A Cross-Sectional Study Assessing Knowledge Gaps and Utilization Patterns among PM-JAY Beneficiaries Attending a Tertiary Care Hospital in Gujarat, India
Authors
Dr.
Damini Joshi 1✉ Email
Apurvakumar Pandya 2
Mehak Chopra 1
Parth Sompura 3
Ekta Modi 3
Partha Sarathi Ganguly 1
1 Parul institute of Public Health Parul University Vadodara Vadodara Gujarat India
2 Indian Institute of Public Health Gandhinagar Gujarat India
3 Parul Sevashram Hospital Parul University Vadodara Gujarat India
Damini Joshi1#*, Apurvakumar Pandya2# Mehak Chopra1, Parth Sompura3#, Ekta Modi3#, and Partha Sarathi Ganguly1
Affiliations
1. Parul institute of Public Health, Parul University Vadodara, Gujarat, India
2. Indian Institute of Public Health, Gandhinagar, Gujarat, India
3. Parul Sevashram Hospital, Parul University, Vadodara, Gujarat, India
*Corresponding author: Dr. Damini Joshi, Assistant Professor, Parul Institute of Public Health
Parul University, Vadodara, Gujarat, India, Email: damini.joshi19835@paruluniversity.ac.in
Dr. Damini Joshi, Apurvakumar Pandya, Parth Sompura and Ekta Modi contributed equally to this work.
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Abstract
Background
Pradhan Mantri Jan Arogya Yojana (PM-JAY) represents India’s flagship publicly funded health insurance scheme and a central pillar of its Universal Health Coverage strategy. Despite extensive population coverage, evidence suggests that limited beneficiary knowledge and information asymmetries constrain effective utilisation of scheme benefits.
Objectives
This study aims to assess knowledge and information gaps among PMJAY beneficiaries.
Methods
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A cross-sectional study was conducted among 450 PMJAY beneficiaries at a tertiary care teaching hospital in Gujarat, India, between January and March 2024. Data were collected using a validated, digitalized structured questionnaire through KOBO toolbox. Descriptive statistics and inferential analyses were performed using SPSS v25 to examine factors associated with knowledge levels.
Results
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The mean age of participants was 37.8 ± 13.4 years; 71.1% were male and 84% resided in rural areas. Although 86.7% had heard of PM-JAY, the mean knowledge score was low (5.09 ± 2.8 out of 15). Awareness of eligibility criteria (15.6%), covered services (13.8%), grievance redressal mechanisms (15.8%), and digital platforms was particularly limited. Knowledge scores were significantly associated with residence, education, income, employment type, and exposure to information from private hospitals (p < 0.001). Major challenges included claim processing delays (41.7%) and non-availability of service packages (22.9%) with minor issues like language barriers and Aadhar card linking affecting about 4.2% of respondents each.
Conclusion
Enhancing PMJAY utilization will require improved information dissemination, addressing rural-urban disparities, and leveraging interpersonal networks to better reach and
educate diverse demographic groups.
Keywords:
PMJAY
healthcare
knowledge gaps
awareness
utilization
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1. Introduction
India’s pursuit of Universal Health Coverage (UHC) has been shaped by persistent challenges related to high out-of-pocket (OOP) health expenditure [1], financial impoverishment [2], and inequitable access to hospital care [3]. Despite sustained public investment, OOP payments continue to account for a substantial share of total health expenditure, pushing an estimated 3–7% of households below the poverty line annually [1]. These structural vulnerabilities have underscored the need for robust publicly funded health insurance (PFHI) mechanisms.
Launched in 2018, the Pradhan Mantri Jan Arogya Yojana (PM-JAY) is the world’s largest PFHI scheme by Government of India, offering cashless secondary and tertiary care coverage of up to INR 5 lakh per family per year to approximately 500 million economically vulnerable individuals [4, 5]. While enrolment and card generation have expanded rapidly, emerging evidence questions the scheme’s effectiveness in translating coverage into utilisation and financial protection [6–7].
A growing body of literature indicates that beneficiary awareness and functional knowledge play a critical role in mediating access to PFHI benefits. Early evaluations show limited beneficiary understanding [8–10]. Studies from multiple Indian states demonstrate that high enrolment does not necessarily correspond with informed utilisation, particularly among rural, less educated, and socioeconomically disadvantaged populations [11–13].
