NEW DELHI : India has made significant progress in expanding health insurance coverage, ranking second among the six Southeast Asian countries, following Indonesia, said a recent study published in the Lancet.
According to the study, which appeared in The Lancet Regional Health – Southeast Asia, 29.8% of women and 33.3% of men aged 15–49 years in India were covered by any form of health insurance.
The researchers from the Health Systems Transformation Platform (HSTP), New Delhi, a not-for-profit organisation which works to strengthen health systems through evidence-based research and implementation across India, said that while these figures reflect a remarkable achievement, they also underline the fact that a large segment of the population remains uninsured.
A key driver of coverage in India has been the expansion of Social Security Health Insurance (SSHI) schemes.
Initiatives such as the Rashtriya Swasthya Bima Yojana (RSBY) and Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) have played an instrumental role in improving financial protection for economically vulnerable populations, it said.
However, it said that in spite of government initiatives, financial vulnerability for healthcare persists in the country.
Out-of-pocket expenditure (OOPE) continues to account for nearly 45% of India’s current health spending, one of the highest shares globally.
India’s health expenditure as a share of GDP remains low at 3.3%, with per capita health spending at just USD 74, emphasising the urgent need for increased public health investment.
It stressed that the government schemes do not adequately cater to the “missing middle”, i.e., individuals who fall outside government subsidy programs yet cannot afford private insurance.
In this context, private insurance has emerged primarily as a supplementary mechanism accessed mainly by higher-income groups.
“While India has taken critical steps towards achieving Universal Health Coverage (UHC), the journey ahead requires context-specific, equitable and financially sustainable strategies. Strengthening community engagement, investing in awareness creation and expanding coverage to underserved groups are essential to realising the goal of health for all,” it said.
The study, ‘Health insurance coverage among men and women in six countries within the Southeast Asia Region (2015–2022): a multilevel analysis of Demographic and Health Surveys’ analysed India’s National Family Health Survey-NFHS (2019–21) data.
One of the crucial findings from the study, which analysed health data of six Southeast Asian countries - Bangladesh, Indonesia, Myanmar, Maldives and Nepal - was the high community-level variation in insurance coverage across India.
After adjusting for individual, demographic and socioeconomic factors, 53.1% of variation among women and 56.3% among men was attributable to contextual and community-level factors.
This suggests that insurance uptake is influenced not only by individual characteristics but also by localised factors such as state policies, administrative capacity, awareness and cultural norms.
The study said that from a socioeconomic lens, the likelihood of being insured was significantly higher among older individuals, those with higher levels of education, those with greater exposure to mass media.
Interestingly, it found that rural residents were also insured, challenging the assumption that urban populations are better covered.
However, gender disparities persist. Deep-rooted social norms and limited decision-making power among women may contribute to lower coverage among women despite being active participants in the economy and healthcare users.
The researchers suggested that India should reduce community-level disparities through decentralised and locally adaptive health insurance strategies; address the unmet needs of the “missing middle” possibly through contributory schemes with premium support; tackle gender-based inequities through social inclusivity at community level and greater awareness efforts and consider tax policy reforms such as reducing the 18% GST on private health insurance premiums to make coverage more affordable.
It also suggested that the government should invest more in health, to not only widen coverage but also ensure effective utilisation and quality of care.
“With an ageing population, healthcare demand and costs in WHO Southeast Asia Region (SEAR) will rise. Context-specific health insurance policies and targeted interventions are crucial for bridging coverage gaps and achieving Universal Health Coverage (UHC),” it said.