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

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