SRINAGAR: Less than half of enrolled beneficiaries under the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana in Jammu and Kashmir have ever used their cards to access healthcare. Critical deficits in physical connectivity and health literacy, rather than direct medical costs or administrative paperwork, present the steepest hurdles to actual hospital treatment.
The empirical investigation, Beyond coverage: why Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana struggles to deliver healthcare in Jammu and Kashmir, was published on March 9, 2026, in the open-access journal Frontiers in Public Health by publisher Frontiers Media SA. The study was conducted by Esarul Ayub and Blessy Sarah Mathew of Lovely Professional University in Phagwara, Punjab; Olusiji Adebola Lasekan of Universidad Católica de Temuco in Temuco, Chile; Margot Teresa Godoy Pena of Universidad de La Frontera in Temuco, Chile; and Abdul Wahid Bhat of Government Degree College, Kishtwar, Jammu and Kashmir.
The flagship national scheme guarantees cashless secondary and tertiary hospitalisation cover of up to Rs 5 lakh per family every year. Yet, the researchers established that among 320 randomly selected cardholders across urban and semi-rural areas, only 48.4 per cent reported accessing medical services through the scheme, leaving 51.6 per cent non-users despite being formally enrolled.
Systemic Gaps
The cross-sectional investigation selected 169 beneficiaries from urban municipal wards in Jammu district and 151 from semi-rural villages in Baramulla district. Eligible participants had to be registered under the scheme for at least one year. Face-to-face structured interviews were conducted between February and April 2025 following institutional ethical clearance from Government Degree College Kishtwar.
The survey sample comprised 54.7 per cent male and 45.3 per cent female participants. In terms of educational attainment, 25.3 per cent were illiterate, 27.5 per cent had primary education, 24.7 per cent had secondary schooling, and 22.5 per cent were graduates. Social category representation included 28.4 per cent Other Backward Classes, 27.2 per cent Scheduled Tribes, 23.4 per cent Scheduled Castes, and 20.9 per cent General category households.
The analysis revealed that utilization rates were virtually identical across both regions, standing at 48.5 per cent in Jammu and 48.3 per cent in Baramulla. A chi-square test confirmed no statistically significant association between district location and service use.
“The absence of geographic variation implies that access restrictions are not confined to specific locations but are embedded within broader systemic constraints,” the authors observed, stressing that barriers to entry reflect structural conditions across the entire Union Territory.
Information Deficits
Using multivariate binary logistic regression on the pooled sample to test ten specific barriers simultaneously, the study identified knowledge gaps as the strongest positive predictors of whether an enrolled patient actually received hospital treatment.
Understanding the scheme’s formal benefits increased the odds of utilisation by 25.3 per cent (odds ratio: 1.253, p = 0.042). Beneficiary knowledge of empanelled hospital lists increased the likelihood of uptake by 24.5 per cent (odds ratio: 1.245, p = 0.027). Pearson correlation analysis similarly documented positive correlations between service uptake and awareness of entitlements (r = 0.148, p < 0.01) as well as access to facility directories (r = 0.121, p < 0.05).
Socio-demographic breakdowns indicated that awareness was highly uneven. Educational background showed a statistically significant link with scheme awareness (p = 0.0001), as did household income (p = 0.0009) and age (p = 0.0002).
Because formal print communication fails to reach semi-literate and illiterate cardholders, the authors argued that information dissemination must shift toward community-centred, interpersonal mechanisms. They recommended deploying Accredited Social Health Activist (ASHA) workers, Anganwadi staff, panchayat members, local broadcast announcements, and face-to-face guidance at health centres to help families navigate hospital selection.
Infrastructural Bottlenecks
Physical transport deficits proved to be the single most potent deterrent to scheme utilisation in the multivariate model. Inadequate road quality emerged as a statistically significant negative factor, reducing the likelihood of hospital care uptake by nearly 24 per cent (odds ratio: 0.761, p = 0.033).
The authors emphasised that the region’s mountainous terrain and long-standing conflict dynamics compound physical isolation. Recurrent mobility curbs, disrupted communications, and transport shortages undermine access to empanelled institutions, turning distance and road conditions into decisive obstacles.
“Conflict also weakens institutional trust and complicates administrative engagement, as populations exposed to prolonged insecurity may be less likely to navigate formal procedures or rely on state-led schemes,” the paper noted, explaining how contextual instability blunts the real-world utility of financial entitlement alone.
Hidden Realities
Descriptive assessments revealed that cardholders frequently confront non-medical expenses, scoring informal payments (mean: 3.21 on a 5-point scale), daily wage losses during hospitalisation (mean: 3.01), and out-of-pocket spending (mean: 2.97) as substantial challenges. Administrative documentation hurdles averaged 2.83.
Yet, when analysed in the regression model alongside informational and physical barriers, neither out-of-pocket payments, informal fees, wage loss, documentation bottlenecks, nor claim rejections showed statistically significant independent associations with scheme utilisation.
The authors clarified that this divergence does not mean financial distress is non-existent. Instead, economic costs operate as generalised background realities, while physical inaccessibility and informational voids act as primary stumbling blocks that prevent cardholders from entering the hospital door in the first place.
“Increasing PM-JAY use in disadvantaged areas requires more than just financial incentives; it also requires better physical infrastructure and informational availability,” the study concluded, urging policymakers to prioritize road connectivity, village-level wayfinding, and hospital mapping over mere enrolment targets.
