Awareness and Coverage of Health Insurance

Schemes: An Empirical Study in Dharwad District

Rajarama K.E.T
C. N. Noolvi
S. K. Naikar

Population Research Centre

J S S Institute of Economic Research
Vidyagiri, Dharwad

Report No. 193

March 2019

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 Acknowledgement

Population Research Centre, Dharwad is very much grateful to Ministry

of Health and Family Welfare, Government of India for sanctioning this
project and for providing financial assistance.

Authors are grateful to the Corporators of Hubli-Dharwad Municipal

Corporation and Presidents of the selected villages for their cooperation
and help in the survey.

We are thankful to Director, joint Director and research staffs of

population Research Centre, Dharwad for their constructive and useful
suggestions on the report.

Rajarama K E T
C. N. Noolvi
S. K. Naikar

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 Contents

1.1 Introduction ............................................................................................................................... 1

1.2 Health Insurance Schemes .................................................................................................... 2
1.2.1 Central Government Health Scheme (CGHS) ................................................................ 2
1.2.2 Employees State Insurance Scheme (ESIS) ................................................................... 2
1.2.3 Rashtriya Swashtya Bima Yojana (RSBY) .................................................................... 3
1.2.4 Vajpayee Arogyashree .................................................................................................... 3
1.2.5 Rajiv Arogya Bhagya (RAB) ......................................................................................... 3
1.2.6 Yashashwini.................................................................................................................... 4
1.2.7 State Government Employees reimbursement Scheme .................................................. 4
1.2.8 Community/Co-operative Health Insurance Scheme (CBHI) ........................................ 4
1.2.9 Public Sector Company: ................................................................................................. 4
1.3 Review of literature ............................................................................................................... 4
1.4 Socio-economic and demographic profile of the studied district .......................................... 7
1.5 Rationale of the study ............................................................................................................ 8
1.6 Objectives: ............................................................................................................................. 8
1.7 Methodology ......................................................................................................................... 8
1.7.1 Study Design and Sample Size ....................................................................................... 8
1.7.2 Data collection ................................................................................................................ 9
1.7.3 Study tool ........................................................................................................................ 9
2. Socioeconomic Characteristics of Household Head ................................................................. 10
2 .1 Socio-economic and demographic profile of Surveyed Households ................................. 10
2.2 Socio-economic and demographic characteristics of household head ................................ 11
3. Knowledge on Health Insurance ............................................................................................... 12
3.1 Respondents Awareness about various types of health insurance schemes ........................ 13
3.2 Awareness on diseases covered and common benefits of health insurance ........................ 14
3.3 Perception about advantageous of health insurance ............................................................ 15
3.4 Source of knowledge ........................................................................................................... 16
3.5 Awareness on Ayushman Bharat......................................................................................... 17

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4: Coverage of Health Insurance................................................................................................... 18
4.1 Household coverage of Health Insurance............................................................................ 18
4.2 Socio-economic characteristics of household Head and Insurance Coverage .................... 20
4.3 Population Coverage of Health Insurance ........................................................................... 21
4.4 Type of Insurance covered .................................................................................................. 21
4.5 Knowledge on coverage of diseases under the enrolled health insurance scheme ............. 23
4.6 Socio-economic characteristics of uninsured households ................................................... 24
4.7 Reason for not being registered under any insurance Schemes .......................................... 25
4.8 Are you interested in enrolling in any health insurance in future? ..................................... 26
5. Utilization of Health Insurance ................................................................................................. 27
5.1 Insurance coverage of hospitalized individuals .................................................................. 27
5.2 Extent of insurance coverage of hospitalized persons by residence ................................... 28
5.3 Clients satisfaction and problem faced................................................................................ 28
5.4 Extent of coverage of outpatient cost of insured persons by residence .............................. 29
6. Conclusions ............................................................................................................................... 30

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 Awareness and Coverage of Health Insurance Schemes: An Empirical Study
in Dharwad District

