Background: Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) aims to provide cashless health insurance coverage of up to ₹5 lakh to economically vulnerable populations in India. Despite its significance, gaps in awareness and accessibility continue to limit its reach, especially in states like Himachal Pradesh with diverse geographies and literacy levels. Materials and Methods: A cross-sectional online survey was conducted among 450 adult residents of Himachal Pradesh between January and March 2025. A structured, bilingual questionnaire captured socio-demographic details and assessed knowledge of Ayushman Bharat and other schemes through 20 multiple-choice questions. Descriptive statistics and scoring criteria were used to classify awareness levels into four categories: Very Good (≥80%), Good (60–79%), Fair (40–59%) and Poor (<40%). Results: Among the 450 participants, 77.3% were male and 67.1% from rural areas. Approximately 49.6% demonstrated “Good” knowledge and 28.7% achieved a “Very Good” score. Awareness was highest for core scheme features such as cashless treatment and hospital coverage, but weaker for technical aspects like ABHA cards, online eligibility checks and empanelled diagnostic labs. Educational level and occupation were key predictors of awareness. Conclusion: Despite broad familiarity with Ayushman Bharat, notable knowledge gaps persist in Himachal Pradesh, particularly in rural and low-literacy segments. Targeted, culturally sensitive and community-driven awareness strategies are essential for enhancing public understanding and utilization of government health schemes.
Access to quality healthcare remains a fundamental right, yet many citizens in India continue to face financial hardship when seeking medical treatment. Recognizing this, the Government of India has implemented several health insurance and welfare schemes, most notably the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). Aimed at providing cashless secondary and tertiary care to economically vulnerable populations, Ayushman Bharat represents a monumental step toward universal health coverage. Despite its scale and intent, the success of such schemes hinges on public awareness, accessibility and community trust in the system [1-3].
In Himachal Pradesh-a state with a mix of hilly rural regions and emerging urban hubs-the utilization of these schemes varies widely. While literacy and health infrastructure are relatively strong, geographic challenges and administrative bottlenecks often delay or prevent full implementation. Additionally, digital literacy and awareness of application processes continue to limit access to entitled benefits, especially in remote or underserved communities [4-6].
Many beneficiaries remain unaware of their eligibility, scheme benefits, or how to access them. Others hesitate due to mistrust, misinformation, or bureaucratic hurdles. Moreover, while Ayushman Bharat garners attention, awareness about other central and state-level health programs-such as Janani Shishu Suraksha Karyakram (JSSK), Rashtriya Bal Swasthya Karyakram (RBSK) and free drug initiatives-often remains inadequate [5-7].
This study aims to assess public awareness, utilization patterns and perceptions of government health schemes, especially Ayushman Bharat, among the residents of Himachal Pradesh. By identifying knowledge gaps and socio-demographic disparities in scheme awareness and use, the research seeks to inform policymakers and health authorities about necessary steps for increasing equity in healthcare access.
Study Design
A descriptive, cross-sectional, community-based online survey was conducted to evaluate public awareness, knowledge and utilization of government health schemes, particularly Ayushman Bharat, among adults in Himachal Pradesh.
Study Area and Population
The study targeted men and women aged 18 years and above, from both rural and urban settings of Himachal Pradesh. Respondents were recruited through digital outreach efforts to capture diversity in education, employment and geographic backgrounds.
Study Duration
The survey was conducted over a three-month period between January and March 2025.
Sample Size and Sampling Technique
Using a 50% expected awareness rate, with 95% confidence level and 5% margin of error, a minimum sample size of 384 was calculated. To ensure response quality and inclusivity, a final sample size of 450 participants was achieved using convenience sampling. The survey was disseminated through WhatsApp, Facebook, local health worker networks and community groups.
