A Cross-Sectional Study Assessing Knowledge Gaps and Utilization Patterns among PM-JAY Beneficiaries Attending a Tertiary Care Hospital in Gujarat, India

A Cross-Sectional Study Assessing Knowledge Gaps and Utilization Patterns among PM-JAY Beneficiaries Attending a Tertiary Care Hospital in Gujarat, India | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A Cross-Sectional Study Assessing Knowledge Gaps and Utilization Patterns among PM-JAY Beneficiaries Attending a Tertiary Care Hospital in Gujarat, India Damini Joshi, Apurvakumar Pandya, Mehak Chopra, Parth Sompura, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8354716/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version 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 PMJAY healthcare knowledge gaps awareness utilization 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 ]. 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). 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. 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. 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. 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 ]. 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. Declarations Acknowledgements. The authors gratefully acknowledge all study participants for their time and cooperation, without which this research would not have been possible. 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). 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. 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. Author contribution: DJ and EM conceptualised the study. MC and PS conducted data collection while EM supervised the data collection. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8354716","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":569023337,"identity":"7008c5f0-92fe-4d7e-8225-58d9dcc95541","order_by":0,"name":"Damini 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Health","correspondingAuthor":false,"prefix":"","firstName":"Apurvakumar","middleName":"","lastName":"Pandya","suffix":""},{"id":569023346,"identity":"86ffad3c-a691-4a71-ae78-9ce5799f6277","order_by":2,"name":"Mehak Chopra","email":"","orcid":"","institution":"Parul University Vadodara","correspondingAuthor":false,"prefix":"","firstName":"Mehak","middleName":"","lastName":"Chopra","suffix":""},{"id":569023351,"identity":"591dad81-0f4c-4e99-9c56-a82b0c8c83c9","order_by":3,"name":"Parth Sompura","email":"","orcid":"","institution":"Parul University","correspondingAuthor":false,"prefix":"","firstName":"Parth","middleName":"","lastName":"Sompura","suffix":""},{"id":569023352,"identity":"1882ca5d-3dfa-49d1-a9dc-3661fc1848e5","order_by":4,"name":"Ekta Modi","email":"","orcid":"","institution":"Parul University","correspondingAuthor":false,"prefix":"","firstName":"Ekta","middleName":"","lastName":"Modi","suffix":""},{"id":569023354,"identity":"488a2a85-c882-4d05-a00d-4120c0303fc0","order_by":5,"name":"Partha Sarathi Ganguly","email":"","orcid":"","institution":"Parul University Vadodara","correspondingAuthor":false,"prefix":"","firstName":"Partha","middleName":"Sarathi","lastName":"Ganguly","suffix":""}],"badges":[],"createdAt":"2025-12-13 19:38:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8354716/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8354716/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":99791323,"identity":"c854745b-cd7c-4d0c-88e5-a63a135bc6ad","added_by":"auto","created_at":"2026-01-08 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09:31:57","extension":"html","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":107060,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8354716/v1/774c78093ff548d450849776.html"},{"id":108086811,"identity":"1ac4d1d6-9b38-47e3-9875-5787b97fe334","added_by":"auto","created_at":"2026-04-29 08:41:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":393013,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8354716/v1/c6122b55-34bb-47bf-8e3f-91e185aa2664.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A Cross-Sectional Study Assessing Knowledge Gaps and Utilization Patterns among PM-JAY Beneficiaries Attending a Tertiary Care Hospital in Gujarat, India","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eIndia\u0026rsquo;s pursuit of Universal Health Coverage (UHC) has been shaped by persistent challenges related to high out-of-pocket (OOP) health expenditure [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], financial impoverishment [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], and inequitable access to hospital care [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Despite sustained public investment, OOP payments continue to account for a substantial share of total health expenditure, pushing an estimated 3\u0026ndash;7% of households below the poverty line annually [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. These structural vulnerabilities have underscored the need for robust publicly funded health insurance (PFHI) mechanisms.\u003c/p\u003e \u003cp\u003eLaunched in 2018, the Pradhan Mantri Jan Arogya Yojana (PM-JAY) is the world\u0026rsquo;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\u0026nbsp;million economically vulnerable individuals [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. While enrolment and card generation have expanded rapidly, emerging evidence questions the scheme\u0026rsquo;s effectiveness in translating coverage into utilisation and financial protection [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA 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 [\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. 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 [\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Information asymmetry, limited understanding of eligibility criteria, and poor awareness of entitlements often result in delayed care-seeking, underutilisation, or avoidable OOP expenditure.\u003c/p\u003e \u003cp\u003eAgainst 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.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003e\u003cstrong\u003e2.1\u0026nbsp;\u0026nbsp;Study design and setting:\u003c/strong\u003e 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\u0026ndash;45,000 beneficiaries.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2\u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eStudy Population and Sampling:\u0026nbsp;\u003c/strong\u003eThe study population included\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eall adult PM-JAY beneficiaries accessing inpatient or outpatient services during the study period (15 January\u0026ndash;20 March 2024). A convenience sampling approach was adopted, and 450 consenting participants were enrolled.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3\u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eData collection tool\u003c/strong\u003e: 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\u0026rsquo;s alpha = 0.78).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA 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\u0026rsquo;s alpha of 0.78.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4 Data analysis:\u003c/strong\u003e Data were analysed using SPSS version 25. Knowledge scores were categorised into poor (1\u0026ndash;5), moderate (6\u0026ndash;10), and good (11\u0026ndash;15). Associations between knowledge levels and socio-demographic variables were examined using chi-square tests, with p \u0026lt; 0.05 considered statistically significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.5 Ethical considerations:\u003c/strong\u003e Ethical clearance was obtained from the Hospital authority before conducting the survey to ensure adherence to ethical standards in research involving human subjects. 