{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T17:52:49Z","timestamp":1791913969471,"version":"4.3.4"},"reference-count":52,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:00:00Z","timestamp":1791849600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100011099","name":"Deutsche Gesellschaft f\u00fcr Internationale Zusammenarbeit","doi-asserted-by":"publisher","award":["13.2111.6005.00"],"award-info":[{"award-number":["13.2111.6005.00"]}],"id":[{"id":"10.13039\/501100011099","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100006456","name":"Bundesministerium f\u00fcr Wirtschaftliche Zusammenarbeit und Entwicklung","doi-asserted-by":"publisher","award":["13.2111.6005.00"],"award-info":[{"award-number":["13.2111.6005.00"]}],"id":[{"id":"10.13039\/501100006456","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["13.2111.6005.00"],"award-info":[{"award-number":["13.2111.6005.00"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>Publicly-funded health insurance schemes, wherein governments subsidize insurance contributions for disadvantaged groups, are a key strategy under universal health coverage. India\u2019s Pradhan Mantri Jan Arogya Yojana (PM-JAY) uses an entitlement-based approach whereby approximately 700 million beneficiaries are automatically eligible for scheme benefits, subject to a simplified identity verification procedure instead of enrolment. This study investigates the determinants of undergoing verification among PM-JAY\u2019s target population to identify underserved groups and inform strategies to expand coverage. We used cross-sectional survey data from 2019-2020, covering 50,002 individuals across five states. We examined individual and household characteristics associated with verification using logistic regression models with district-level random effects, and beneficiary experiences with the verification process. About one-fifth of eligible individuals had verified their status within a year of launch. Verification was more likely among older adults, with those \u226560years having higher odds than those 0\u201315 years of age (adjusted Odd Ratio [AOR] 2.339; 95% CI 2.071-2.641). Those with higher education had higher odds than those with no formal education (AOR 2.303; 95% CI 2.048-2.590), those with prior PFHI enrolment had higher odds compared to those not enrolled (AOR 1.947; 95% CI 1.827-2.075), and those with chronic illness had higher odds than those without (AOR 1.175; 95% CI 1.071-1.289). Women and household members other than spouses were less likely to verify. Disadvantaged castes and minority religions demonstrated relatively higher verification rates. District-level factors explained nearly one-third of variability, indicating that infrastructure and implementation capacity differences influence uptake. Many beneficiaries reported long wait times, varying documentation demands, and informal payments during verification. Addressing these barriers requires gender-sensitive outreach, streamlined household-wide verification, and strengthened local health system capacity. Policy reforms that simplify verification, ensure equitable access, and strengthen health infrastructure are vital to advancing effective universal health coverage for India\u2019s most vulnerable populations.<\/jats:p>","DOI":"10.1371\/journal.pgph.0007451","type":"journal-article","created":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T17:25:56Z","timestamp":1791912356000},"page":"e0007451","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Bridging the gap between health insurance eligibility and uptake: A multistate quantitative analysis of entitlement-based verification patterns under India\u2019s PM-JAY Scheme"],"prefix":"10.1371","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1864-9783","authenticated-orcid":true,"given":"Swati","family":"Srivastava","sequence":"first","affiliation":[{"name":"Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University","place":["Heidelberg, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tads","family":"Ciecierski-Holmes","sequence":"additional","affiliation":[{"name":"Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University","place":["Heidelberg, Germany"]},{"name":"University of Cambridge, School of Clinical Medicine, Addenbrooke\u2019s Hospital","place":["Cambridge, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Strupat","sequence":"additional","affiliation":[{"name":"Economic and Social Systems, German Institute of Development and Sustainability (IDOS)","place":["Bonn, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Divya","family":"Parmar","sequence":"additional","affiliation":[{"name":"School of Life Course and Population Sciences, King\u2019s College London, King\u2019s College London","place":["London, United Kingdom"],"department":["Department of Population Health Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nishant","family":"Jain","sequence":"additional","affiliation":[{"name":"Asian Development Bank","place":["Mandaluyong City, Metro Manila, Philippines"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuela","family":"De Allegri","sequence":"additional","affiliation":[{"name":"Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University","place":["Heidelberg, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,10,13]]},"reference":[{"issue":"2","key":"pgph.0007451.ref001","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1257\/jep.37.2.123","article-title":"The prices in the crises: What we are learning from 20 years of health insurance in low- and middle-income countries","volume":"37","author":"J 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