1.1 Introduction
India is experiencing changes in two important areas namely demography and
epidemiology. The median age of Indian population is increasing as a result of decline in fertility
and increase in life expectancy. On the other hand, there is a change in the disease pattern, non-
communicable illness are on the rise. The increase in the lifestyle disease led to sharp increase in
the cost of healthcare expenditure in the recent years. Studies have revealed that the share of out
of pocket spending (OOPS) has increased from 4 percent to 7 percent in the past two decades
(Hoonda, 2015) and per capita expenditure for availing the healthcare services has also been
increased. It was around 10 rupees per person in 2000 and it has been increased to 75 rupees in
2012. The burden of treatment has become heavier on part of the poor families as 20 percent of
their total household expenditure go to healthcare treatment (Chowdari S 2011) as 70 percent of
the health care expenditure is borne by the sick individual or family. This kind of situation is
forcing many households to reduce consumption of food and non-food items. For instance,
overall, monthly average consumption level per individual has been reduced to 7.4 rupees due to
high spending on healthcare. It is more in BPL families as compared to non BPL households
(Rs.27.8 against Rs. 2.86) (Hoonda, 2017). Substantial proportion of both rural (47 percent) and
urban (31 percent) households depend on loan or sale of property to settle the hospital bills
(WHO). As per the WHO estimation, a little more than 3 percent of Indians fall under the BPL
bracket due to high healthcare payments. According to an estimation close to 95 million people
became economically weak in 2014 due to high medical expenditure (DH, 2018). These facts
and figures proclaim that the cost of healthcare treatment has become as one of the push factors
of poverty in India.

In this backdrop, health insurance has been gaining more importance in the recent years.
It is a health financing method which takes care of healthcare expenditure of ailing individuals
who enrolled or purchased a health insurance product according to its terms and condition
(Shabeer, V. P 2015). It safeguards the individuals from the fear of high OOPS and helps to get
better healthcare treatments. Common services which are available to the consumers in various
health insurance policies are settlement or reimbursement of medical bills, cashless

1
hospitalization, medical treatment in the best hospitals, policy renewal benefits, group insurance
benefits etc. (Sonal, 2015). A significant proportion of population both in rural and urban areas
do not have health insurance and those who have registered or purchased the insurance product,
majority of them are either enrolled under the government sponsored schemes or employer
supported schemes. With respect coverage, it is more among the urban population than the rural.

The government of India and the state governments are committed to safeguard the poor
and the weaker sections of the community from the catastrophic healthcare expenditure and to
ensure universal health care by launching various health insurance schemes at different point of
time which are suitable to different population sub-groups. In the following paragraphs, a few
health insurance schemes which are exist till recent times in the market has been briefly
described.

1.2 Health Insurance Schemes

1.2.1 Central Government Health Scheme (CGHS)
CGHS is a contributory health scheme that provides comprehensive medical care to the
central government employees and their dependents. Senior citizens and retired personnel who
have worked in central government bodies, judges of the Supreme Court and High Court,
Freedom fighter, Ex-Governors, Ex-Vice Presidents of India, Accredited Journalists are covered
under the scheme. Besides, it also covers central government employees. The scheme was
introduced in 1955.

1.2.2 Employees State Insurance Scheme (ESIS)

Employees State Insurance Scheme (ESIS) was introduced way back in 1952. It is
managed by Employees State Insurance Corporation. It is compulsory in nature and meant for
social security benefit of workers in the formal sector. It is a self–financing social security and
health insurance scheme for worker who work in factory/industry which has 10 or more workers
or establishments such as hotel, hospitals, educational institutions and business units etc, which
has 20 or more workers drawing salary less than Rs.21000/- per month. Employers contribute
4.75% and employees contribute 1.75% of their salary to the scheme. Both medical and cash
benefits are available under the scheme. Besides, state government provides a subsidy equivalent

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to 12.5% of the expenditure on hospitalization. It has its own clinic and hospitals in which
treatment are being provided to the ailing individuals.

1.2.3 Rashtriya Swastya Bima Yojana (RSBY)

The Ministry of Labour, Government of India, has started this scheme in 2007 for
providing health insurance to the unorganized sector workforce which comprised 94% of India’s
total working population. In 2015, the scheme had been transferred to Ministry of Health and
Family Welfare for implementation. The objective of the RSBY is to provide protection to BPL
households from financial liabilities arising out of health shocks that involve hospitalization.
Beneficiary families enrolled under the scheme are entitled to get hospitalization coverage up to
Rs. 30000/- per year for 5 persons. The premium amount is borne by the government. The
beneficiaries can avail treatment either in government hospitals or in empaneled private hospitals
as per their choice.
Some criticisms are leveled against the scheme and its implementation. It has failed to
cover the entire target population. A large chunk of the BPL households has not been covered
yet. The beneficiaries of the scheme had paid 2-3 times of the assured amount from their pocket
to meet the over treatment and prescription of unnecessary drugs and diagnostics.