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.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Sociodemographic profile of study participants\u003c/h2\u003e \u003cp\u003eA total of 450 participants participated in the study. The sociodemographic characteristics of the participants are summarised in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The mean age of the participants were 37.8\u0026thinsp;\u0026plusmn;\u0026thinsp;13.4 years. Majority of study participants (71.1%) were men and belonged to 18\u0026ndash;37-year age group (35.4%). A substantial majority of respondents resided in rural areas (84%), reflecting the hospital\u0026rsquo;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%).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic profile of study participants (N\u0026thinsp;=\u0026thinsp;450)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003ef\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e%\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u0026ndash;27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.33%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e28\u0026ndash;37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.11%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e38\u0026ndash;47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.44%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e48\u0026ndash;57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.78%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e58 and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.33%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e320\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e128\u003c/p\u003e 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\u003cp\u003e84%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStates\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGujarat\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e268\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBihar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMadhya Pradesh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e156\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaharashtra\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRajasthan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUttar Pradesh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUttarakhand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEemployment status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e346\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployment Type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf Employed/Business\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.22%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrivate Job\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.67%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLabour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.78%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eService Providers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.22%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFarmers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e145\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32.22%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.78%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot working\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducational Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e413\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91.78%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot educated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.22%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation Type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot Educated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.22%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1st to 9th grade (Primary)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e165\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.67%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10th grade (Secondary)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e117\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11th to 12th grade (Higher Secondary)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.33%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.44%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.22%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost Graduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.11%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10,000\u0026ndash;30,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e189\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e31,000\u0026ndash;50,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e51,000\u0026ndash;80,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e81,000-100000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e100000\u0026ndash;150000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;150000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eParticipants\u0026rsquo; knowledge across different domains of the PM-JAY scheme is presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. 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.\u003c/p\u003e \u003cp\u003eKnowledge 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.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Overall knowledge\u003c/h2\u003e \u003cp\u003eAnalysis of composite knowledge scores revealed generally low levels of understanding among participants. Over half of the respondents (50.4%) fell into the \u0026ldquo;poor\u0026rdquo; knowledge category (score 1\u0026ndash;5), while 37.9% demonstrated a moderate level of knowledge (score 6\u0026ndash;10). Only 11.6% achieved scores indicative of good knowledge (score 11\u0026ndash;15). These findings indicate a substantial gap between general awareness and meaningful comprehension of PM-JAY entitlements.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eKnowledge Assessment Questions among study participants (N\u0026thinsp;=\u0026thinsp;450)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e%\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ef\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e%\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeard of PMJAY also known as Pradhan Mantri Yan Arogya Yojna or Ayushman Yojna\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e390\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e86.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAmount covered under PMJAY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e319\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePMJAY is funded by Governments for secondary and tertiary care hospitalization\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e245\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e205\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e45.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWho all can avail benefit under PMJAY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e360\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e80%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEligibility criteria for Urban and Rural people who can avail PMJAY services to maximize the benefit of Scheme\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e380\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e84.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAware about your eligibility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e206\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e244\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e54.