Ayushman Bharat PM-JAY: Evaluating Gaps Between Policy Commitments and Ground-Level Healthcare Delivery

Sabr Bedi

Abstract: Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) aims to provide eligible families with cashless access to specified secondary and tertiary hospital care. This study evaluates the extent to which this objective is reflected in beneficiary experience while remaining operationally and financially workable for empanelled hospitals. A mixed-methods approach combined secondary evidence with primary data from 500 eligible individuals and 50 empanelled hospitals. Among 340 active cardholders, 143 had used PM-JAY for hospitalization. Of these users, 38% reported completely cashless treatment, while 62% reported some out-of-pocket expenditure. Nevertheless, 76% were satisfied or very satisfied with clinical care, and 78% would definitely use PM-JAY again. Among hospitals, 90% reported at least a 10% increase in patient volume, while 56% considered package rates inadequate, 78% reported claim turnaround exceeding 30 days, and 62% considered documentation excessive. The findings indicate that PM-JAY provides meaningful access and financial protection but continues to face implementation gaps affecting both beneficiaries and providers. Improvements in claim processing, package-rate revision, beneficiary communication, monitoring of covered expenditure, and active hospital access could strengthen the scheme.

Keywords: Ayushman Bharat, PM-JAY, health financing, financial protection, out-of-pocket expenditure, hospital reimbursement, Universal Health Coverage

How to Cite?: Sabr Bedi, "Ayushman Bharat PM-JAY: Evaluating Gaps Between Policy Commitments and Ground-Level Healthcare Delivery", Volume 15 Issue 8, August 2026, International Journal of Science and Research (IJSR), Pages: 1743-1755, https://www.ijsr.net/getabstract.php?paperid=SR26825010848, DOI: https://dx.doi.org/10.21275/SR26825010848

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