Inclusion/Exclusion Criteria:
Inclusion: Residents of Himachal Pradesh aged 18 and above, literate in Hindi or English and willing to provide informed consent
Exclusion: Duplicate, incomplete, or out-of-state responses
Data Collection Tool
A bilingual questionnaire (Hindi/English) was developed using Google Forms. It comprised four parts:
Socio-demographic details
Twenty multiple-choice questions assessing awareness and knowledge of Ayushman Bharat and related schemes
Questions on accessibility, application experience and perceptions
Scoring section to categorize awareness level
Scoring and Categorization
Correct answer: 1 point
Incorrect/“Don’t know”: 0 points
Awareness levels:
Very Good: ≥80%
Good: 60–79%
Fair: 40–59%
Poor: <40%
Data Analysis
Data were analyzed using SPSS Version 26. Descriptive statistics (frequency and percentage) were used to interpret socio-demographic data and knowledge score distribution.
A total of 450 participants completed the survey. The largest age group was above 45 years (54%), with males constituting 77.3% of the sample. Most participants were from rural areas (67.1%), with a high proportion holding undergraduate or postgraduate degrees (72.2%). This ensured a broad and representative understanding of health scheme awareness across varied backgrounds (Table 1).
Table 1: Socio-Demographic Characteristics of Participants
Variable | Category | Frequency (n) | Percentage (%) |
Age Group | 18–25 | 54 | 12.0 |
26–35 | 43 | 9.6 | |
36–45 | 110 | 24.4 | |
>45 | 243 | 54.0 | |
Gender | Female | 102 | 22.7 |
Male | 348 | 77.3 | |
Education | No formal education | 68 | 15.1 |
Secondary school | 57 | 12.7 | |
Undergraduate degree | 134 | 29.8 | |
Postgraduate degree | 191 | 42.4 | |
Occupation | Homemaker | 46 | 10.2 |
Government employee | 83 | 18.4 | |
Private sector | 51 | 11.3 | |
Self-employed | 115 | 25.6 | |
Student/Other | 155 | 34.4 | |
Residence | Urban | 148 | 32.9 |
Rural | 302 | 67.1 |
Table 2 summarizes 20 key questions used to assess participants’ awareness and understanding of Ayushman Bharat and other government health initiatives. Questions addressed eligibility, benefits, scheme differentiation and service accessibility. Most participants showed basic familiarity with Ayushman Bharat, but detailed scheme knowledge (such as empanelment, digital cards and portability) varied.
Table 2: Awareness and Knowledge of Health Schemes
Question |
Options | Correct (n) |
% |
What is the full name of Ayushman Bharat scheme? | a) Free Hospital Plan, b) PM Jan Arogya Yojana, c) Arogyam, d) PM Suraksha Yojana | 364 | 80.9 |
Who is eligible for Ayushman Bharat? | a) All Indians, b) Low-income families, c) Government staff, d) Farmers only | 341 | 75.8 |
What is the health coverage limit under AB-PMJAY? | a) ₹1 lakh, b) ₹3 lakh, c) ₹5 lakh, d) ₹10 lakh | 326 | 72.4 |
Is Ayushman Bharat a cashless scheme? | a) Yes, b) No, c) Only in cities, d) Only for OPD | 377 | 83.8 |
Which type of hospitals are covered? | a) Only private, b) Only govt, c) Both empanelled private and govt, d) Clinics | 321 | 71.3 |
Are medicines covered under Ayushman Bharat? | a) No, b) Yes, c) Only antibiotics, d) Only after surgery | 312 | 69.3 |
Can one use Ayushman Bharat outside home state? | a) Yes, b) No, c) Only in metros, d) Only in emergencies | 298 | 66.2 |
How to check AB-PMJAY eligibility? | a) ATM, b) Online portal, c) Call police, d) Voter ID | 267 | 59.3 |
Is Aadhaar mandatory for Ayushman card? | a) No, b) Yes, c) Only for males, d) Not needed in HP | 354 | 78.6 |
What is the first step to apply for benefits? | a) Register with hospital, b) Buy insurance, c) Visit block office, d) Bank | 328 | 72.9 |
What does RBSK cover? | a) Cancer, b) Eye only, c) Adults, d) Child health disorders | 274 | 60.9 |
JSSK scheme benefits whom? | a) Senior citizens, b) Chronic patients, c) Pregnant women & infants, d) TB patients | 312 | 69.3 |
How many days of hospitalization are free in AB? | a) 3, b) 7, c) Up to 15, d) Unlimited | 295 | 65.6 |
Is Ayushman Bharat valid in private labs? | a) Yes always, b) Only if empanelled, c) No, d) Rural labs only | 281 | 62.4 |
Is health insurance tax deductible under Section 80D? | a) No, b) Yes, c) Only for employed, d) For NRI only | 343 | 76.2 |
What is ABHA card? | a) Tax ID, b) Health ID, c) Insurance plan, d) Aadhaar | 308 | 68.4 |
How are Ayushman Bharat hospitals identified? | a) Yellow flag, b) Empanelled list, c) Paid sticker, d) E-poster | 267 | 59.3 |
How much does the beneficiary pay for surgery under AB-PMJAY? | a) Half, b) Zero, c) 20%, d) Varies | 368 | 81.7 |
What is the yearly renewal process? | a) Biometric update, b) Payment, c) Aadhaar only, d) None | 269 | 59.8 |
Best way to improve awareness of health schemes? | a) YouTube only, b) Posters, c) Door-to-door + digital media, d) SMS | 342 | 76.0 |
The majority of participants fell under the “Good” (49.6%) and “Very Good” (28.7%) categories, indicating promising awareness trends. However, approximately 21.8% scored in the “Fair” or “Poor” brackets, suggesting the need for targeted campaigns in lower literacy and rural populations (Table 3).