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Information asymmetry, limited understanding of eligibility criteria, and poor awareness of entitlements often result in delayed care-seeking, underutilisation, or avoidable OOP expenditure.
Against this backdrop, the present study aims to assess knowledge gaps, information sources, utilisation experiences, and implementation challenges among PM-JAY beneficiaries accessing services at a tertiary care hospital in Gujarat. By identifying socio-demographic and system-level correlates of knowledge, the study seeks to inform strategies for strengthening scheme implementation and advancing equitable health system performance.
2. Methods
2.1
Study design and setting: This study employed a facility-based cross-sectional at Parul Sevashram Hospital, a 750-bed NABH-accredited tertiary care teaching hospital located in Waghodia block, Vadodara district, Gujarat. The hospital serves a predominantly rural and low-income population and reports an annual PM-JAY patient footfall of approximately 40,000–45,000 beneficiaries.
2.2
Study Population and Sampling: The study population included all adult PM-JAY beneficiaries accessing inpatient or outpatient services during the study period (15 January–20 March 2024).
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A convenience sampling approach was adopted, and 450 consenting participants were enrolled.
2.3
Data collection tool: A structured questionnaire was developed through literature review. Content validity of the questionnaire was established using a modified Delphi process. An initial pool of items was developed through literature review and programme documents and reviewed by a panel of subject-matter experts. Experts independently rated items for relevance and clarity and provided qualitative feedback. Based on aggregated ratings and comments, items were revised and refined across iterative rounds until consensus was achieved. Total 50 items were finalized. Following pilot testing among 50 beneficiaries, the final instrument comprised 37 items across domains of awareness, knowledge of scheme components, information sources, utilisation experiences, and perceived barriers. Internal consistency was satisfactory (Cronbach’s alpha = 0.78).
A structured questionnaire was developed based on an extensive review of relevant literature and programme documents. Content validity was established using a modified Delphi process. An initial pool of 48 items was reviewed by a panel of subject-matter experts, who independently assessed each item for relevance, clarity, and contextual appropriateness and provided qualitative feedback. Based on aggregated expert ratings and comments, items were iteratively revised and refined until consensus was achieved. The refined instrument was subsequently pilot tested among 50 PM-JAY beneficiaries, who were not included in the main study. Following pilot testing and item reduction, the final questionnaire comprised 37 items covering domains of awareness, knowledge of scheme components, sources of information, utilisation experiences, and perceived barriers. The internal consistency of the final instrument was satisfactory, with a Cronbach’s alpha of 0.78.
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2.4 Data analysis: Data were analysed using SPSS version 25. Knowledge scores were categorised into poor (1–5), moderate (6–10), and good (11–15). Associations between knowledge levels and socio-demographic variables were examined using chi-square tests, with p < 0.05 considered statistically significant.
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2.5 Ethical considerations: Ethical clearance was obtained from the Hospital authority before conducting the survey to ensure adherence to ethical standards in research involving human subjects.
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Additionally, written consent was obtained from each participant, ensuring their voluntary participation and informed consent throughout the study process. These ethical measures were implemented to safeguard the rights and well-being of the participants involved in the study.
3. Results
3.1 Sociodemographic profile of study participants
A total of 450 participants participated in the study. The sociodemographic characteristics of the participants are summarised in Table 1. The mean age of the participants were 37.8 ± 13.4 years. Majority of study participants (71.1%) were men and belonged to 18–37-year age group (35.4%). A substantial majority of respondents resided in rural areas (84%), reflecting the hospital’s catchment population. More than half of the participants were residents of Gujarat (59.8%), while over one-third were from neighbouring Madhya Pradesh (34.7%). Most participants were employed (76.9%), with agriculture being the most common occupation (32.2%).
