PMJAY patients pay Rs 53,965 in private hospitals, study shows

Patients using the PMJAY scheme are spending more than expected. Those in private hospitals pay almost double compared to public hospitals for treatment.
By Newsroom | Health, India |

Significant Out-of-Pocket Spending Persists, Especially in Private Facilities

A recent study, commissioned by the Niti Aayog, reveals that patients utilizing private healthcare providers under the Pradhan Mantri Jan Arogya Yojana (PMJAY) incur an average out-of-pocket expenditure (OOPE) of Rs 53,965 per hospitalisation. This figure stands in stark contrast to the average OOPE of Rs 21,827 for those admitted to public facilities under the same scheme.

The findings suggest a substantial financial burden remains for beneficiaries, particularly when opting for private care.

The research further indicates that, on average, PMJAY beneficiaries spent Rs 34,790 out-of-pocket. This is marginally less than the Rs 38,084 spent by individuals without any insurance coverage. This nuanced comparison implies that while the scheme offers some financial relief, the overall cost of healthcare, especially in private settings, continues to be a significant concern.

For individuals without insurance, the disparity between public and private hospital costs is even more pronounced. Uninsured patients reportedly spend an average of Rs 74,847 in private facilities compared to Rs 11,146 in public ones. The study identified medicines, transportation, and diagnostic tests as primary components of this out-of-pocket spending.

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Background Context

The study comes at a critical juncture as the government evaluates various centrally sponsored health programs, including PMJAY, ahead of the 16th Finance Commission period commencing April 1, 2026. The financial implications of accessing healthcare under such schemes, as highlighted by this research, will likely factor into these decisions. Niti Aayog and the Ministry of Health and Family Welfare have not yet provided comment on the study's findings.

Frequently Asked Questions

Q: How much do PMJAY patients pay out-of-pocket in private hospitals?
Patients using private hospitals under the PMJAY scheme pay an average of Rs 53,965 for each hospital stay. This is a significant amount of money they have to pay themselves.
Q: How much do PMJAY patients pay out-of-pocket in public hospitals?
For PMJAY patients who go to public hospitals, the average out-of-pocket cost is Rs 21,827 per hospital stay. This is much less than what they pay in private hospitals.
Q: What are the main reasons for out-of-pocket spending in PMJAY?
The study found that people spend extra money on medicines, travel to and from the hospital, and tests to check their health. These costs add up even with the scheme.
Q: How does PMJAY spending compare to not having insurance?
On average, PMJAY patients spend Rs 34,790 out-of-pocket. This is a little less than people with no insurance, who spend Rs 38,084. The scheme helps a bit, but costs are still high.
Q: Why is this study important now?
The government is looking at health programs like PMJAY before April 1, 2026. The study's findings about healthcare costs will help them make decisions about future plans.