Coverage and correlates of health insurance in the north-eastern states of India

Abstract

Purpose – The paper aims to analyze the coverage of health insurance and its correlates in the north-eastern region of India. Design/methodology/approach – The study accessed the raw data of the National Family Health Survey (NFHS-4) (2015–16), which was an extensive, multiround survey conducted in a representative sample of households throughout India, which included socioeconomic, demographic and information on coverage of health insurance of any member of the household. The multivariate analysis of logistic regression was adopted to find the correlates of health insurance for all the eight (8) north-eastern states of India. Findings – The results observed that among the north-eastern states, the coverage of health insurance was highest in Arunachal Pradesh (59%) followed by Tripura (58%), Mizoram (47%) surpassing the all India level of 27%, whereas the lowest was in Manipur (4%) followed by Nagaland (6%) and Assam (10%). The multivariate analysis of logistic regression found that the socioeconomic and demographic factors, households with a bank account and below poverty line (BPL) cardholders played a significant role in the coverage of health insurance in the north-eastern states of India. Research limitations/implications – The study focuses only on the coverage and correlates of health insurance. Further evaluation studies on each scheme of the social health insurance are needed for proper assessment of the health insurance schemes in the region. Practical implications – There has been evidence around the world (South Korea, Taiwan and Thailand) that health insurance could be a protective shield from the entrapment into poverty due to high health expenditure. The NFHS-4 put up the finding that in the north-eastern part of India, the coverage of health insurance had been low. This implied that the region could fall into poverty due to high medical expenses on health. Taking account of multiple health insurance providers, risk pooling and consolidation of health insurance providers have become the need of the hour. Originality/value – The study is different from other studies of health insurance since it covered all the eight (8) north-eastern states of India, which are ethnically, culturally and historically distinct from the rest of India in general and within the region and states in particular and examines the impact of each of the independent variables with the dependent variables. The study has shown that the variation in health insurance coverage associated with socioeconomic and other household-level demographic attributes (although not very strong).

Keywords

• out-of-pocket expenditure
• financial hardship
• north-eastern region
• social health insurance