1.2.4 Vajpayee Arogyashree

This scheme again is meant for the BPL families. In RSBY, the poor families cannot get
treatment beyond thirty thousand rupees. Therefore, the Government of Karnataka introduced
Vajpayee Arogyashree Scheme in order to ensure tertiary care treatment to the BPL category.
There is no condition on the type of illness treated and surgeries are also covered. They can avail
medical care both in empaneled private hospitals and in government hospitals.

1.2.5 Rajiv Arogya Bhagya (RAB)

Rajiv Arogya Bhagya scheme makes super specialty quality tertiary health care treatment
accessible and affordable to APL households of Karnataka. APL household can avail treatment
under any private or government hospital super specialty treatment for 7 types of diseases such
as cardiology, cancer, urology, neurosurgery, pediatric surgery, burns and poly trauma. The
scheme is on co-payment basis.

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1.2.6 Yashashwini
Yashashwini cooperative farmers’ health care scheme provides cost effective medical
facilities to farmers across the state provided he/she is a member of any cooperative societies
such as milk union, etc. It also covers family members of enrolled person below 75 years of age.
It became operational from 2013 through network of hospitals spread across Karnataka state.
Annual premium of rural member was Rs. 300/- and urban was Rs. 710/-. Around 803 surgical
procedures are included in the scheme. Only surgical procedures are covered under this scheme.

1.2.7 State Government Employees reimbursement Scheme

According to this scheme the state government employees are entitled to get medical
reimbursement for medical expenses made for themselves or for their dependent family members
by the Government of Karnataka. There is no contribution from the employee.

1.2.8 Community/Co-operative Health Insurance Scheme (CBHI)

CBHI is a mechanism that allows for pooling of resources to cover the cost of future, un-
predicable health related events. It offers individual and households protection against the
uncertain risk of catastrophic medical health expense in exchange for regular payment of
premiums. These schemes are usually run by the NGOs and self-help groups. The targeted
community is involved in defining the contribution level and collecting mechanism, the content
of the benefit package and/ or allocating the scheme’s financial resources.

1.2.9 Public Sector Company:

There are public sector insurance companies such as Oriental insurance, general
insurance etc. which have launched health insurance products along with other insurance
schemes. The schemes are on the payment basis and premium amount will be fixed on the basis
of the type of services, type of individuals covered, current health status and age of individuals.

1.3 Review of literature

Several studies have been conducted on Health Insurance (HI) to assess knowledge level,
coverage, utilization and reason for non-enrolment in any insurance schemes in other parts of the
state as well as in the country. In this section, we have given findings of a few such studies.

A cross sectional study of insured and uninsured BPL households in Trivandrum district
conducted in 2015 showed that insurance coverage matters in utilization of inpatient service.
Hospitalization was found to be high among insured BPL families than uninsured households.

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However, insurance coverage status of households is not a significant correlates for utilization of
outpatient services. Further, the study observed that the average hospitalization expenditure of
insured households was larger than the inpatient service cost of uninsured households. Close to
eight-tenth of uninsured household had faced difficulty in clear the hospital bills and had settled
the bills by raising loans, gold loans, sale of property/assets and mortgage of lands etc. The
major reason for not being insured was lack of awareness about the scheme and deadline for
enrolment (Elezebeth N P. et. al. 2016).

A study conducted in a village of Bangalore Rural district with 331 households has found
that only one-third of households were aware of health insurance schemes and only a little more
than one-fifth of such households have enrolled under any form of health insurance. Varities of
reasons have been mentioned from the uninsured households for non- participation in any
insurance scheme. Reasons are low household income (43%), difficult to keep faith on insurance
company (27 %), acquaints are not using insurance scheme (27 %), better to invest money in
other areas, Poor knowledge on benefits of the insurance products(16%), not useful (29%)
(Suwarna M et. al. 2012).

A cross sectional study on 300 beneficiaries of RSBY conducted in the rural and urban
areas of Jamnagar district in 2015 observed that majority of study participants were aware of the
scheme and its entitlements except transportation service and accommodation facilities during
hospitalization. A large number of respondents had been enrolled under the scheme from last 2
years (Patel M R. et al. 2018).