Table 1
Sociodemographic profile of study participants (N = 450)
Variables
f
%
Age
    
18–27
114
25.33%
28–37
140
31.11%
38–47
101
22.44%
48–57
53
11.78%
58 and above
42
9.33%
Gender
    
Men
320
71.1%
Women
128
28.4%
Residence
    
Urban
72
16%
Rural
378
84%
States
    
Gujarat
268
59.8%
Bihar
1
0.2%
Madhya Pradesh
156
34.7%
Maharashtra
12
2.7%
Rajasthan
7
1.6%
Uttar Pradesh
4
0.9%
Uttarakhand
2
0.4%
Eemployment status
    
Employed
346
76.9%
Unemployed
104
23.1%
Employment Type
    
Self Employed/Business
37
8.22%
Private Job
48
10.67%
Labour
53
11.78%
Service Providers
55
12.22%
Farmers
145
32.22%
Others
8
1.78%
Not working
104
23.1%
Educational Status
    
Educated
413
91.78%
Not educated
37
8.22%
Education Type
    
Not Educated
37
8.22%
1st to 9th grade (Primary)
165
36.67%
10th grade (Secondary)
117
26%
11th to 12th grade (Higher Secondary)
60
13.33%
Diploma
2
0.44%
Graduate
64
14.22%
Post Graduate
5
1.11%
Income
    
10,000–30,000
189
42%
31,000–50,000
135
30%
51,000–80,000
45
10%
81,000-100000
16
3.5%
100000–150000
45
10.0%
> 150000
20
4.5%
Participants’ knowledge across different domains of the PM-JAY scheme is presented in Table 2. While general awareness of PM-JAY was high, with 86.7% reporting that they had heard of the scheme, detailed and functional knowledge was considerably limited. Approximately 70.9% of participants were aware of the financial coverage amount under PM-JAY. However, only 54.4% correctly identified the scheme as a government-funded programme providing secondary and tertiary care. Knowledge concerning eligibility and beneficiaries is quite limited, as only 20% are aware of all potential beneficiaries and just 15.6% reported awareness of the eligibility criteria. Less than half of the participants (45.8%) are aware of their own eligibility.
Knowledge regarding healthcare services covered under the scheme was particularly poor, with only 13.8% reporting awareness prior to utilization. Similarly, awareness of digital platforms such as the PM-JAY website and mobile application was limited (14.2% and 14.7%, respectively). Although a majority of participants were aware of the enrolment process (61.8%), fewer respondents were knowledgeable about hospital empanelment criteria (25.8%) or the availability of Pradhan Mantri Arogya Mitra (PMAM) help desks (18.9%). Awareness of treatment package rates (10.2%) and grievance redressal mechanisms (15.8%) was minimal.
3.2 Overall knowledge
Analysis of composite knowledge scores revealed generally low levels of understanding among participants. Over half of the respondents (50.4%) fell into the “poor” knowledge category (score 1–5), while 37.9% demonstrated a moderate level of knowledge (score 6–10). Only 11.6% achieved scores indicative of good knowledge (score 11–15). These findings indicate a substantial gap between general awareness and meaningful comprehension of PM-JAY entitlements.
Table 2
Knowledge Assessment Questions among study participants (N = 450)
Variables
Yes
NO
F
%
f
%
Heard of PMJAY also known as Pradhan Mantri Yan Arogya Yojna or Ayushman Yojna
390
86.7%
60
33.3%
Amount covered under PMJAY
319
70.9%
131
29.1%
PMJAY is funded by Governments for secondary and tertiary care hospitalization
245
54.4%
205
45.6%
Who all can avail benefit under PMJAY
90
20%
360
80%
Eligibility criteria for Urban and Rural people who can avail PMJAY services to maximize the benefit of Scheme
70
15.6%
380
84.4%
Aware about your eligibility
206
45.8%
244
54.2%
Aware that there is no restriction on the family size, age or gender under PMJAY and anyone under eligibility criteria can avail services
224
49.8%
226
50.2%
Aware of all the healthcare services covered under PMJAY before utilizing them
62
13.8%
388
86.2%
Use the PM-JAY website or helpline for information
64
14.2%
386
85.8%
Aware that you can make and Link your PMJAY card by using PMJAY App by yourself
66
14.7%
384
85.3%
Aware of the enrollment process for PM-JAY?
278
61.8%
172
31.2%
Aware of that the hospital has process to become part of a network or panel of facilities that are authorized to provide services /empanelment criteria for hospitals under PM-JAY
116
25.8%
334
74.2%
Aware of the enrollment process for PM-JAY?
