New Delhi: India has made significant progress in expanding health insurance, ranking second among six Southeast Asian countries after Indonesia, according to a study published in The Lancet Regional Health – Southeast Asia.
The study, conducted by the Health Systems Transformation Platform (HSTP), New Delhi, found that 29.8% of women and 33.3% of men aged 15–49 years in India are covered by some form of health insurance.
Key Drivers of Progress
- Social Security Health Insurance (SSHI) schemes such as:
- Rashtriya Swasthya Bima Yojana (RSBY)
- Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)
These have expanded coverage, especially for economically vulnerable populations.
Persistent Challenges
- High Out-of-Pocket Expenditure (OOPE): Accounts for 45% of health spending—one of the highest globally.
- Low Public Investment: Health expenditure remains at 3.3% of GDP, with per capita spending just USD 74.
- The “Missing Middle”: Those outside government subsidy schemes but unable to afford private insurance remain largely uncovered.
- Private Insurance: Functions mainly as a supplementary mechanism for higher-income groups.
Inequalities and Disparities
- Community-Level Variation:
- 53.1% variation among women
- 56.3% among men
→ Insurance uptake influenced by state policies, local capacity, awareness, and cultural norms. - Socioeconomic Factors: Higher likelihood of insurance coverage among:
- Older individuals
- Educated groups
- Those with mass media exposure
- Rural vs. Urban: Surprisingly, rural residents showed significant coverage, challenging assumptions of urban advantage.
- Gender Gaps: Women remain less insured than men due to social norms and limited decision-making power.
Recommendations from Researchers
- Decentralised, locally adaptive insurance strategies to address community-level gaps.
- Schemes for the “missing middle” with contributory models and premium support.
- Gender-focused interventions: Promote inclusivity, awareness, and empowerment for women.
- Tax policy reforms: Consider reducing the 18% GST on private health insurance premiums.
- Higher public investment in health to widen coverage and ensure quality care.
Regional Context
The study compared India, Indonesia, Bangladesh, Myanmar, Maldives, and Nepal (2015–2022) using national survey data. With an ageing population and rising healthcare demands in the region, the researchers warn that context-specific, equitable, and financially sustainable strategies are crucial for achieving Universal Health Coverage (UHC).
