Ayushman Bharat Scheme: A Comprehensive Analysis of Knowledge, Awareness, Utilization and Impact on Healthcare Access in India - A Multi-State Review

Background: Ayushman Bharat scheme is an initiative taken as a flagship healthcare program in India due to the need to have universal health coverage by offering comprehensive healthcare services. This review combines the evidence of several studies which investigate knowledge, awareness, practices, and patterns of use at the level of different states and the different stakeholder categories. Objectives: This paper is aimed at analysing where Ayushman Bharat is with its implementation and how well or poorly its stakeholders understand and are aware of launching the scheme; how well or poorly it is utilised and also which are the obstacles in successful implementation of such a scheme across the different Indian states. Methods: This systematic review examines the findings of 11 studies that had been conducted in various states namely Haryana, Madhya Pradesh, Karnataka, Uttar Pradesh, and Bihar. They used varied research methods such as cross-sectional surveys, qualitative phenomenological methods, and mixed-method assessments, and quasi-experimental studies that covered healthcare workers, healthcare beneficiaries and certain population groups. Findings: The level of knowledge adequacy among the healthcare workers was between 46.72 and 55 percentages with considerable differences according to the subjective parameters of age and experience. Awareness among the beneficiaries reflected regional differences where the rates of registration levels were higher in the rural areas (58) than urban areas (37) in Bihar. Ownership levels were as low as 44% in Karnataka and as high as 48.8% in the state of Uttar Pradesh. Usage levels were critically low at 3% in certain areas although awareness levels were as high as 65%. The scheme also proved to have a great contribution in bringing down out-of-pocket spending especially on cancer care where median spending of 3.10 lakh between enrolled patients was starkly lower when compared to non-enrolled ones. Conclusions: Ayushman Bharat is promising towards addressing issues related to healthcare access and lower cost of care; however, there are still numerous barriers to its full implementation including poor knowledge level among healthcare workers, low utilization rates despite awareness, administrative barriers, and technical issues during the use of digital platforms.