278
61.8%
172
31.2%
Variables
Yes
NO
f
%
f
%
Aware of that the hospital has process to become part of a network or panel of facilities that are authorized to provide services /empanelment criteria for hospitals under PM-JAY
116
25.8%
334
74.2%
Aware regarding empanelled hospitals having dedicated help desks with Pradhan Mantri Arogya Mitras (PMAMs) and Whom to reach out for PMJAY Services
85
18.9%
365
81.1%
Aware about the specified package rates for treatments
46
10.2%
404
89.8%
Aware of the grievance redressal mechanism for Complain or any query for PM-JAY that is active 24 hours
71
15.8%
379
84.2%
3.3 Sources of Information on PM-JAY
The primary sources of information regarding PM-JAY are summarised in Table 3. Community-based and interpersonal channels were the most commonly reported sources. Gram Panchayats were the leading source of information (24.7%), followed by public healthcare professionals (23.3%) and private hospitals (20.9%). Friends and relatives accounted for 16% of information dissemination.
Mass media and digital platforms contributed minimally to awareness, with television (2.7%), social media (2.2%), newspapers (2.2%), and the official PM-JAY website (1.8%) reported infrequently. These findings suggest that information dissemination remains heavily dependent on local governance structures and healthcare providers rather than formal digital or media-based communication channels.
Table 3
Sources of information about PMJAY among study participants (N = 450)
Sources of Information
f
%
Gram Panchayat
111
24.67%
Public Health Professionals
105
23.33%
Private Hospitals
94
20.89%
Friends & Relatives
72
16.00%
Government camps
24
5.33%
Television
12
2.67%
Social media
10
2.22%
Leaflet
4
0.89%
Newspaper
10
2.22%
Official website
8
1.78%
3.4 Factors Associated with Knowledge Levels
Statistical analysis demonstrated significant associations between sociodemographic variables and PM-JAY knowledge scores. Knowledge levels varied significantly by place of residence (χ² = 12.639, p = 0.002), employment type (χ² = 132.211, p < 0.001), and income level (χ² = 31.965, p < 0.001). Educational attainment was also significantly associated with knowledge scores (χ² = 42.418, p < 0.001). Additionally, exposure to information communicated by private hospitals showed a strong association with higher knowledge scores (χ² = 51.775, p < 0.001), highlighting the influence of provider-led communication on beneficiary understanding of the scheme. These findings underscore the influence of sociodemographic factors and information dissemination channels on individuals' understanding of the PMJAY scheme.
3.5 Challenges faced in the PMJAY Scheme
Table 4 highlights PMJAY related challenges shared by participants. The most frequently reported challenge was delay in claim processing (41.7%), followed by non-availability of specific treatment packages within the hospital (22.9%). Other reported barriers included difficulties in obtaining refunds for pre-approval payments (12.50%), communication barriers due to English-only text messages (4.17%), and issues with Aadhar card linkage, including discrepancies in names (4.17%) and difficulties with deactivation from previous hospitals. Technical challenges, such as issues with biometric verification (8.33%) and card renewal (2.08%), also hinder smooth utilization of the scheme. Moreover, a lack of clear and comprehensive information regarding the scheme and its procedures further complicates the process for both beneficiaries and healthcare providers. Addressing these challenges effectively will be crucial to optimizing the implementation and impact of the PMJAY Scheme at Parul Sevashram Hospital.
Table 4
PMJAY related challenges faced by study participants (N = 48)
Description of challenges
f
%
Delay in process of claim
20
41.67%
Package services not available in hospital
11
22.92%
Issues with Refund of money that was paid before approval
6
12.50%
All the message received in text message regarding Ayushman is received in English only
2
4.17%
In emergency patient is admitted but Aadhar card has different name so unable to Link card
2
4.17%
Admitted in new hospital but card hasn't stopped from previous hospital
2
4.17%
Lack of information and paid earlier
2
4.17%
Was not capturing finger print
4
8.33%
Unable to renew card
1
2.08%
Total
48
100.0
3.6 PM-JAY Card Linkage Status
Overall, 67.1% of participants reported successful PM-JAY card linkage for all eligible family members. However, nearly one-third (32.9%) experienced difficulties. Among those facing linkage issues (n = 148), the most common reason was outdated or unavailable ration cards (60.8%). A quarter of respondents perceived no need for card linkage, while 14.2% were unaware of the requirement altogether. These findings point to both administrative bottlenecks and persistent gaps in beneficiary awareness.
