ABSTRACT:
India faces significant out-of-pocket expenditure (OOPE) for Non-Communicable Disease (NCD) treatment, and health insurance plays a crucial role in providing financial protection. While initiatives like Ayushman Bharat and state-level Publicly Financed Health Insurance Schemes have been established by the government, gaps in coverage continue to exist along gender and income lines. This study examines inequalities in health insurance coverage by income quantiles and gender among NCD patients in India, using the latest large-scale survey data from the 75th Round of the NSS (2017-18). The study examined patterns and the extent of inequality using cross-tabulation and the concentration index (CI). The study showed considerable interstate variation: states with a low epidemiological transition (ET) or a high burden of NCDs, such as Bihar and Uttar Pradesh, exhibit very low health insurance coverage. In contrast, states with higher ET or lower NCD burden, including Chhattisgarh, Meghalaya, and Mizoram, reported relatively higher coverage. The results show that female patients were less frequently covered by health insurance, and the inequality in health insurance coverage is pro-rich in states such as Rajasthan, Odisha, and Telangana, whereas it is pro-poor in states like Jammu & Kashmir and Himachal Pradesh. The evidence showed that a greater percentage of insurance coverage among economically disadvantaged individuals comes from a government-sponsored program, but a substantial number of the poorest patients with an NCD still rely on OOPE. These results underscore the imperative for gender- and income-responsive, state-level policy interventions to enhance equitable access to health insurance and mitigate the financial risks associated with NCD care in India.