Another study conducted in Bangalore in 2015 has revealed that more than three-fourth
of respondents have knowledge on health insurance. Among the known, 67 percent of
households enrolled under one or the other health schemes. Majority of insured households had
been enrolled under government sponsored schemes such as Yashaswini, Vajpayee Arogyashree,
Rastriya Swasth Bima Yojana. Only 15 percent households have registered under the public
sector insurance; mostly higher income households have chosen such products. Major source of
information was family/friends and relative (76 %) (Indumathi K, et al 2016).

A study conducted in Mandya Institute of Medical Sciences’ field area in 2016 observed
that 58 percent of the sampled households have been covered under one or the other health

5
insurance products. Majority of households covered under the Yashaswini scheme followed by
RSBY. Among the total BPL families, only 25 percent families have enrolled under the RSBY
scheme. With regard to out of pocket spending for hospitalization cost between the insured and
the uninsured there is no much variation. For instance, in aggregate, insured inpatients spent 74
percent of total hospitalization cost from their pocket while, uninsured hospitalized individuals
had paid 84 percent hospitalization cost from the same source. It indicates that insurance is not
helping much in reducing OOPS. Lack of information on health insurance is the predominant
cause for non-enrollment under any insurance scheme (57 %). Twenty-two percent of uninsured
respondents reported that the enrolled scheme may be utilized or may not that is why no need to
buy HI product. Another 21 percent respondents have expressed financial inability to enroll
under any scheme (Harish B. R. et. al. 2018)

A survey in 200 rural households in a village in Karnataka carried out in 2007 has found
that only 41 percent of households have knowledge on health insurance. Major source of
information on health insurance was cooperative society (milk and silk). Literate household were
3 times higher in coverage of insurance than the illiterate households (74 percent against 26
percent). Further, insurance coverage is more common among the households suffering from
illness, chronic sickness and household decision is usually made by a literate person
(B.Ramakrishna Goud, 2014).

An online survey on health insurance coverage and utilization of health services among
the urban educated individuals conducted in 2016 observed that only 32 percent of respondents
enrolled under health insurance mainly with private health insurance (58.6 percent) followed by
employer insurance (25 %) and government employee insurance(10.1 %). Close to 50 percent of
non-insured respondents reported the reason for non-coverage of insurance is financial
constraint. Another 30 percent mentioned that no need of insurance. Around 18 percent of
respondent expressed lack of faith in insurance agencies (Adil SO, et. al. 2016).

Summary: Almost all studies are micro level studies covering both rural and urban
population. The general population and specific population groups were the subjects of the
studies. Levels of knowledge, coverage, reason for non-coverage of health insurance etc. are the
areas covered in the surveys. The level of knowledge of respondent on insurance ranges from 33

6
percent to 75 percent and the coverage of insurance among the studied population varies from 20
percent to 67 percent. The main reason for low coverage has been the lack of awareness about
health insurance and financial constraint. There is not much difference in out of pocket spending
between insured and uninsured groups.

1.4 Socio-economic and demographic profile of the studied district

Hubli-Dharwad is a twin city and second largest city in Karnataka and known for
education, business and industry in northern Karnataka region. The Dharwad district consists of
8 tahshils namely Dharwad, Hubblli (Rural), Hubballi (Urban), Kundgol, Navalgund, Kalghatgi,
Annigrei and Alnavar. The geographical area of the district is 200.23 square kilo meters.
According to 2011 Census, total population of the district is 18, 47,023. The rural-urban
population distribution of the district indicates it is more urbanized. The district has a
population density of 434 inhabitants per sq. kilo meter. The decadal population growth rate of
the district is 15.13 between 2001and 2011. The district sex ratio is 971 and urban sex ratio is
better than the rural. It is a literate district where more than 80 of its subjects can read and write.
The district social groupings indicate that scheduled caste (SC) and Scheduled tribe (ST)
population is less than 14 percent (Census of India. 201)

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1.5 Rationale of the study
The field based studies have found that high cost of healthcare services has resulted in
reduced consumption of food and nonfood items of households, decreased accessibility to health
care services, pushes many households to below poverty line and a good proportion of
households are made to be deprived of availing the treatment due to of lack of money etc.
Realizing the reality at ground level, Government of India and the state governments have
launched various health insurance schemes to safeguard the poor and the weaker sections from
the catastrophic health expenditure. The fact is that a considerable proportion of both rural and
urban eligible households have not enrolled and utilized the government health insurance
schemes despite being available in the community. Therefore, a study at this juncture at micro
level is needed to understand the level of awareness on various health insurance schemes and
coverage, reason for non-enrolment, out of pocket payments among insured and as well as non-
insured family etc. Findings of the study will be useful to identify the gaps in implementation of
the schemes and utilization of the schemes.

