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. 2023 Jul 10:11:1160088.
doi: 10.3389/fpubh.2023.1160088. eCollection 2023.

Socioeconomic and geographic variation in coverage of health insurance across India

Mayanka Ambade  1 , Sunil Rajpal  2   3 , Rockli Kim  3   4 , S V Subramanian  5   6
Affiliations

Socioeconomic and geographic variation in coverage of health insurance across India

Mayanka Ambade et al. Front Public Health. .

Abstract

Introduction: In India, regular monitoring of health insurance at district levels (the most essential administrative unit) is important for its effective uptake to contain the high out of pocket health expenditures. Given that the last individual data on health insurance coverage at district levels in India was in 2016, we update the evidence using the latest round of the National Family Health Survey conducted in 2019-2021.

Methods: We use the unit records of households from the latest round (2021) of the nationally representative National Family Health Survey to calculate the weighted percentage (and 95% CI) of households with at least one member covered by any form of health insurance and its types across socio-economic characteristics and geographies of India. Further, we used a random intercept logistic regression to measure the variation in coverage across communities, district and state. Such household level study of coverage is helpful as it represents awareness and outreach for at least one member, which can percolate easily to the entire household with further interventions.

Results: We found that only 2/5th of households in India had insurance coverage for at least one of its members, with vast geographic variation emphasizing need for aggressive expansion. About 15.5% were covered by national schemes, 47.1% by state health scheme, 13.2% by employer provided health insurance, 3.3% had purchased health insurance privately and 25.6% were covered by other health insurance schemes (not covered above). About 30.5% of the total variation in coverage was attributable to state, 2.7% to districts and 9.5% to clusters. Household size, gender, marital status and education of household head show weak gradient for coverage under "any" insurance.

Discussion: Despite substantial increase in population eligible for state sponsored health insurance and rise in private health insurance companies, nearly 60% of families do not have a single person covered under any health insurance scheme. Further, the existing coverage is fragmented, with significant rural/urban and geographic variation within districts. It is essential to consider these disparities and adopt rigorous place-based interventions for improving health insurance coverage.

Keywords: India; National Family Health Survey; geographic variation; health insurance; multilevel modelling.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
(A) Percentage of households with at least one member having any health insurance in states of India, 2019–20 and (B) Percentage of households with type of insurance among those who have at least some form of health insurance, India, 2019–20.
Figure 2
Figure 2
Percentage of households covered by any health insurance across districts of India, 2019–20.
Figure 3
Figure 3
Partitioning Variation (VPC) in insurance coverage among households across multiple geographies, India, NFHS.
See this image and copyright information in PMC

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