What stops private hospitals from engaging with publicly funded health insurance schemes? A mixed-methods study on PMJAY/MJPJAY in Maharashtra, India

This study enhances understanding of private sector engagement challenges and provides insights for improving PFHIS and UHC in India. The framework developed can also be applied beyond India to assess the complexities of intent, capacity, and interactions between private and public actors in PFHIS. To create an enabling environment for private sector engagement and achieve the scheme's objectives, the state could increase reimbursement rates, implement responsive grievance redressal, regulate private hospitals, and improve governance processes. A two-fold strategy of strengthening the public health system and engaging with regulated private hospitals could enhance the scheme's effectiveness.