An evaluation study commissioned by NITI Aayog has revealed that patients using private hospitals under Pradhan Mantri Jan Arogya Yojana (PMJAY) still spend an average of ₹53,965 out of pocket per hospitalisation on medicines, transport, and diagnostic services.
The assessment was conducted by IQVIA Consulting and Information Services India Pvt. Ltd. and submitted to the Development Monitoring and Evaluation Office of NITI Aayog.
Study Commissioned by NITI Aayog Finds High Out-of-Pocket Costs for Pradhan Mantri Jan Arogya Yojana Patients in Private Hospitals
The study evaluated several centrally sponsored health schemes, including PMJAY, at a time when the government is reviewing programs before deciding on their continuation for the 16th Finance Commission period beginning April 1, 2026. NITI Aayog and the Ministry of Health and Family Welfare did not respond to requests for comment.
Researchers surveyed 2,283 households across 13 states and Union Territories. Of these, 1,489 households (65%) had some form of health insurance, while 794 households (35%) had none. Among the insured, 1,380 households were covered by government schemes and 81 households (5%) had private insurance. Within the government group, 1,156 households were PMJAY beneficiaries.
The survey also found that 1,201 individuals from these households had been hospitalised in the past five years, representing about 23% of the sample. While 35% of PMJAY beneficiaries reported no out-of-pocket expenses during hospitalisation, 65% still paid for medicines, travel, and diagnostics.
Patients treated in private hospitals under PMJAY spent an average of ₹53,965 per hospitalisation, while those using public hospitals spent ₹21,827.
PMJAY Patients Spend Over Twice as Much in Private Hospitals Compared to Public Facilities
Overall, insured patients spent ₹34,790 on average, compared with ₹38,084 for those without insurance—meaning PMJAY beneficiaries spent about ₹3,294 less. Uninsured patients faced particularly high costs in private hospitals, averaging ₹74,847 per hospitalisation, compared with ₹11,146 in public facilities.
The report noted: “Despite coverage of pre and post-hospitalisation care, beneficiaries continue to incur OOPE for medicines and diagnostics… transport cost is not covered under the scheme.”
PMJAY, part of the Ayushman Bharat initiative launched on September 23, 2018, aims to provide ₹5 lakh annual health coverage per family for secondary and tertiary care. With a ₹40,112 crore allocation for 2019–20 to 2024–25, the program targets over 12 crore families (about 55 crore people) and covers 1,961 procedures across 27 specialities. In September 2024, eligibility was expanded to include all citizens aged 70 and above, regardless of income.