1.6 Objectives:
 To assess the level of awareness among the public on health insurance scheme;
 To know the extent of coverage of various health insurance schemes;
 To understand the utilization pattern of health insured by the clients;
 To understand the level of satisfaction of clients on services received and problems faced
in getting the various entitlements under the enrolled scheme.

1.7 Methodology
1.7.1 Study Design and Sample Size
The study was conducted in rural and urban areas of Dharwad taluk in Dharwad district.
The district and taluk were selected intentionally. Five urban wards of the total 67 and five
villages out of 110 villages were selected separately by employing proportional-to-population
size procedure. In the selected areas, a cluster consisting of 90-120 households were formed.
Four clusters in each selected villages and urban wards were selected using systematic random
sample method. Further, 10 households from each selected cluster were chosen systematically
and covered. Altogether, 381 households were covered (191 households from urban area and 190
households from rural areas). Descriptive statistics have been used for data analysis.

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 Table 1.2: Sample coverage

Ward no
Household Household
Village Name
covered covered
Marewada 38 Ward No. 10 39
Venkatapura 36 Ward No. 24 39

Kotabagi 39 Ward No. 36 35

Honnapura 37 Ward No. 48 39

Managundi 40 Ward No. 64 39

Total 190 191
Grand total 381

Following are the broad areas covered in the survey – knowledge on various health
insurance schemes, enrolment in the schemes, available services, extent of utilization of services,
premium amount, reason for no enrolment, OOP, household expenditure, and problems and
service satisfaction etc.

1.7.2 Data collection

Four trained interviewers of the centre, 3 males and 1 females interviewed the selected
household head. Two day training including field practice was organized to make the field
investigators more conversant with the questionnaire and become perfect in the data collection
process. Doubts and queries expressed by the field investigators during and after the field
training were informally clarified. Principal investigator monitored the entire fieldwork. The
field work was carried out from December 13th 2018 to 10th, January 2019.

1.7.3 Study tool

A semi-structured schedule was designed to collect information from the respondents.
Before finalizing the schedule, it was pre-tested with around 10 households from non-sampled
area. It was shared with the faculty members of the centre. After making the relevant
modification based on pre-test experience and comments shared by the faculty members of the
centre, the revised schedule was prepared and was used to gather the information from the
selected households. The schedule consists of four main parts namely, background information
of the selected households, knowledge on health insurance, coverage of health insurance, and

9
utilization of enrolled health insurance schemes. Information on current age, education,
occupation of head of the household, and religion, caste, annual household income, annual
household expenditure including medical expenditure etc. were collected under the first section.
Awareness on various health insurance products and knowledge on types of services available in
health insurance are covered under the second section. Data pertaining to coverage of insurance
such as enrolment of individuals and households under any health insurance, premium amount
sum assured of the insured policy etc. are gathered under section three. In the last section, we
tried to collect the information on utilization of health insurance for hospitalization and out-
patient visits, out of pocket spending, cooping strategy for high OOPs etc.

To maintain the quality of data, the principal investigator monitored the fieldwork by
observing the interview and editing each and every questionnaire in the field itself. Data was
entered using Statistical Package for Social Sciences (SPSS) version 20. Univariate and bivariate
techniques of data analysis were used based on the suitability of the technique in a particular
analysis. Chi-square tests have been applied to assess the association between variables.

2. Socioeconomic Characteristics of Household Head

2 .1 Socio-economic and demographic profile of Surveyed Households

The level of knowledge and extent of utilization of health insurance differs according
individual and household characteristics. Therefore it is important to understand the background
characteristics of the study subjects. Table 2.1 shows socio-economic and demographic features
of the households and head of the interviewed households. Overall, three-fourths of surveyed
households are Hindus and close to 50 percent belong to OBC community. Almost similar
pattern has been observed both in rural and urban areas with respect to religion and caste. A little
more than a quarter of households fall under the low income category (less than one lakh
rupees). The mean annual household income is 2.04 lakh for the district as a whole and the mean
annual household income of urban families is much more than the rural households.