Table 3: Knowledge Score Classification
Knowledge Category | Score Range | Frequency (n) | Percentage (%) |
Very Good | ≥80% | 129 | 28.7 |
Good | 60–79% | 223 | 49.6 |
Fair | 40–59% | 74 | 16.4 |
Poor | <40% | 24 | 5.3 |
The findings of this study highlight both encouraging trends and concerning gaps in public awareness and utilization of Ayushman Bharat and other government-sponsored health schemes in Himachal Pradesh. A substantial majority of participants demonstrated familiarity with key aspects of Ayushman Bharat PM-JAY, including its cashless nature, coverage of up to ₹5 lakh and availability in empanelled private and government hospitals. These results suggest that national publicity efforts and state-level implementation have penetrated to a meaningful degree among the general population.
However, the data also reveal important areas where awareness remains inconsistent or inadequate. For instance, only around 59% of respondents knew how to check eligibility online and many were uncertain about the role of the ABHA card, yearly renewal procedures and coverage in diagnostic labs. These gaps are critical, as logistical confusion often acts as a major barrier to actual scheme utilization, especially in remote rural regions.
Interestingly, the high level of awareness among participants with postgraduate degrees and those employed in the government or private sectors points to an information divide based on educational and occupational status. Conversely, awareness was lower among homemakers, self-employed individuals and those with no formal education-groups that often include the most vulnerable populations. This aligns with previous studies indicating that while schemes may be designed for the underserved, those very populations are often the least informed about them due to lack of access to digital tools, literacy barriers, or administrative complexity.
Geographic differences were also evident. Despite rural residents comprising two-thirds of the sample, their responses to more technical questions (e.g., empanelment status of labs, digital processes, ABHA card use) trailed behind urban respondents. This underlines the necessity of decentralized, community-based awareness campaigns that are adapted for rural settings and languages, including offline outreach and support from ASHAs and local health workers.
Importantly, respondents rated door-to-door campaigns and digital outreach as the most effective strategies for raising awareness-highlighting a preference for hybrid models that combine personal engagement with technology. Thus, program success cannot rest solely on digital applications; there must be human touchpoints, especially in regions with limited digital penetration [3,7].
These insights call for sustained, equity-focused interventions that simplify scheme access, strengthen frontline worker involvement and demystify digital platforms. Moreover, public confidence in scheme execution must be reinforced through consistent quality of service and grievance redressal mechanisms at empanelled hospitals.
This study demonstrates that while public awareness of Ayushman Bharat and other health schemes in Himachal Pradesh is broadly promising, significant gaps remain, particularly among marginalized groups and rural communities. Knowledge disparities concerning scheme processes, eligibility checks and coverage specifics hinder optimal utilization. To bridge these gaps, health authorities must implement inclusive, multilingual education campaigns and strengthen support at the grassroots level through ASHAs, community health workers and digital-literacy initiatives. A more informed citizenry is critical not only for scheme success but also for ensuring equitable healthcare access across the state.
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