Among participants reporting card linkage issues (n = 148), the most frequently cited barrier was the absence or outdated status of ration cards (60.8%), highlighting administrative constraints within eligibility verification processes. Ration cards serve as official documents entitling households to subsidised food grains through government-authorised outlets. Additionally, one-quarter of participants (25.0%) perceived no need for card linkage, indicating gaps in beneficiary awareness, while 14.2% were unaware of the linkage requirement altogether. These findings suggest that, despite overall progress in PM-JAY enrolment, streamlining ration card systems and strengthening targeted awareness initiatives are critical to improving comprehensive family-level card linkage.
4. Discussion
This study demonstrates a substantial disconnect between nominal awareness and functional knowledge of PM-JAY among beneficiaries. Although most participants had heard of the scheme, detailed understanding of eligibility, covered services, and grievance mechanisms remained limited. These findings reinforce evidence from multi-state studies indicating that information asymmetry is a critical barrier to effective PFHI utilisation in India [12, 13, 14]. This knowledge deficit often led to beneficiaries opting for out-of-pocket payments instead of utilizing their entitlements.
The strong association between education, income, and knowledge underscores the inequitable distribution of informational resources within the health system. Rural residence and informal employment further compounded knowledge deficits, reflecting broader structural inequities in access to health information. Notably, communication from private hospitals emerged as a significant predictor of knowledge, highlighting the pivotal role of provider–beneficiary interactions in shaping scheme comprehension. While public hospitals played a crucial role, involving private hospitals more actively in awareness campaigns is crucial to broaden outreach [15].
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While overall awareness of the scheme has increased, a considerable portion of the population, particularly those with lower socioeconomic status, remains uninformed. This disparity is accentuated among older, less educated, and rural populations. Achieving universal awareness of PMJAY necessitates targeted interventions to address these knowledge gaps and empower beneficiaries [16, 17].
Implementation challenges such as claim delays, package unavailability, and documentation barriers illustrate systemic bottlenecks rather than individual shortcomings. These findings align with recent evaluations of PM-JAY that identify administrative complexity and weak grievance redressal as persistent constraints on scheme performance [18, 19, 20, 21].
4.1 Implications of the study
From a health systems perspective, improving PM-JAY utilisation requires moving beyond enrolment-centric metrics towards capability-oriented implementation, where beneficiaries are empowered with actionable knowledge [22, 23]. Strengthening frontline communication, integrating scheme education into routine care pathways, and leveraging local governance structures such as Panchayats may enhance both awareness and trust in the system [23]. Furthermore, strengthening the capacity of healthcare providers to effectively communicate scheme benefits is essential to optimize PMJAY's impact.
4.2 Strengths and limitations of the study
The present study contributes empirically to the limited facility-based evidence on PM-JAY beneficiary knowledge within private tertiary care settings. The use of a validated instrument and inclusion of inferential analysis strengthen internal validity. However, findings are limited by the single-centre design and convenience sampling, which may affect generalisability. Despite these limitations, the study highlights the critical importance of beneficiary awareness, administrative efficiency, and targeted interventions in maximizing PMJAY's impact. Longitudinal and multi-site studies are warranted to capture temporal changes in knowledge and utilisation.
5. Conclusion
The study highlights critical knowledge gaps among PM-JAY beneficiaries that undermine effective utilization of entitlements. Socio-demographic inequities and system-level communication failures contribute substantially to these gaps. Addressing them through targeted information strategies, strengthened provider engagement, and simplified administrative processes is essential for improving health literacy and translating PM-JAY coverage into equitable health system gains.
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Acknowledgement
The authors gratefully acknowledge all study participants for their time and cooperation, without which this research would not have been possible.
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Funding:
This study received no external funding.
Conflict of interest: Authors declare no conflicts of interest.
Ethics approval and consent to participate: The study was approved by Technical & Ethical Review Committee of the Parul Institute of Public Health, Parul University, Vadodara (PIPH/FOM/TERC/2024-25/08).
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The study adhered to the Declaration of Helsinki and National ethical guidelines for biomedical and health research involving human participants published by Indian Council of Medical Research.
