In the realm of healthcare, understanding the experiences of patients is pivotal for improving services and creating patient-centered care systems. A recent study conducted by Srivastava, Parmar, Strupat, and their colleagues sheds light on the experiences of patients under India’s National Health Insurance Scheme, known as PM-JAY (Pradhan Mantri Jan Arogya Yojana). This mixed-methods research reveals crucial insights into the impact of PM-JAY on healthcare accessibility and satisfaction among patients, presenting a nuanced view that combines quantitative and qualitative data.
The PM-JAY initiative, launched in 2018, aims to provide a safety net for economically vulnerable populations by offering cashless and paperless access to healthcare services. The scheme covers secondary and tertiary hospitalization for up to 500,000 Indian Rupees per family per year, providing insurance cover to over 100 million families. As the largest health assurance scheme in the world, PM-JAY plays a transformative role in the Indian healthcare landscape, particularly for those who previously had limited access to medical services due to financial constraints.
The research conducted by Srivastava et al. focuses on understanding how beneficiaries of PM-JAY perceive their healthcare experiences. Utilizing qualitative interviews alongside quantitative surveys, the researchers aimed to gather comprehensive data reflecting the complexities of healthcare navigation under the scheme. Respondents included patients who have utilized PM-JAY services, healthcare providers, and administrative personnel involved in implementing the program. This methodological approach ensured a holistic understanding of the varying perspectives related to the insurance scheme.
Upon analyzing the qualitative data, the researchers identified several key themes that signify the impact of PM-JAY on patients’ healthcare experiences. Participants expressed feelings of empowerment and support, which were previously lacking due to financial barriers. The sentiment of “We get support now” emerged as a recurring statement among beneficiaries, indicating a significant shift in their perception of accessibility to necessary medical services. With financial burdens alleviated, patients reported a notable increase in their willingness to seek timely medical care.
Despite these positive experiences, the study also highlighted areas for improvement. Many patients voiced concerns regarding the quality of care received, emphasizing the need for better infrastructure and trained medical personnel. While PM-JAY has succeeded in providing insurance coverage, the delivery of care remained inconsistent across various healthcare facilities. Such disparities underscore the complexity of implementing a vast scheme in a country with diverse healthcare systems and standards.
The mixed-methods approach allowed for a robust exploration of patient experiences, blending numerical data with rich qualitative narratives. Quantitative survey results indicated a significant increase in healthcare utilization among PM-JAY beneficiaries, while qualitative interviews revealed personal stories of struggle and triumph. The combination of these findings fosters a deeper understanding of patient experiences, showcasing not just statistical significance but the human aspect behind the numbers.
As healthcare systems across the globe grapple with maintaining quality while expanding access, PM-JAY serves as a critical case study. The scheme’s design reflects an understanding of universal healthcare principles, but also demonstrates challenges inherent in large-scale health reforms. The experiences of patients enrolled in PM-JAY could inform similar initiatives in other low- and middle-income countries seeking to enhance patient care through insurance schemes.
In the light of these findings, the authors advocate for continued monitoring and evaluation of PM-JAY, emphasizing the necessity for adaptive strategies that respond to patient needs. Recommendations include strengthening healthcare systems through investment in training and infrastructure, as well as involving patients in decision-making processes that directly affect their care. By prioritizing patient feedback and experiences, healthcare policymakers can work towards creating more responsive and equitable healthcare systems.
The study does not merely end with presenting data; it encourages an ongoing dialogue on how lessons from PM-JAY could shape future health policies. As the healthcare landscape continues to evolve, integrating the voices of those it aims to serve will be paramount in creating systems that uphold quality and accessibility.
The implications of the study extend beyond India, as many nations strive to achieve universal health coverage amid increasing healthcare demands. The experiences gleaned from PM-JAY provide valuable insights applicable to similar health insurance initiatives worldwide. It advocates for a patient-centered approach that values the lived experiences of individuals seeking care, ensuring that healthcare remains a right rather than a privilege.
In conclusion, Srivastava et al.’s mixed-methods study serves as a vital contribution to the ongoing discourse surrounding health insurance schemes and patient experiences. Through an innovative blend of quantitative and qualitative analysis, the researchers highlight both successes and areas for improvement within PM-JAY. As nations embark on journeys toward universal coverage, the voice of the patient must remain at the forefront of healthcare discussions.
The study hoping to ignite conversations amongst policymakers, healthcare providers, and patients alike, ultimately aims to foster an environment where quality healthcare is accessible to all, illuminating a path forward that prioritizes the needs of the most vulnerable populations.
Subject of Research: Patients’ experiences under the national health insurance scheme (PM-JAY) in India.
Article Title: “We get support now …”: a mixed methods study of patients’ experiences of healthcare under the national health insurance scheme (PM-JAY) in India.
Article References:
Srivastava, S., Parmar, D., Strupat, C. et al. “We get support now …”: a mixed methods study of patients’ experiences of healthcare under the national health insurance scheme (PM-JAY) in India.
BMC Health Serv Res 25, 1552 (2025). https://doi.org/10.1186/s12913-025-13632-6
Image Credits: AI Generated
DOI: https://doi.org/10.1186/s12913-025-13632-6
Keywords: healthcare, PM-JAY, patient experiences, national health insurance, India, quality of care, accessibility, health insurance schemes.
Tags: cashless healthcare serviceseconomic vulnerability and healthhealthcare accessibility in IndiaIndia’s National Health Insuranceinsurance coverage for low-income familiesmixed-methods research in healthpatient experiences in healthcarepatient satisfaction with PM-JAYPM-JAY scheme impactqualitative research in healthcarequantitative data in health studiestransformative healthcare initiatives