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 Table 2.1: Socio-economic characteristics of households and head of household

Household Characteristics Rural Urban Total

Religion
Hindu 86.32 63.35 74.80
Muslim 8.95 29.32 19.16
Other 4.74 7.33 6.04
Caste
SC & ST 24.74 15.71 20.21
OBC 41.05 53.93 47.51
Other 34.21 30.37 32.28
Annual household income (Rs.)
Low income 31.05 20.42 25.72
Middle income 55.79 46.07 50.92
High income 6.32 28.27 17.32
DK 6.84 5.24 6.04
Mean income in lakh 1.63 2.44 2.04
N 190 191 381

2.2 Socio-economic and demographic characteristics of household head

Coming to the demographic and socio-economic characteristics of head of the
households, majority of the household heads have crossed 50 years both in rural and urban areas.
The overall median age is 50 years. It indicates that head of the households are middle aged.
With respect to occupation of household head is concerned, overall, 28 percent are pensioners or
presently not working and 27 percent are working as casual labourer. Occupational differences
have been found between the household heads of urban and rural area. Farming activity and
casual labour are more frequently reported economic activities of households heads in rural areas
while, majority of urban household heads are engaging in casual labour and are working in
salaried jobs (Table 2.2).

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 Table 2.2: Socio-economic demographic characteristics of head of household

Characteristics Rural Urban Total

Age
Less than 50 40.53 49.74 45.14
More than 50 59.47 50.26 54.86
Median age 52.50 50.00 50.00
Education
Illiterate 50.53 26.18 38.32
1-7 years 25.79 17.28 21.52
8-12 years 19.47 31.94 25.72
13 & above years 4.21 21.99 13.12
DK 0 2.62 1.31
Mean years of schooling 4.00 8.00 6.00
Occupation
Salaried 6.32 22.00 14.17
Business 9.50 17.28 13.39
Agriculture 34.21 1.57 17.85
Casual labourer 28.42 25.13 26.77
Pensioner/not working etc. 21.58 34.03 27.82
N 190 191 381

3. Knowledge on Health Insurance

A good knowledge of health insurance is a prerequisite for utilization of insurance
scheme. In this chapter, we have tried to assess the knowledge level of the respondents on health
insurance and its various components and features of health insurance. Table 3.1 shows
knowledge of respondents on health insurance schemes in general by residence. Overall, 71
percent of the respondents in the study area are aware of at least one of the health insurance
schemes. Awareness is found to be high among the urban respondents (80 percent) compared to
their rural counterparts (62 percent). Table further reveals that socio-economic and rural-urban
differentials in knowledge are high. The urban households have better knowledge than the rural
families. This pattern is found in all the population sub-groups. Annual household is significantly
associated with knowledge in all the regions. Association between religion and knowledge is
significant and positive in urban area.

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 Table 3.1: Awareness on health insurance by socio-economic characteristics of
household

Household Characteristics Rural Urban Total

Religion Percent n Percent n Percent n
Hindu 61.59 164 86.78 121 72.28 285
Muslim 52.94 17 62.50 56 60.27 73
Other 77.78 9 85.71 14 82.61 23
Chi-Square 1.534 P=0.464 14.235 P=0.001 5.74 P=0.057
Caste
SC & ST 61.70 47 80.00 30 68.83 77
OBC 56.41 78 73.79 103 66.30 181
Other 67.69 65 89.66 58 78.05 123
Chi-Square 1.91 P=0.385 5.754 P=0.056 5.081 P=0.081
Annual household income (Rs.)
Low 47.46 59 69.23 39 56.12 98
Middle 66.04 106 75.00 88 70.10 194
High 83.33 12 90.74 54 89.39 66
Chi-Square 8.586 P=0.035 10.412 P=0.015 22.750 P=0.000
Total 61.58 190 79.58 191 70.60 381

3.1 Respondents Awareness about various types of health insurance schemes

There are many health insurance products available in the market. Some are launched by
the public sector company, some are introduced by the private companies. Besides, cooperative
health insurance and standalone insurance schemes are also available in the community. We have
attempted to assess the respondents’ level of awareness about the different health insurance
schemes which are available in the market and a few more information such as eligibility criteria
for enrolment, place of registration and place of treatment if the insured person is hospitalized
etc. This information is given in Table 3.2. Overall, knowledge about different types of health
insurance is limited among the studied population. However, Yashaswini is relatively well
known scheme (44 percent) and it is followed by Employee State Insurance Scheme (ESIS) (32
percent) and Rashtriya Swastya Bima Yojana (RSBY) (23 percent). Other schemes are the least
known to the respondents. Among the informants who have reported the name of the insurance
schemes, eligibility criteria, place of enrolment and empanelled hospitals are known to less
proportions of respondents; only the persons who have reported Yashaswini, RSBY, ESIS and
CGHS schemes have relatively better knowledge on other details of the schemes. The emerging

