The present study attempts to assess beneficiaries’ awareness of the policy, factors associated with the awareness and challenges of access to Pradhan Mantri Jan Arogya Yojana (PMJAY) in Uttar Pradesh. Further, it explores the exclusion of beneficiaries at each level of PMJAY implementation and tries to explain the exclusion by utilising the beneficiaries’ and stakeholders’ narratives. The study adopts descriptive statistics and a probit regression model to assess the awareness level and determine the associated factors, respectively. The findings suggest that a significant proportion of the population is unaware of the basic features of the scheme, and sociocultural and political factors play a significant role in this regard. Furthermore, the study found that the unawareness from both the demand and supply sides restricted many households from utilising the services under the scheme. The study highlights the need for targeted awareness campaigns and improved implementation strategies to utilise PMJAY services effectively.
AbiolaA. O., Ladi-AkinyemiT. W., OyeleyeO. A., OyelekeG. K., OlowoseluO. I., & AbdulkareemA. T. (2019). Knowledge and utilisation of National Health Insurance Scheme among adult patients attending a tertiary health facility in Lagos State, South-Western Nigeria. African Journal of Primary Health Care and Family Medicine, 11(1), 1–7. https://doi.org/10.4102/phcfm.v11i1.2018
2.
AngellB. J., PrinjaS., GuptA., JhaV., & JanS. (2019). The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana and the path to universal health coverage in India: Overcoming the challenges of stewardship and governance. PLoS Medicine, 16(3), e1002759. https://doi.org/10.1371/JOURNAL.PMED.1002759
3.
Ayushman Bharat—Pradhan Mantri Jan Arogya Yojna. (n.d.). About MMJAA scheme. https://ayushmanup.in/pages.aspx?pt=About-MMJAA-scheme
4.
BelliP. (2013). How adverse selection affects the health insurance market[Policy research working paper]. https://doi.org/10.1596/1813-9450-2574
5.
BrymanA. (2016). Social research methods (5th ed.). Oxford University Press. https://ktpu.kpi.ua/wp-content/uploads/2014/02/social-research-methods-alan-bryman.pdf
6.
CerrutiD., DaminatoC., & FilippiniM. (2023). The impact of policy awareness: Evidence from vehicle choices response to fiscal incentives. Journal of Public Economics, 226. https://doi.org/10.1016/j.jpubeco.2023.104973
7.
DattaS., & BagliS. (2024). Health insurance for universal health coverage in India. Arthaniti: Journal of Economic Theory and Practice. https://doi.org/10.1177/ 09767479241277927
8.
DubeyS., DeshpandeS., KrishnaL., & ZadeyS. (2023). Evolution of government-funded health insurance for universal health coverage in India. The Lancet Regional Health—Southeast Asia, 13, 100180.
9.
DuttaS. S. (2024, July26). House panel flags gaps in identifying & registering beneficiaries in Ayushman Bharat-PMJAY. The Print. https://theprint.in/health/house-panel-flags- gaps-in-identifying-registering-beneficiaries-in-ayushman-bharat-pmjay/2192601/
10.
EdwardsG. C. (1980). Implementing public policy. Congressional Quarterly Press.
11.
FabozziF. J., FocardiS. M., RachevS. T., & ArshanapalliB. G. (2014). The basics of financial econometrics: Tools, concepts, and asset management applications. In The basics of financial econometrics. John Wiley & Sons, Ltd. https://doi.org/10.1002/ 9781118856406.APP5
12.
GargS., BebartaK. K., & TripathiN. (2020). Performance of India’s national publicly funded health insurance scheme, Pradhan Mantri Jan Arogaya Yojana (PMJAY), in improving access and financial protection for hospital care: Findings from household surveys in Chhattisgarh state. BMC Public Health, 20(1), 1–10. https://doi.org/10.1186/S12889-020-09107-4
13.
Government of Uttar Pradesh. (2023). Multidimensional Poverty Index: District wise analysis Uttar Pradesh 2023. https://epariyojana.up.gov.in/sdg/SdgCIF/PDF/Analysis_Note/MPI_UP_Districtwise%20Analysis_UNDP.pdf
14.
GowdaN. R., HakimA., SinghG., GuptaA., & SharmaD. K. (2022). The experience of patient and implementation of the landmark scheme Ayushman Bharat (AB-PMJAY) of Government of India in a tertiary care hospital. Journal of Health Management, 24(4), 566–571. https://doi.org/10.1177/09720634221128082
15.
Health Inc. Consortium. (2014). Towards equitable coverage and more inclusive social protection in health. ITG Press. http://eprints.lse.ac.uk/63010/
16.
JenaB. B., & RoulM. K. (2020). Estimates of health insurance coverage in India: Expectation and reality. Economic & Political Weekly, 55(37). https://www.epw.in/journal/2020/37/notes/estimates-health-insurance-coverage-india.html
17.
JoinerA. J. (2018). Implementing the affordable care act’s health insurance marketplaces: An analysis of enrollment success by marketplace type. University of Nevada. https://www.proquest.com/docview/2181575510?%20Theses&fromopenview=true&pq-origsite=gscholar&sourcetype=Dissertations%20&parentSessionId=AxCjMd1UIGaKMr1uAoC1obRdzm9OCat%2BGsBkY5BD2Vc%3D
18.
