OBJECTIVES: COVID has proved to be a big unforeseen challenge for healthcare providers worldwide. it has put tremendous pressure on health systems globally. At the same time, health care providers have been put under substantial strain- physical, mental and financial in order to cope and meet the demands of the system. It is important to understand the challenges faced by providers under public-funded healthcare schemes to ensure that they can be addressed and any adverse impact on patient health outcomes is averted.

METHODS: We conducted a survey of 250 providers in 5 states who implemented the public funded health insurance scheme PM-JAY in India. Hailed to be the largest state funded healthcare scheme in the world, it has the potential to ensure equity in access to quality healthcare services and improved patient health outcomes for the poorest across the country. We conducted an online survey of healthcare providers to understand the key challenges they are facing under the scheme during COVID time.

RESULTS: Most of the providers cited challenges pertaining to reimbursements under the scheme, beneficiary awareness . The challenges were around the inadequacy of package rates to meet the additional expenditures being incurred due to COVID protocol. It was found that unlike global experiences, no increase in provider payments had been accorded due to DRGs to compensate for this in India.. Other key challenges cited were around delays in provider payments and limitations of the medical staff.

CONCLUSIONS: Delays in provider reimbursements and incorrect denial have been known to be adversely associated with patient health outcomes. In conclusion we provide recommendations around how SHAs can address the challenges mentioned by the providers by inclusion of adjustment factors in the package price, mechanisms of appropriate package pricing and avoiding delays in reimbursement through automated payment disbursements.