Presentation (CTI)

OBJECTIVES: To assess healthcare providers’ perspectives on service delivery under AB-PMJAY, with focus on reimbursement mechanisms, operational efficiency, and challenges experienced by empanelled hospitals.
METHODS: A cross-sectional mixed-methods study was conducted among PM-JAY empanelled six public and six private tertiary care hospitals in Gujarat, India. Data were collected through structured interviews with hospital administrators and PM-JAY nodal officers. Key domains included service utilization, claim management, reimbursement timelines, package adequacy, administrative burden, and implementation challenges. Quantitative findings were summarized descriptively, while qualitative responses were analysed thematically.
RESULTS: Providers reported that PM-JAY substantially improved access to inpatient care among financially vulnerable populations and increased utilization of their healthcare services. However, significant operational and financial constraints were identified. Major concerns included delayed claim reimbursements, claim denials and deductions, inadequate package pricing for high-cost interventions, documentation burden, and delays in preauthorization approvals from other states. Private providers expressed concerns regarding financial viability, whereas public facilities reported increased workload and pressure on existing infrastructure. Providers emphasized the need for streamlined claims processing, timely reimbursement, periodic revision of package rates, and improved digital and administrative support.
CONCLUSIONS: PM-JAY has strengthened healthcare access and financial protection in India; however, reimbursement inefficiencies and operational barriers remain important constraints for providers. Addressing these challenges through payment reforms, administrative simplification, and stronger provider engagement will be critical to improving programme sustainability and service delivery performance.