KamathS., SinghalN., JeffinJ., BrandH., & KamathR. (2024). Out-of-pocket expenditure for selected surgeries in the cardiology department for Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), private health insurance, and uninsured patients in a tertiary care teaching hospital in Karnataka, India. Cureus. https://doi.org/10.7759/cureus.62444
19.
KwatraN. (2022, July1). These are the gaps the centre must fill to ensure 100% coverage of welfare beneficiaries. Scroll.In. https://scroll.in/article/1026091/these-are-the-gaps- the-centre-must-fill-to-ensure-100-coverage-of-welfare-beneficiaries
20.
Ministry of Health and Family Welfare. (2024, September11). Press Release: Press Information Bureau. https://pib.gov.in/PressReleasePage.aspx?PRID=2053883
21.
NandiA., AshokA., & LaxminarayanR. (2013). The socioeconomic and institutional determinants of participation in India’s health insurance scheme for the poor. PLoS One, 8(6). https://doi.org/10.1371/journal.pone.0066296
22.
NandiS., NundyM., PrasadV., KanungoK., KhanH., HaripriyaS., MishraT., & GargS. (2012). The implementation of RSBY in Chhattisgarh, India: A study of the Durg district. Health, Culture and Society, 2(1), 40–70. https://doi.org/10.5195/hcs.2012.61
23.
NandiS., SchneiderH., & DixitP. (2017). Hospital utilization and out of pocket expenditure in public and private sectors under the universal government health insurance scheme in Chhattisgarh State, India: Lessons for universal health coverage. PLoS One, 12(11). https://doi.org/10.1371/JOURNAL.PONE.0187904
24.
National Health Authority. (2024a). Empanelled hospitals search. PMJAY. https://hospitals.pmjay.gov.in/Search/empnlWorkFlow.htm?actionFlag=ViewRegisteredHosptlsNew
25.
National Health Authority. (2024b). Ayushman Bharat Digital Mission public dashboard. ABDM. https://dashboard.abdm.gov.in/abdm/
26.
National Health Systems Resources Centre. (2024). National health accounts estimates for India (2021–22).
27.
ParisiD., SrivastavaS., ParmarD., StrupatC., BrennerS., WalshC., NeogiR., BasuS., ZieglerS., JainN., & De AllegriM. (2023). Awareness of India’s national health insurance scheme (PM-JAY): A cross-sectional study across six states. Health Policy and Planning, 38(3), 289–300. https://doi.org/10.1093/HEAPOL/CZAC106
28.
ParmarD., StrupatC., SrivastavaS., BrennerS., ParisiD., ZieglerS., NeogiR., WalshC., & De AllegriM. (2023). Effects of the Indian National Health Insurance Scheme (PM-JAY) on hospitalizations, out-of-pocket expenditures and catastrophic expenditures. Health Systems and Reform, 9(1). https://doi.org/10.1080/23288604.2023.2227430
29.
PatnaikI., RoyS., & ShahA. (2018). The rise of government-funded health insurance in India[NIPFP working paper series issue 231]. NIPFP. https://www.nipfp.org.in/media/medialibrary/2018/05/WP_231.pdf
30.
PMJAY Dashboard. (2024). National Health Authority–National Family Health Survey. https://dashboard.pmjay.gov.in/pmj/#/
31.
Pradhan Mantri Jan Arogya Yojana (PM-JAY). (n.d.). About Pradhan Mantri Jan Arogya Yojana. https://www.pmjay.gov.in/about/pmjay
32.
PrasadS. S. V., SinghC., NaikB. N., PandeyS., & RaoR. (2023). Awareness of the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana in the rural community: A cross-sectional study in eastern India. Cureus, 15(3). https://doi.org/10.7759/CUREUS.35901
33.
ReshmiB., Sreekumaran NairN., SabuK. M., & UnnikrishnanB. (2007). Awareness of health insurance in a South Indian population—A community-based study. Health and Population: Perspectives and Issues, 30(3), 177–188.
34.
SenguptaR., & RoojD. (2019). The effect of health insurance on hospitalization: Identification of adverse selection, moral hazard and the vulnerable population in the Indian healthcare market. World Development, 122, 110–129. https://doi.org/10.1016/j.worlddev.2019.05.012
35.
SharmaD., BasnetP., & KafleR. (2021). Awareness, enrollment and utilization of health insurance among adults of Pokhara. Journal of College of Medical Sciences—Nepal, 17(2), 109–116. https://doi.org/10.3126/jcmsn.v17i2.29389
36.
Socio Economic and Caste Census (SECC). (2011). SECC 2011 highlights (rural). https://secc.gov.in/
37.
Stata Corp. (2023). Stata 18 base reference manual. Stata Press.
38.
ThakurH. (2016). Study of awareness, enrollment, and utilization of Rashtriya Swasthya Bima Yojana (National Health Insurance Scheme) in Maharashtra, India. Frontiers in Public Health, 3(January), 1–13. https://doi.org/10.3389/fpubh.2015.00282
39.
WHO. (2025). Global Health Expenditure Database. https://apps.who.int/nha/database
40.
YadavM. K., & MohantyP. C. (2021). Determinants of choice of health insurance: Empirical evidence from responses of Indian households. The International Journal of Health Planning and Management, 36(5), 1809–1829. https://doi.org/10.1002/HPM.3267
