining the national scheme. Within the resource-scarce setting of Odisha state, BSKY promises free health care for all the people of the state irrespective of their socio-economic conditions. The scheme has inherent features to strengthen public health system in order to achieve UHC for its 43 million people.

In this paper, we critically examined the scope, key features, challenges and potentiality of BSKY to achieve UHC in Odisha. The scheme is new and many processes are undergoing rapid changes during the implementation phase. Hence, evidence generated and recommendation made at the initial stage (within one and half years of implementation) by the study might help the State and the other regions alike globally, with similar financial and service provision challenges to learn from this experiment.