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAware that there is no restriction on the family size, age or gender under PMJAY and anyone under eligibility criteria can avail services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e224\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e226\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e50.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAware of all the healthcare services covered under PMJAY before utilizing them\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e388\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e86.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUse the PM-JAY website or helpline for information\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e386\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e85.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAware that you can make and Link your PMJAY card by using PMJAY App by yourself\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e384\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e85.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAware of the enrollment process for PM-JAY?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e278\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e172\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAware 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\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e334\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e74.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAware of the enrollment process for PM-JAY?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e278\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e172\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ef\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ef\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAware 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\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e334\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e74.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAware regarding empanelled hospitals having dedicated help desks with Pradhan Mantri Arogya Mitras (PMAMs) and Whom to reach out for PMJAY Services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e365\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e81.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAware about the specified package rates for treatments\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e404\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e89.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAware of the grievance redressal mechanism for Complain or any query for PM-JAY that is active 24 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e379\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e84.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Sources of Information on PM-JAY\u003c/h2\u003e \u003cp\u003eThe primary sources of information regarding PM-JAY are summarised in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. 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.\u003c/p\u003e \u003cp\u003eMass 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.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSources of information about PMJAY among study participants (N\u0026thinsp;=\u0026thinsp;450)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSources of Information\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003ef\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e%\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGram Panchayat\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e111\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24.67%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePublic Health Professionals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23.33%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrivate Hospitals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20.89%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFriends \u0026amp; Relatives\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.00%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGovernment camps\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.33%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTelevision\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.67%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial media\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.22%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeaflet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.89%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNewspaper\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.22%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOfficial website\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.78%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Factors Associated with Knowledge Levels\u003c/h2\u003e \u003cp\u003eStatistical analysis demonstrated significant associations between sociodemographic variables and PM-JAY knowledge scores. Knowledge levels varied significantly by place of residence (χ\u0026sup2; = 12.639, p\u0026thinsp;=\u0026thinsp;0.002), employment type (χ\u0026sup2; = 132.211, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and income level (χ\u0026sup2; = 31.965, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Educational attainment was also significantly associated with knowledge scores (χ\u0026sup2; = 42.418, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Additionally, exposure to information communicated by private hospitals showed a strong association with higher knowledge scores (χ\u0026sup2; = 51.775, p\u0026thinsp;\u0026lt;\u0026thinsp;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.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e3.5 Challenges faced in the PMJAY Scheme\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e 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.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePMJAY related challenges faced by study participants (N\u0026thinsp;=\u0026thinsp;48)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDescription of challenges\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003ef\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e%\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDelay in process of claim\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41.67%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePackage services not available in hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22.92%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIssues with Refund of money that was paid before approval\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12.50%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAll the message received in text message regarding Ayushman is received in English only\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.17%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIn emergency patient is admitted but Aadhar card has different name so unable to Link card\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.17%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdmitted in new hospital but card hasn't stopped from previous hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.17%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLack of information and paid earlier\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.17%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWas not capturing finger print\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.33%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnable to renew card\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.08%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.6 PM-JAY Card Linkage Status\u003c/h2\u003e \u003cp\u003eOverall, 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\u0026thinsp;=\u0026thinsp;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.