13
point from the table is that the large proportion of the respondents lack minimum level awareness
about the available insurance schemes in the market and its features. The study which has
conducted in other parts of the country also found the similar findings, more than half of the
respondents lack awareness on terms and conditions of the schemes (Sarojini, 2018).

Table 3.2: Respondents' awareness about various health insurance schemes

Awaren
ess on awareness Place of
Awaren
Health Insurance Schemes eligibilit on place of treatme N
ess
y enrolment nt
criteria
Percent
Central govt. health schemes 12.86 10.50 8.39 5.25 381
State govt. employees reimburse
scheme 13.12 7.61 0.52 5.51 381
Yashaswini 43.57 22.83 19.69 9.71 381
Rashtriya Swastya Bima Yojana 23.42 10.5 8.4 5.25 381
ESIS 31.50 10.76 8.39 7.82 381
Vajpayee Arogyashree 6.82 0.79 0.82 1.52 381
Rajiv Arogya Bhagya 2.90 0.52 2.00 0.79 381
Cooperative Health Insurance 1.31 1.05 0.52 0.79 381
Public sector Health Insurance 1.31 0.79 0.79 0.26 381
Mediclaim (LIC) 5.25 3.41 1.59 0.79 381
Private Health Insurance 8.40 6.56 2.36 2.1 381

3.2 Awareness on diseases covered and common benefits of health insurance

We have also tried to capture the respondents’ awareness on other components of health
insurance. Mainly, we attempted to assess the respondents’ knowledge on major diseases
covered under the scheme such as cardiology, cancer, neurology, etc. and available facilities like
free medicine, diagnostics, surgery, hospitalization etc. This information is given in Table 3.3.
The Table displays a dismal picture; more than half of the respondents have no idea regarding
type of diseases covered in any health insurance. No knowledge is more common among the
rural informants when compared with the urban. Overall, only a 17 percent of respondents have
informed that all types of illness covered under the health insurance, and around 30 percent
informants said that some specific diseases are covered under the HI. The knowledge gap is more

14
among the rural respondents compared to their urban counterparts.

Table 3.3: Respondents' awareness about diseases covered by health Insurance scheme by
residence

Awareness on type of illness covered Rural Urban Total

All diseases 8.42 26.18 17.32
Some specific diseases 34.21 26.18 30.18
No knowledge 57.37 47.65 52.50
Awareness on common benefits covered
All free 1.05 4.19 2.62
Some specific services are free 30.00 41.36 35.70
No knowledge 68.95 54.45 61.68
N 190 191 381

Similarly, knowledge on common facilities/ benefits available in the health insurance is

also awfully low; only 2 percent of rural respondents, 5 percent of urban respondents have
informed that all the facilities are available for free once enrolled under the health insurance.
Around 30 to 40 percent of study participants reported that some specific services are free if one
purchases the health insurance policy. The proportion of respondents who have no knowledge is
high in the rural area as compared to the respondents of the urban area. Similar finding has been
observed in the study conducted in Rajasthan, 55 percent of respondents are unaware of terms
and conditions of health insurance because the promoter has just briefed about the product and
explained nothing about features of the policy (Sonal, 2015).

3.3 Perception about advantageous of health insurance

Further, we enquired with the respondents who have knowledge on health insurance
about what are the advantages of having a health insurance. Table 3.4 presents perceived
advantages of respondents who have health insurance by residence. Majority of respondents
perceived that economic burden on health care treatment will be reduced if one has health
insurance (63 percent). This perception is found to be less among the rural participants than the
urban respondents. Further, overall 18 percent of respondents perceived that having health
insurance will help to get higher level of medical treatment without bothering cash arrangement.
Such perception is found to be more among the urban respondents (37 percent) compared to the
rural informants (21 percent). These perceptions indicate that having a health insurance policy

15
will help in reducing out of pocket spending on part of individuals and households.

