Health insurance coverage and its sociodemographic determinants among urban and rural residents of Haryana

Abstract

BACKGROUND: The National Family Health Survey 4 data state that health insurance (HI) coverage is 28.2% in urban areas, 29.0% in rural areas, and overall 28.7% in India. To achieve universal health coverage and to reduce out-of-pocket expenditure, it is prudent to enhance coverage of HI, especially among middle and low socioeconomic status (SES) strata. OBJECTIVES: The objectives of this study were to estimate HI coverage among rural and urban households and compare the sociodemographic determinants of HI. METHODOLOGY: A community-based, cross-sectional study was conducted in 179 rural and 193 urban households. The tool was a structured questionnaire administered to all consented participants. RESULTS: Awareness about any type of HI scheme was almost equal in rural and urban areas (74.9% and 74.6%, respectively) whereas coverage was much better in urban (58.0%) than rural areas (38.5%). TPA/private schemes were mostly availed by rural while the majority in urban areas availed employer-based or public sector HI schemes. The main reason for availing HI as quoted by rural families was tax gains (66.7%) and to cover medical expenses (46.4%) or compulsion from employer (41.1%) by urban families. HI coverage was observed to be better among urban families having dependents (children or elderly) as compared to rural and rural Hindus as compared to urban. HI coverage was significantly higher among upper- and upper-middle-class strata (as per BG Prasad classification) rural households than urban (P = 0.005 and 0.008, respectively). However, lower-middle and lower classes in urban areas have better coverage (P = 0.028 and 0.076, respectively). CONCLUSION: HI awareness among the rural as well as the urban population is quite good. There is a need to bridge the gap between awareness and coverage of HI by motivating middle and low SES strata and introducing affordable and acceptable HI schemes for them.