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Written informed consent was obtained from all study participants. They were also informed that by signing the informed consent, they had also consented to the data being used in a manuscript for publication. Participants were further informed of their right to exit the study at any point in time if they so wished. The privacy and confidentiality of participants' data were strictly maintained. Data gathered were stored in a password-protected database, accessible only to the research team.
Data availability: The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.
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Author Contribution
DJ and EM conceptualised the study. MC and PS conducted data collection while EM supervised the data collection. MC and DJ performed data analysis. AP supervised data analysis and provided substantial feedback on the initial manuscript. MC prepared the initial draft of the manuscript. PSG provided overall guidance and critical input on the manuscript. All authors reviewed the manuscript, provided critical feedback, and approved the final version for submission.
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Data Availability
The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.
References
1.
Ghosh S. Catastrophic payments and impoverishment due to out-of-pocket health spending. Econ Polit Wkly. 2011;46(47):63–70. https://www.jstor.org/stable/41720524.
2.
Sangar S, Dutt V, Thakur R. Burden of out-of-pocket health expenditure and its impoverishment impact in India: evidence from national sample survey. J Asian Public Policy. 2019;12(3):66–77. https://doi.org/10.1080/17516234.2019.1601065.
3.
Berman P, Ahuja R, Bhandari L. The impoverishing effect of healthcare payments in India: new methodology and findings. Econ Polit Wkly. 2010;45(16):65–71. http://www.jstor.org/stable/25664359.
4.
Shende V, Wagh V, Public Health Insurance Status and Utilization of Healthcare Services Across India. Narrative Rev Cureus. 2024;16(2):e54308. https://doi.org/10.7759/cureus.54308.
5.
Indumathi K, Hajira SI, Gopi A, Subramanian M. Awareness of health insurance in a rural population of Bangalore, India. Int J Med Sci Public Health. 2016;5(10):2162–7. https://doi.org/10.5455/ijmsph.2016.07032016462.
6.
Lahariya C. Ayushman Bharat program and universal health coverage in India. Indian Pediatr. 2018;55(6):495–506. https://pubmed.ncbi.nlm.nih.gov/29978817/.
7.
World Health Organization. Report on evolution of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana. New Delhi: WHO Regional Office for South-East Asia; 2022. https://apps.who.int/iris/handle/10665/354267.
8.
Dubey S, Deshpande S, Krishna L, Zadey S. Evolution of Government-funded health insurance for universal health coverage in India. Lancet Reg Health Southeast Asia. 2023;13:100180. https://doi.org/10.1016/j.lansea.2023.100180.
9.
Kanore S, Sankhe L, Sarang B, et al. Awareness and utilization of government health insurance schemes in urban slums of Maharashtra. J Fam Med Prim Care. 2019;8(2):482–7. https://doi.org/10.4103/jfmpc.jfmpc_361_18.
10.
Kumar K, Singh A, Kumar S, Ram F. Health insurance coverage in India: determinants and coverage gap. J Public Health (Oxf). 2015;23(2):79–86. https://doi.org/10.1007/s10389-014-0669-6.
11.
La Forgia GM, Nagpal S. Government-sponsored health insurance in India: are you covered? Washington DC: World Bank; 2012. https://doi.org/10.1596/978-0-8213-9618-6.
12.
Vitsupakorn S, Bharali I, Yamey G, Mao W. Early experiences of Pradhan Mantri Jan Arogya Yojana in India: a narrative review. Duke Glob Health Innov Cent Work Pap. 2021.
A
13.
Netra G, Rao BAV. Awareness, coverage and willingness to avail health insurance among residents of a rural area in central Karnataka. Natl J Community Med. 2019;10(4):190–6. https://njcmindia.com/index.php/file/article/view/483.
12.
Prasad SS, Singh CM, Naik BN, Pandey S, Rao R. Awareness of Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana in a rural community of eastern India. Cureus. 2023;15(1):e33788. https://doi.org/10.7759/cureus.33788.
13.
Parisi D, Srivastava S, Parmar D, Strupat C, Brenner S, Walsh C, et al. Awareness of India’s national health insurance scheme (PM-JAY): a cross-sectional study across six states. Health Policy Plan. 2023;38(3):289–300. https://doi.org/10.1093/heapol/czac106.
14.
