Policy to Practice: A Qualitative Study of Experiences of Ayushman Card Beneficiaries in India

Abstract

Ayushman Bharat, Pradhan Mantri Jan Arogya Yojana (PM-JAY) is a flagship health insurance initiative of the Government of India aimed at advancing universal health coverage for economically vulnerable populations. While the scheme offers substantial financial protection, limited evidence exists on how beneficiaries experience its implementation in everyday healthcare settings. This study examines the lived experiences and challenges faced by Ayushman Card users in accessing healthcare services in urban slum communities of Vadodara, Gujarat. A qualitative exploratory approach was used. Data were collected through one-on-one interviews and case-based narratives with ten beneficiaries from the Mujhmoda and Ramnagar slum areas. The study focused on understanding barriers encountered during enrollment, verification, and service utilization. The findings indicate a significant gap between policy intent and service delivery. Beneficiaries reported low awareness of scheme features, lack of required documentation, dependence on middlemen and agents, and unofficial payments demanded by hospitals despite insurance coverage. Aadhaar based KYC and biometric verification created serious obstacles for elderly persons and individuals with disabilities. Migration and address inconsistencies further increased reliance on agents, leading to card errors and access denial. The study concludes that although Ayushman Bharat is comprehensive in design, systemic and administrative barriers undermine its effectiveness in practice. Enhancing beneficiary awareness, simplifying verification procedures, strengthening hospital accountability, and providing local facilitation support are essential for ensuring equitable and inclusive access to healthcare services.