Knowledge, utilisation and perception regarding Ayushman Bharat Pradhan Mantri Jan Arogya Yojana among Mysuru residents: insights from a cross-sectional analysis

INTRODUCTION

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is a cornerstone of India’s national health policy, launched on September 23, 2018, by the Honourable Prime Minister, Shri Narendra Modi.¹ As one of the largest government-funded health insurance programs globally, AB-PMJAY aims to provide financial protection for secondary and tertiary healthcare services to economically vulnerable families. The scheme offers annual health coverage of up to ₹5 lakh per family, benefiting approximately 12 crore families, which constitute nearly 40% of India's population.²

Beneficiary identification under AB-PMJAY is based on the 2011 Socio-Economic and Caste Census (SECC) data, incorporating both occupational and deprivation-based criteria. A defining feature of the scheme is its cashless service model, which facilitates seamless access to healthcare. The program imposes no restrictions on family size, age, or gender, and it provides comprehensive coverage, including pre-existing conditions from the first day of enrolment. Additionally, the scheme encompasses pre-hospitalization expenses for three days and post-hospitalization care for up to 15 days, covering diagnostic tests, medications, consumables, food, and accommodation.²

The level of awareness and comprehension of an insurance scheme significantly influences its acceptance and utilization. While awareness is a prerequisite, a thorough understanding of its benefits further determines its effectiveness. Various states have undertaken initiatives to enhance awareness, enrolment, and utilization of AB-PMJAY. As of November 30, 2024, nearly 36 crore individuals have been verified under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY). Additionally, over 8.39 crore hospitalizations, amounting to more than ₹1.16 lakh crore, have been approved as part of the program. This initiative has notably reduced beneficiaries’ out-of-pocket expenses for hospitalization.³ However, studies indicate regional disparities in awareness levels. For instance, a study conducted in rural Tamil Nadu reported that 77% of respondents were aware of the scheme, whereas a study in rural Jammu documented a considerably lower awareness rate of 28%.⁴

Publicly funded health insurance (PFHI) schemes play a crucial role in mitigating out-of-pocket expenditure (OOPE) on healthcare. Historically, OOPE has constituted a substantial portion of India’s healthcare spending, accounting for approximately 48% of total health expenditure in 2018.⁵ In response, AB-PMJAY was introduced to alleviate this financial burden and improve healthcare accessibility. Consequently, OOPE declined to 42.06% of total health expenditure in 2019.⁵ However, despite these improvements, government healthcare expenditure remains relatively low at approximately 2% of GDP.⁶

A key challenge to the successful implementation of AB-PMJAY is the lack of public awareness, which can hinder its optimal utilization. This study aimed to assess the knowledge, utilization and perception regarding AB-PMJAY among residents of Mysuru, providing valuable insights into the scheme’s awareness.

METHODS

This study employed a cross-sectional design to assess the knowledge, awareness, and practices (KAP) regarding Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) among the population of Mysuru district. The study was conducted over a period of three months from (December 2024- February 2025). A simple random sampling method was employed to select primary health centres (PHCs) and community health centres (CHCs) across Mysuru district. Both walk-in and in-patients at these healthcare facilities were included in the study. A semi-structured questionnaire was administered to assess socio-demographic characteristics, availability of AB-PMJAY services, and participants’ knowledge, awareness, and practices regarding the scheme.

A similar study conducted in rural Tamil Nadu reported a lower awareness rate of 28% regarding AB-PMJAY.⁴ The required sample size was determined based on an expected response rate of 88% (i.e., 12% non-response rate). A total of 350 participants were recruited for the study

Participants aged between 30 and 60 years, residing in Mysuru district, who provided informed consent and were either walk-in or in-patients at selected PHCs and CHCs, were included in the study. Individuals below 30 years or above 60 years, and non-residents of Mysuru were not taken for the study.

Ethical clearance for the study was obtained from the Institutional Ethics Committee of JSS Medical College. Written informed consent was obtained from all participants before data collection, ensuring adherence to ethical guidelines and confidentiality protocols.

The collected data were entered into Microsoft Excel 2019 and analysed using SPSS version 30. Descriptive statistics, including frequencies and percentages, were computed. A chi-square test was performed to assess associations between categorical variables, with a p value <0.05 considered statistically significant.

RESULTS

A total of 350 individuals participated in the study. The majority were aged 30-45 years (202, 57.7%) and resided in urban areas (222, 63.4%). Males (184, 52.6%) slightly outnumbered females. The predominant religion among participants was Hinduism (267, 76.3%). Regarding educational status, nearly half were graduates (173, 49.4%). The most common occupation was professional work (134, 38.3%). Most participants were married (191, 54.6%). A substantial proportion reported a monthly household income of more than ₹20,000 (153, 43.7%). Additionally, 233 (66.6%) participants owned a ration card (Table 1).

The primary source of information about Ayushman Bharat among respondents was friends and relatives (31.7%), followed closely by doctors and hospitals (28.3%) and ASHA/ANM/healthcare workers (27.1%) and media contributed the least, with only 12.9% of individuals reporting it as their primary source (Figure 1).

In the current study, 164 (46.9%) participants correctly identified BPL cardholders as eligible for the Ayushman Bharat card, while 167 (47.7%) were unsure. Only 39 (11.1%) knew that all family members could benefit. Awareness about PM-JAY benefits was mixed, with 187 (53.4%) knowing about cashless treatment, and 155 (44.3%) aware that private hospitals accept PM-JAY. Only 160 (45.7%) knew about the transport allowance benefit. Regarding specific benefits, 182 (52.1%) knew about free hospitalization and 151 (43.2%) about cashless treatment up to ₹5 lakh. However, 133 (38.0%) participants did not know any benefits of the Ayushman Bharat card (Table 2).

