Abstract Background Publicly-funded health insurance (PFHI) schemes are widely employed in low- and middle-income countries to enhance financial protection and advance universal health coverage. India’s Pradhan Mantri Jan Arogya Yojana (PM-JAY), launched in 2018, provides inpatient coverage to over 500 million socioeconomically disadvantaged individuals. Although positive patient experiences are linked to improved health outcomes, evidence on patient experiences under PM-JAY remains limited. This mixed-methods study investigates patient experiences with PM-JAY healthcare services, while incorporating provider reflections on these experiences. Methods A concurrent triangulation mixed-methods study was conducted across 16 districts in 7 Indian states. Qualitative data were collected via semi-structured interviews ( n = 219 doctors, n = 55 beneficiaries) and 28 focus group discussions with beneficiaries. Quantitative data included 508 patient exit surveys, 115 hospital surveys, and 115 infrastructure checklists. Quantitative data were analyzed using descriptive statistics, while qualitative data were analyzed using content analysis. Data triangulation occurred during the analysis phase. Results While hospitals had the required physical amenities and patient exit surveys indicated very high satisfaction with PM-JAY services, the qualitative interviews and group discussions with beneficiaries and healthcare providers revealed several areas needing procedural and service improvements. Chief among these were the need for better communication, and enhanced abilities of PM-JAY implementers to provide empathetic and coordinated care. There were also stark differences across states: beneficiaries in Chhattisgarh, Gujarat, Kerala, Meghalaya and Tamil Nadu were more appreciative of PM-JAY services, while those in Bihar and Uttar Pradesh reported significant dissatisfaction. Conclusions Beneficiaries and healthcare providers identified key areas for improvement, including patient-provider communication, empathy, emotional support, care coordination, and quality. Barriers included limited awareness of scheme processes among beneficiaries and providers, and deficient communication skills. Addressing organizational and structural challenges, alongside using informal community networks via frontline health workers, offer opportunities to enhance PM-JAY healthcare delivery.
Susanne Ziegler (Fri,) studied this question.