Awareness, Utilization, Satisfaction, and Out-of-Pocket Expenditure of Ayushman Bharat Pradhan Mantri Jan Arogya...

Background Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) represents India's flagship publicly funded health insurance initiative aimed at advancing universal health coverage by improving access to secondary and tertiary care while reducing out-of-pocket expenditure (OOPE). Despite its scale and policy significance, real-world evidence on awareness, utilization, patient experience, and residual financial burden in rural settings remains limited. Objectives To assess the awareness, utilization, satisfaction, and OOPE associated with AB-PMJAY among rural beneficiaries in the district of Meerut, Uttar Pradesh. Methods A community-based cross-sectional study was conducted from November 2024 to November 2025 across four randomly selected villages within a 10-km rural radius of Subharti Medical College, Meerut. A total of 208 households possessing and utilizing AB-PMJAY cards were included. Data were collected through house-to-house interviews using a pretested semi-structured questionnaire. Key outcome variables included awareness (scheme knowledge, empanelled hospitals, grievance redressal), utilization (enrolment duration, documentation, coverage), satisfaction (clinical care, staff behaviour, administrative services), and OOPE.  Results Overall awareness of AB-PMJAY was high (96.6%), and most participants were aware of scheme benefits (96.2%) and service availability in both public and private hospitals (94.7%). However, awareness of empanelled hospitals (30.3%) and grievance redressal mechanisms (26.4%) remained low. All participants reported utilizing the scheme, with 43.8% enrolled for more than three years. Most beneficiaries (74.0%) reported coverage utilization up to Rs. 1 lakh. Despite insurance coverage, 100% of participants incurred OOPE, though the majority (78.8%) spent less than Rs. 10,000. Additionally, awareness alone may not be sufficient to prevent OOPE and may reflect a more complex pattern of healthcare use and hidden costs. Satisfaction with clinical services (97.2%) and healthcare staff behaviour (99%) was high; however, satisfaction with administrative aspects such as file management (17.8%) and food quality (14.4%) was substantially lower. Socio-demographic factors, including education, caste, and socioeconomic status, were significantly associated with awareness indicators. Conclusion While AB-PMJAY demonstrates high awareness, substantial utilization, and strong satisfaction with clinical care among rural beneficiaries, critical gaps persist in functional awareness, particularly regarding empanelled facilities and grievance mechanisms. Importantly, persistent OOPE across all beneficiaries highlights incomplete financial risk protection. Strengthening beneficiary education, improving administrative efficiency, and addressing hidden healthcare costs are essential to optimize the scheme's impact.