Saikia D. Health insurance awareness and utilization in India: evidence from NFHS-5. BMC Health Serv Res. 2023;23:412. https://doi.org/10.1186/s12913-023-09341-2.
15.
Thomas B, Raykundaliya DP, Bhatt S, Vadhel K. Awareness, enrolment and utilization of PM-JAY in Gujarat, India. Int J Community Med Public Health. 2023;10:2741–7. https://doi.org/10.18203/2394-6040.ijcmph20231839.
16.
Saxena A, Trivedi M, Shroff ZC, Sharma M. Improving hospital-based processes for effective implementation of PM-JAY in India. BMC Health Serv Res. 2022;22(1):109. https://doi.org/10.1186/s12913-022-07469-8.
17.
Trivedi M, Saxena A, Shroff ZC, Sharma MM. Experiences and challenges in accessing hospitalization under PM-JAY in India. PLoS ONE. 2022;17(5):e0266798. https://doi.org/10.1371/journal.pone.0266798.
18.
World Health Organization. Report on evolution of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana. New Delhi: WHO Regional Office for South-East Asia; 2022. https://apps.who.int/iris/handle/10665/354267.
19.
Naaz N, Nigudgi S. Evaluation of PM-JAY utilization in a teaching hospital of Kalaburagi, Karnataka. Indian J Public Health Res Dev. 2022;13(1):74–9. https://doi.org/10.37506/ijphrd.v13i1.17618.
20.
Srivastava S, Bertone MP, Basu S, De Allegri M, Brenner S. Implementation of PM-JAY in India: a qualitative study exploring the role of competency, organizational and leadership drivers shaping early roll-out of publicly funded health insurance in three Indian states. Health Res Policy Syst. 2023;21(1):65. 10.1186/s12961-023-01012-7.
21.
Dixit R, Chauhan A, Juneja K. Awareness and Utilization of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-NHPM) among Beneficiaries of Gautam Buddha Nagar District: A Comparative Study. Indian J Community Med. 2025 Jan-Feb;50(1):213–9. https://doi.org/10.4103/ijcm.ijcm_728_23.
22.
Garg S, Bebarta KK, Tripathi N. Performance of India’s national publicly funded health insurance scheme (PM-JAY) in improving access and financial protection for hospital care: findings from Chhattisgarh. BMC Public Health. 2020;20:949. https://doi.org/10.1186/s12889-020-09071-7.
23.
Prinja S, Dixit J, Nimesh R, Garg B, Khurana R, Paliwal A, Aggarwal AK. Impact of health benefit package policy interventions on service utilisation under government-funded health insurance in Punjab, India: analysis of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY). Lancet Reg Health Southeast Asia. 2024;28:100462. https://doi.org/10.1016/j.lansea.2024.100462.
Yes
Abstract
Background: Pradhan Mantri Jan Arogya Yojana (PM-JAY) represents India’s flagship publicly funded health insurance scheme and a central pillar of its Universal Health Coverage strategy. Despite extensive population coverage, evidence suggests that limited beneficiary knowledge and information asymmetries constrain effective utilisation of scheme benefits. Objectives: This study aims to assess knowledge and information gaps among PMJAY beneficiaries. Methods: A cross-sectional study was conducted among 450 PMJAY beneficiaries at a tertiary care teaching hospital in Gujarat, India, between January and March 2024. Data were collected using a validated, digitalized structured questionnaire through KOBO toolbox. Descriptive statistics and inferential analyses were performed using SPSS v25 to examine factors associated with knowledge levels. Results: The mean age of participants was 37.8 ± 13.4 years; 71.1% were male, and 84% resided in rural areas. Although 86.7% had heard of PM-JAY, the mean knowledge score was low (5.09 ± 2.8 out of 15). Awareness of eligibility criteria (15.6%), covered services (13.8%), grievance redressal mechanisms (15.8%), and digital platforms was particularly limited. Knowledge scores were significantly associated with residence, education, income, employment type, and exposure to information from private hospitals (p 0.001). Major challenges included claim processing delays (41.7%) and non-availability of service packages (22.9%) with minor issues like language barriers and Aadhar card linking affecting about 4.2% of respondents each. Conclusion: Enhancing PMJAY utilization will require improved information dissemination, addressing rural-urban disparities, and leveraging interpersonal networks to better reach and educate diverse demographic groups.
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