Health insurance coverage across India and Its States
The overall health insurance coverage in India was around 25% out of which 22% was mandatory health insurance. Figure 2 shows the coverage of health insurance scheme in all 29 states of India. Andhra Pradesh (including Telangana) and Chhattisgarh have the highest coverage of health insurance, which stands at 74.5% and 68.4% respectively. Majority of the households in Tamil Nadu, Arunachal Pradesh, and Tripura were covered by health insurance. More than 30% of households were covered by health insurance in Kerala, Odisha, Mizoram, Meghalaya, West Bengal, and Sikkim. In Karnataka, Himachal Pradesh, Gujarat, and Punjab at least two out of every ten households were covered. Health insurance coverage in some of the largest states in India was very low. Two most populous states, viz., Uttar Pradesh and Maharashtra have very limited health insurance coverage of 6.1% and 15% respectively. Even the national capital territory of Delhi also has low insurance coverage of 15.5%. Most of the states in Empowered Action Group (EAG) and Assam have low health insurance coverage (<20%). Mandatory health insurance has been the most common type of health insurance across all the states. The coverage of CBHI was only 0.14% for overall India. None of the states has more than 1% coverage of CBHI. The proportion of voluntary health insurance was highest in Maharashtra (5.8%) followed by Kerala (5.7%) and Delhi (5.5%). The coverage of voluntary health insurance was more than 4% in the other three states, namely, Gujarat, Odisha, and Haryana. Employer-based health insurance coverage was also very low (0.83%) at the national level. Only five states, viz., Tamil Nadu, Sikkim, Himachal Pradesh, Gujarat, and Goa have more than 2% coverage of employer-based health insurance (Figure 2).
Socio-demographic characteristics of households and health insurance coverage
Table 2 shows the coverage of health insurance schemes according to socio-demographic characteristics of households. The overall health insurance coverage was highest among the households with age of head of household between 46 to 65 years. Education of the head of household and health insurance coverage was found to be positively associated. The coverage of health insurance was found to be higher in accordance with the educational attainment of the household head. The difference in coverage between nuclear and non-nuclear households was not much.
Scheduled Castes (SC) and Scheduled Tribes (ST) households have higher coverage than other backward class (OBC) and other caste households mainly due to higher coverage of mandatory health insurance. However, coverage of voluntary and employer-based health insurance was lower among these groups. Hindu households have higher coverage than Muslims and other religions. Health insurance coverage was found to be higher among rural households as compared to their urban counterparts. But, the coverage of voluntary and employer-based health insurance was higher among urban households (Table 1).
Socio-economic status of households and health insurance coverage
The coverage of health insurance was almost directly associated with household wealth. Households falling under top three wealth quantile (richest, richer and middle-class) have higher health insurance coverage than those falling under lower two wealth quantile (poorer and poorest) households. More households from the urban, affluent and educated group were covered by any health insurance as compared to other groups. But the households in Below Poverty Line (BPL) category have 14% higher coverage as compared to non-BPL households. Similarly, households with a bank account have much higher coverage of health insurance. The households who preferred public health facilities for seeking treatment have better health insurance coverage (Figure 3).
Predictors of household health insurance coverage
We used logit regression analyses to understand the predictors of health insurance coverage in India. It was observed that the odds of being covered by any health insurance were significantly higher among the households where the age of head of the household was between 46 to 65 years followed by elderly (>65 years) households. Average marginal effect (AME) also suggests that the likelihood of having any health insurance was the highest among this group. Non-nuclear households have a higher likelihood of having health insurance as compared to nuclear families. The odds of having any health insurance was the highest among households, where the head of the households completed more than the secondary level of education. Households with an educated head of household significantly increased the odds of having any health insurance. Households belonging to the OBC and other castes, and Muslim and other religions have significantly lower odds of being covered as compared to SC/ST households. Possession of a bank account by household increased the likelihood of having health insurance by 9.2%. Odds and the likelihood of having health insurance increased significantly with increasing wealth quantile of households. Rural households also have significantly higher odds of having health insurance. The gap in the likelihood of having health insurance between rural and urban households was found to be 3.4% (Table 2).