Health insurance coverage up in India but not robust yet, says NFHS

In case of illness, households tilt slightly in favour of the public sector in seeking care compared to the private sector

A little over two-fifths, or 41 per cent, of households in India have at least one individual covered by a health insurance plan or health scheme, according to the recently released National Family Health Survey-5 (NFHS-5). The fifth edition of the survey, the data of which pertains to 2019-21, shows a significant improvement in health insurance coverage in the country despite it remaining far from satisfactory.

According to the NFHS-4, just 29 per cent households had at least one member covered under health insurance or health scheme as of 2015-16.

The latest report suggests that only 30 per cent of women aged 15-49 and 33 per cent of men in the age group are covered by health insurance or a health scheme. Almost half (46 per cent) of those with insurance are covered by a state health insurance scheme and about one-sixth (16 per cent) by the Rashtriya Swasthya Bima Yojana (RSBY). Three to six per cent of women and 4-7 per cent of men are covered by the Employees’ State Insurance Scheme (ESIS) or the Central Government Health Scheme (CGHS). The highest proportion of households covered under health insurance or a health scheme is in Rajasthan (88 per cent), followed by Andhra Pradesh (80 per cent). And the lowest coverage (below 15 per cent) is in the Andaman and Nicobar Islands, and Jammu and Kashmir.

The insurance coverage is slightly higher in rural areas (42 per cent) than in urban areas (38 per cent).

In case of illness, households tilt slightly in favour of the public sector (50 per cent) in seeking care compared to the private sector (48 per cent). In 2015-16, the preference for the public sector was 45 per cent.

Government and municipal hospitals are the most important source of health care in the public sector, providing services to 20.2 per cent of households. In the private sector, private doctors and clinics (28.2 per cent) are most frequently visited.

There is, meanwhile, an urban-rural split in the primary source of health care. The private sector is the main source of health care for 52 per cent of households in urban areas, where the public sector is relied upon by 47 per cent. In rural areas, the public sector is the primary source of health care (52 per cent), with the private sector preferred by 46 per cent.

The NFHS-5 report also points out that 50 per cent of households do not generally seek health care from the public sector. The percentage of households that do not generally use government health facilities is highest in Bihar (80 per cent) and Uttar Pradesh (75 per cent), and lowest (less than 5 per cent) in Ladakh, Lakshadweep, and the Andaman and Nicobar Islands.

The most commonly reported reason for not using government health facilities at the national level is the poor quality of care. This was cited by 48 per cent of the households that do not generally use government facilities. The second most commonly reported reason is the long waiting time at government facilities (46 per cent), followed by the absence of health centres nearby (40 per cent).