Abstract
This study reports the awareness, access, and utilization of health insurance by the urban poor in Delhi, India. The study included 2998 households from 85 urban clusters spread across Delhi. The data were collected through a pretested, interviewer-administered questionnaire. Logistic regression was performed for determinants of health insurance possession. Only 19% knew about health insurance; 18% had health insurance (Employees State Insurance Scheme — ESIS — 8%; Central Government Health Scheme — CGHS — 1.4%; Rashtriya Swasthya Bima Yojana (RSBY) — 9.4% of the eligible households). In case of health needs, 95% of CGHS, 71% ESIS beneficiaries, and 9.5% of RSBY beneficiaries utilized the schemes for episodic and chronic illnesses. For hospitalization needs, 54% of RSBY, 86% of ESIS, 100% CGHS utilized respective services. Residential area, migration period, possession of ration card, household size, and occupation of the head of the household were significantly associated with possession of RSBY. RSBY played a limited role in meeting the healthcare needs of the people, thus may not be capable of contributing significantly in the efforts of achieving equity in healthcare for the poor. Relatively, ESIS and CGHS served the healthcare needs of the beneficiaries better. Expansion of ESIS to the informal workers may be considered.
Highlights
Health planners advocated for the expansion of health insurance as an essential component of India’s healthcare reform and poverty reduction [1,2]
· Urban poor have limited awareness and access to health insurance. · The mandatory health insurance schemes better served the healthcare needs. · Rashtriya Swasthya Bima Yojana (RSBY) played a limited role in meeting the healthcare needs of the people. · The type of slum, migration duration, and ration card were associated with RSBY enrollment
The occupation of the head of the household reveals that a majority were working in the informal sector and only 9.5% were working in the formal sector
Summary
Health planners advocated for the expansion of health insurance as an essential component of India’s healthcare reform and poverty reduction [1,2]. Enrollment to health insurance in India is very limited. State-run mandatory health insurance schemes, namely, Central Government Health Scheme (CGHS) and Employees State Insurance Scheme (ESIS) are available for working people. Employer-based schemes are offered by public sector organizations such as railways, defence and security forces, mining sectors, and so on by offering medical services and benefits to the employee and his/her dependent family. Private insurance companies offer medical care insurance through individual subscriptions. For those who worked in the informal sector, community-b ased schemes and government sponsored subsidised schemes are offered. Some NGOs offer community-based health insurance or micro-insurance schemes. In 2008, the Government of India launched the Rashtriya Swasthya Bima Yojana (RSBY – meaning National Health Insurance Scheme) for below the poverty line families.
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