Equity in health insurance coverage in India: a spatio-temporal analysis
1
Department of Population and Development, International Institute for Population Sciences, Mumbai, India
Popul. Med. 2026;8(Supplement Supplement 1):A1531
ABSTRACT
INTRODUCTION:
India's health insurance landscape has undergone significant transformation over the past decades. Despite these efforts, the distribution of health insurance remains uneven, influenced by socio-economic and spatial factors. So, understanding these spatial and socio-economic disparities is crucial for achieving universal health coverage.
METHODS:
This study used the last three rounds of the National Family and Health Survey (NFHS) data. Spatial analysis using GIS, spatial autocorrelation, and LISA will be applied to map and identify geographic clustering of health insurance coverage across states and districts by insurance type. To measure the magnitude of socio-economic inequality, this study used concentration index (CI) values and concentration curves.
RESULTS:
Between 2005 and 2021, although health insurance coverage in India expanded substantially, still, socio-economic inequality remained pronounced and uneven across insurance types and states. Overall insurance coverage was pro-rich, with CI values remaining positive but reducing over the period. Publicly-funded health insurance (PFHI) shifted from pro-rich in 2005–06 (CI: 0.009) to near equality in 2015–16 (CI: -0.003) and became clearly pro-poor by 2019–21 (CI: -0.025), indicating increasing coverage among poorer households over time. However, employer-based and private health insurance coverage remained consistently pro-rich over time. Between 2015–16 and 2019–21, overall health insurance coverage was predominantly pro-rich in many states, with very high inequality in Delhi (CI: 0.44) and Chandigarh (0.40). However, several states showed a clear pro-poor shift, with CI values turning negative in Bihar (−0.06), Uttar Pradesh (−0.02), Rajasthan (−0.06), Assam (−0.08), and Kerala (−0.16). This improvement was driven mainly by PFHI, which became strongly pro-poor in states such as Bihar (−0.08), West Bengal (−0.09), Odisha (−0.07), and Telangana (−0.17).
CONCLUSIONS:
While PFHI has reduced inequality in several poorer states, overall coverage in India remains pro-rich, driven by persistently high inequalities in employer-based and private health insurance.
India's health insurance landscape has undergone significant transformation over the past decades. Despite these efforts, the distribution of health insurance remains uneven, influenced by socio-economic and spatial factors. So, understanding these spatial and socio-economic disparities is crucial for achieving universal health coverage.
METHODS:
This study used the last three rounds of the National Family and Health Survey (NFHS) data. Spatial analysis using GIS, spatial autocorrelation, and LISA will be applied to map and identify geographic clustering of health insurance coverage across states and districts by insurance type. To measure the magnitude of socio-economic inequality, this study used concentration index (CI) values and concentration curves.
RESULTS:
Between 2005 and 2021, although health insurance coverage in India expanded substantially, still, socio-economic inequality remained pronounced and uneven across insurance types and states. Overall insurance coverage was pro-rich, with CI values remaining positive but reducing over the period. Publicly-funded health insurance (PFHI) shifted from pro-rich in 2005–06 (CI: 0.009) to near equality in 2015–16 (CI: -0.003) and became clearly pro-poor by 2019–21 (CI: -0.025), indicating increasing coverage among poorer households over time. However, employer-based and private health insurance coverage remained consistently pro-rich over time. Between 2015–16 and 2019–21, overall health insurance coverage was predominantly pro-rich in many states, with very high inequality in Delhi (CI: 0.44) and Chandigarh (0.40). However, several states showed a clear pro-poor shift, with CI values turning negative in Bihar (−0.06), Uttar Pradesh (−0.02), Rajasthan (−0.06), Assam (−0.08), and Kerala (−0.16). This improvement was driven mainly by PFHI, which became strongly pro-poor in states such as Bihar (−0.08), West Bengal (−0.09), Odisha (−0.07), and Telangana (−0.17).
CONCLUSIONS:
While PFHI has reduced inequality in several poorer states, overall coverage in India remains pro-rich, driven by persistently high inequalities in employer-based and private health insurance.
| eISSN: | 2654-1459 |
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