The awareness levels about Ayushman Bharat indicate that a majority of respondents (55.7%) had poor awareness, while 30.9% demonstrated an average level of awareness. Only a small proportion (13.4%) had excellent awareness (Figure 2).

Among the participants, 131 (37.4%) possessed an AB-PMJAY card, while 219 (62.6%) did not. A total of 118 (33.7%) reported availing health services under AB-PMJAY, whereas 232 (66.3%) had not utilized the services. Among those who availed the services, 36 (10.3%) rated their experience as excellent, 68 (19.4%) as good, 15 (4.3%) as average, and 1 (0.3%) as poor, while 230 (65.7%) had not availed of any services. Regarding improvement in healthcare access, 133 (38.0%) felt AB-PMJAY had improved access, 23 (6.6%) felt it had not, and 194 (55.4%) were uncertain. To enhance awareness, 176 (50.3%) suggested media campaigns, local leader involvement, health camps, and better communication. Additionally, 146 (41.7%) indicated they would recommend AB-PMJAY to others, while 25 (7.1%) would not, and 179 (51.1%) were unsure (Table 3).

Among participants aged 30-45 years, 121 (59.9%) had poor awareness. Gender-wise, poor awareness was noted among 102 (55.4%) males and 93 (56.0%) females. Marital status, education, place of residence, occupation, and religion did not show a significant association with awareness. However, household income showed a significant association (p=0.011), with those earning less than ₹5000 per month having a higher proportion of awareness, 14 (20.3%) compared to other income groups. Religion, place of residence, and occupation did not show a significant association with awareness levels (Table 4).

DISCUSSION

Ayushman Bharat PM-JAY, the world’s largest health assurance scheme, aims to cover the bottom 40% of India’s population, marking a significant milestone in healthcare coverage.⁷ However, a major limitation remains the lack of awareness about the scheme. Our study focused on assessing the awareness levels of the Mysuru population regarding Ayushman Bharat. The primary sources of information were friends and relatives (31.7%), followed by doctors and hospitals (28.3%), ASHA/ANM/healthcare workers (27.1%), and media (12.9%). These findings are comparable to a study conducted by Prasad et al, where friends and relatives (30.9%) were the main source of information, followed closely by ASHA/AWW/HCW (30.5%).⁸

One of the major initiatives to raise awareness was the additional data collection drive (ADCD) held on 30^th April 2018 during “Ayushman Bharat Diwas”, which involved ASHA workers, ANMs, and Gram Sevaks covering approximately 3 lakh villages. Posters and banners in Hindi and regional languages were widely distributed during camps and village meetings.² Despite such large-scale initiatives, full awareness among the population remains a significant challenge.

Regarding eligibility knowledge, 164 (46.9%) participants in our study correctly identified families from poor and vulnerable backgrounds, as defined by the socio-economic caste census (SECC), as eligible, while 167 (47.7%) were unsure. This reflects the AB-PMJAY eligibility criteria, which are based on deprivation and occupational factors from the SECC 2011 data for rural and urban areas.⁹ Although Ayushman Bharat is intended for people below the poverty line, our assessment shows that awareness about the eligibility and benefits of the scheme remains limited, leading to poor enrolment and utilization.¹⁰

In our study, 131 (37.4%) participants possessed an AB-PMJAY card, while 219 (62.6%) did not. When asked whether the Ayushman Bharat card offers cashless treatment and hospitalization across India, 163 (46.6%) responded “no” and 187 (53.4%) responded “yes”. This is in line with findings from Prasad et al, where only 117 (32.3%) of participants were aware that the card could be used beyond their residential state.⁸

Awareness of PM-JAY benefits was also mixed, with 53.4% of participants knowing about the cashless treatment provision, while 46.6% remained unaware. Similarly, a survey conducted by Sharan across 175 households in six states revealed significant gaps in awareness- 56% of participants were unaware of the diseases and treatments covered under PM-JAY, and 74% were unaware of the claims process to avail cashless treatment.¹¹

In terms of utilization and patient experience, a study by Kamalpreet et al. found that only 14% (79 out of 576) of the participants expressed satisfaction with the services received under AB-PMJAY, with satisfaction levels of 17% in Ludhiana and 9% in Mansa.¹² In comparison, our study showed that 118 (33.7%) participants reported using AB-PMJAY services, while 232 (66.3%) had never utilized them. Among the users, 36 (10.3%) rated their experience as excellent, 68 (19.4%) as good, 15 (4.3%) as average, and 1 (0.3%) as poor. This indicates a relatively higher level of satisfaction among our study population compared to Kamalpreet’s findings, although a significant portion still rated their experience as average or poor. When asked about improvements in healthcare access due to AB-PMJAY, 133 (38.0%) of our participants responded affirmatively, 23 (6.6%) said no, and a notable 194 (55.4%) were unsure. These findings highlight a mixed perception regarding the scheme’s effectiveness in improving healthcare accessibility.

Similarly, Garg et al, in their study, observed that there was little difference in median out-of-pocket expenditure (OOPE) between AB-PMJAY beneficiaries and uninsured patients. Their findings suggested that private hospitals remained expensive irrespective of scheme enrolment, highlighting an important limitation in the financial protection offered by AB-PMJAY.¹³

CONCLUSION

The study highlights suboptimal awareness and utilization of AB-PMJAY among Mysuru residents. Targeted awareness campaigns and community engagement strategies are essential to enhance public understanding and uptake of the scheme.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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