Inequality in Health Insurance Coverage in a Pluralistic Health Insurance System: Evidences from India

Himanshu Sekhar ROUT, Utkal University, Bhubhaneswar
Pragyan Sahoo, Utkal University, Bhubhaneswar

Persistent inequality in healthcare financial protection remains a critical issue in India's pluralistic health insurance system, disproportionately affecting marginalized groups. This study used NFHS-4 and NFHS-5 household data to explore disparities in health insurance coverage prevalence and transitions across socioeconomic and demographic groups. Health insurance coverage was categorized by the number and type of coverage, considering factors such as provider, pooling mechanism, and target population. We employed descriptive statistics and concentration index scores to assess coverage prevalence. To further examine the determinants of enrolment in different coverage types, we created 24 mutually exclusive groups based on the intersection of sex, income, marriage status, and caste. These groups and other variables were analyzed using multinomial logistic regression models. While health insurance coverage increased from NFHS-4 to NFHS-5, 59.01% of the population remained uninsured, highlighting inadequate progress. Both survey rounds showed considerable disparities in coverage based on state-level, social, economic, and demographic factors. Although social and demographic determinants had a modest influence, the economic gradient and state-level variations in insurance prevalence were significant. Despite India's pluralistic system, most households had only single coverage, primarily under SHI. Addressing these disparities offers policy tools for targeted interventions to improve health insurance coverage and reduce inequality.

Keywords: Inequality, Disadvantage and Discrimination, Health and Morbidity, Big data

See paper.