Abstract
Background: The movement for Universal Health Coverage (UHC) is gaining momentum. Health insurance is emerging as one of the favoured means to finance healthcare. The union government of India also started a health insurance scheme in 2018 in the spirit to leap towards UHC. Therefore, this study was carried out with the following objectives. To understand the coverage, distribution, and predictors of health insurance coverage in India. To examine the role of Pradhan Mantri Jan Arogya Yojana (PM-JAY) towards the goal of UHC in India. Methods: We analyzed unit-level data from the fourth round of National Family Health Survey (NFHS-4) to understand the coverage, distribution and predictors of health insurance. We categorized the health insurance schemes into four major categories based on standard categorization . The descriptive and bivariate analysis was conducted to understand the coverage and distribution and logit regression analysis was carried out to understand the predictors. Results: The overall health insurance coverage in India was around 25% out of which 22% is mandatory health insurance. Less than 2% of households reported having any voluntary health insurance. Household wealth and education of the head of households were found to be directly proportional to health insurance coverage. Overall, there was very wide inter-state and inter-class variation in health insurance coverage, which reflect a major void in the existing programmes. Conclusions: To achieve UHC in India, a definite policy direction is needed to protect those groups of citizens, who either not covered or are only partially covered from health insurance scheme. Either the PM-JAY scheme should be expanded for the larger population or an alternative health financing model is to be explored to expand the population coverage. Key-words: Health Insurance, Universal Health Coverage, India, Ayushman Bharat, Pradhan Mantri Jan Arogya Yojana, National Family Health Survey.
Health Insurance for Universal Health Coverage in India: A Critical Analysis based on Coverage, Distribution and Predictors from National Family Health Survey – 4 Data