India’s health sector is characterized by fragmented health insurance coverage, an increasing burden of chronic diseases, and high out of pocket (OOP) expenditure on healthcare. Health insurance should be an integral part of a household’s portfolio as it helps the household better manage its health expenses and avert health related-financial shocks. Health shocks are among the most common reasons for households falling into a poverty trap. Low-income households are especially vulnerable to health shocks and adverse health diagnoses due to not only delayed health seeking behaviour, but also the volatile nature of their incomes coupled with a lack of safety nets, makes ill-health costlier for them to treat. However, access to health insurance among Indian households (and not only among low-income Indian households) has been historically low. Although health insurance ownership has increased considerably in the last seven years from 29% in 2015-16 to 41% in 2020-21 (NFHS), the overall uptake remains insufficient. Among those who do hold a health insurance account, coverage is often insufficient.
In this study, we conduct a quantitative analysis of household finance data to understand the status of health insurance ownership in India, identify the determinants of health insurance ownership, and understand the relationship between households’ access to health insurance and their health expenditure. We use data from Centre for Monitoring Indian Economy’s (CMIE’s) Consumer Pyramids Household Survey (CPHS), Aspirational India Survey, and Household Income Survey from 2014 to 2020, to answer these questions. The dataset from 2014 to 2020 has a sample of 1,47,868 households from across the country representing both rural and urban geographies. The analysis is largely based on data from the years 2019 and 2020 which offers a comparison between a normal year (2019) and an anomaly (2020 with the Covid-19 pandemic).
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