\u003c/p\u003e \u003cp\u003eAmong participants reporting card linkage issues (n\u0026thinsp;=\u0026thinsp;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.\u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis 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 [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. This knowledge deficit often led to beneficiaries opting for out-of-pocket payments instead of utilizing their entitlements.\u003c/p\u003e \u003cp\u003eThe 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\u0026ndash;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 [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhile 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 [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eImplementation 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 [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e\u003cb\u003e4.1\u003c/b\u003e Implications of the study\u003c/h2\u003e \u003cp\u003eFrom 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 [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. 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 [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Furthermore, strengthening the capacity of healthcare providers to effectively communicate scheme benefits is essential to optimize PMJAY's impact.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e\u003cb\u003e4.2\u003c/b\u003e Strengths and limitations of the study\u003c/h2\u003e \u003cp\u003eThe 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.\u003c/p\u003e \u003c/div\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThe 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.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAcknowledgements. The authors gratefully acknowledge all study participants for their time and cooperation, without which this research would not have been possible.\u003c/p\u003e\n\u003cp\u003eFunding: This study received no external funding.\u003c/p\u003e\n\u003cp\u003eConflict of interest: Authors declare no conflicts of interest.\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate: The study was approved by Technical \u0026amp; Ethical Review Committee of the Parul Institute of Public Health, Parul University, Vadodara (PIPH/FOM/TERC/2024-25/08). 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. 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\u0026apos; data were strictly maintained. Data gathered were stored in a password-protected database, accessible only to the research team.\u003c/p\u003e\n\u003cp\u003eData availability: The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eAuthor 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.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGhosh S. Catastrophic payments and impoverishment due to out-of-pocket health spending. \u003cem\u003eEcon Polit Wkly\u003c/em\u003e. 2011;46(47):63\u0026ndash;70. https://www.jstor.org/stable/41720524\u003c/li\u003e\n\u003cli\u003eSangar S, Dutt V, Thakur R. Burden of out-of-pocket health expenditure and its impoverishment impact in India: evidence from national sample survey. \u003cem\u003eJ Asian Public Policy\u003c/em\u003e. 2019;12(3):66\u0026ndash;77. https://doi.org/10.1080/17516234.2019.1601065\u003c/li\u003e\n\u003cli\u003eBerman P, Ahuja R, Bhandari L. The impoverishing effect of healthcare payments in India: new methodology and findings. \u003cem\u003eEcon Polit Wkly\u003c/em\u003e. 2010;45(16):65\u0026ndash;71. http://www.jstor.org/stable/25664359\u003c/li\u003e\n\u003cli\u003eShende V, Wagh V. Public Health Insurance Status and Utilization of Healthcare Services Across India: A Narrative Review. Cureus. 2024 Feb 16;16(2):e54308. https://doi.org/10.7759/cureus.54308\u003c/li\u003e\n\u003cli\u003eIndumathi K, Hajira SI, Gopi A, Subramanian M. 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Early experiences of Pradhan Mantri Jan Arogya Yojana in India: a narrative review. \u003cem\u003eDuke Glob Health Innov Center Work Pap\u003c/em\u003e. 2021.\u003c/li\u003e\n\u003cli\u003eNetra G, Rao BAV. Awareness, coverage and willingness to avail health insurance among residents of a rural area in central Karnataka. \u003cem\u003eNatl J Community Med\u003c/em\u003e. 2019;10(4):190\u0026ndash;196. https://njcmindia.com/index.php/file/article/view/483\u003c/li\u003e\n\u003cli\u003ePrasad SS, Singh CM, Naik BN, Pandey S, Rao R. Awareness of Ayushman Bharat\u0026ndash;Pradhan Mantri Jan Arogya Yojana in a rural community of eastern India. \u003cem\u003eCureus\u003c/em\u003e. 2023;15(1):e33788. https://doi.org/10.7759/cureus.33788\u003c/li\u003e\n\u003cli\u003eParisi D, Srivastava S, Parmar D, Strupat C, Brenner S, Walsh C, et al. 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Performance of India\u0026rsquo;s national publicly funded health insurance scheme (PM-JAY) in improving access and financial protection for hospital care: findings from Chhattisgarh. \u003cem\u003eBMC Public Health\u003c/em\u003e. 2020;20:949. https://doi.org/10.1186/s12889-020-09071-7\u003c/li\u003e\n\u003cli\u003ePrinja 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 Aug 19;28:100462. https://doi.org/10.1016/j.lansea.2024.100462.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"PMJAY, healthcare, knowledge gaps, awareness, utilization","lastPublishedDoi":"10.21203/rs.3.rs-8354716/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8354716/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePradhan Mantri Jan Arogya Yojana (PM-JAY) represents India\u0026rsquo;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.\u003c/p\u003e\u003ch2\u003eObjectives\u003c/h2\u003e \u003cp\u003eThis study aims to assess knowledge and information gaps among PMJAY beneficiaries.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e 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.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe mean age of participants was 37.8\u0026thinsp;\u0026plusmn;\u0026thinsp;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\u0026thinsp;\u0026plusmn;\u0026thinsp;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\u0026thinsp;\u0026lt;\u0026thinsp;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.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eEnhancing PMJAY utilization will require improved information dissemination, addressing rural-urban disparities, and leveraging interpersonal networks to better reach and\u003c/p\u003e","manuscriptTitle":"A Cross-Sectional Study Assessing Knowledge Gaps and Utilization Patterns among PM-JAY Beneficiaries Attending a Tertiary Care Hospital in Gujarat, India","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-05 09:31:52","doi":"10.21203/rs.3.rs-8354716/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e7447289-805d-412c-b1b2-b0a62c43c023","owner":[],"postedDate":"January 5th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-29T08:38:59+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-05 09:31:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8354716","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8354716","identity":"rs-8354716","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}