Table 3.4: Respondents' perception about advantage of enrolling under the health
insurance

Advantage* Rural Urban Total

Reduce economic burden 55.79 70.68 63.25
higher level treatment can be availed without 12.63 22.51 17.59
much fear of arrangement of cash
Tertiary care can be availed easily 10.53 29.32 19.95
Other benefits 3.68 4.71 4.20
N 190 191 381
*multiple response

Among the households which were not covered under any of the insurance schemes, we
further tried to assess their future plans with regard to purchasing any insurance products to
safeguard their family from the catastrophic healthcare expenditure. To our surprise, almost all
respondents, irrespective of residence expressed their intention to purchase health insurance in
future (Table not given)

3.4 Source of knowledge

Knowing the sources of knowledge on health insurance is important as dominant sources

can be employed for enhancing the level of knowledge among the least informed groups. Table
3.5 presents source of knowledge by residence. Majority of respondents have got information on
health insurance through their friends, colleagues and relatives (67 percent). This is the dominant
source of information both in urban and rural areas. Second most important source of
information is work place. This source of knowledge is more popular among the urbanites than
the rural folks. This is an informal source and thus there exists a lot more ways to get distorted
information. The knowledge should be delivered through formal and scientific way.

16
 Table 3.5: Source of knowledge by residence

Source* Rural Urban Total

Agent 7.69 6.58 7.06
Media 2.56 24.34 14.96
Friends/relatives 55.56 75.00 66.54
Work place 21.37 44.74 34.57
Cooperative society 15.38 9.21 11.90
Other 28.21 12.50 19.33
N 117 152 269
*Multiple response

The rural respondents gained knowledge through diversified source which we have
clubbed under ‘other’ category. The rural and urban respondents have received the information
from different sources; there is no common source in which both rural and urban community is
relied upon.

3.5 Awareness on Ayushman Bharat

Government of India has recently launched a mega health insurance scheme called
“Ayushman Bharat” for safeguarding the poor and vulnerable population from impoverishment
due to catastrophic health care expenditure. The scheme would provide cashless health care
treatment benefits up to 5 lakh rupees per BPL family in a year. It includes cost of 1350
procedures, pre and post hospitalization cost, diagnosis, medicine and transportation cost. The
APL families can also register under this scheme, but sum assured is only 30 percent of the total
cost. During last 5 months, nearly 13 lakh beneficiaries have availed the scheme and 1200 crores
rupees have been dispersed to the health institutions. We have tried to assess in this section the
respondents’ knowledge on the Ayushman Bharat and its different components. Table 3.6 shows
proportion of respondents who have knowledge on Ayushman Bharat and its different
components. Overall, one-fourth of the respondents were knowledgeable about the scheme. More
urban respondents have reported the scheme (38 percent against 11 percent) when compared to
the rural. The knowledge among the informants about the other components of the scheme such
as, month of launching the scheme, eligible households, sum assured etc. was found to be very
17
low. However, urban households are in a better position than the rural households. The
government of Karnataka has also joined the hands with the Government of India in launching
the programme. This information is widely known to the rural study participants than the urban
respondents.

Table 3.6: Knowledge on Ayshman Bharath by residence

Knowledge Rural Urban Total

Awareness on Ayushman Bharat 11.05 38.22 24.67
Correct knowledge on date of launching the scheme 1.58 8.9 5.25
Eligible family-BPL 4.21 16.75 10.5
Eligible family-APL 3.16 8.38 5.77
Insured amount to BPL family Rs. 500000 8.42 29.84 19.16
Insured amount to APL family Rs. 150000 10.53 0.52 0.79
Govt. Karnataka launched this scheme 2.11 10.99 6.56
N 190 191 381

4: Coverage of Health Insurance

4.1 Household coverage of Health Insurance

In the previous chapter, we have tried to assess the level of knowledge of health
insurance among the study population. In this section, we attempted to know the extent of HI
coverage Proportion of households covered under any health insurance scheme by characteristics
of households and residence is presented in Table 4.1. Overall, about 30 percent of the
households in the study area have been enrolled under any health insurance scheme. According
to recent round of NFHS, 33 percent of households in Dharwad have been covered under any of
the health insurance.

18
 Table 4.1: Coverage of health insurance by socio-economic characteristics of household

Religion Rural n Urban n Total n

Hindu 19.51 164 42.98 121 29.47 285
Muslim 29.41 17 25.00 56 26.03 73
Other 22.22 9 78.57 14 56.52 23
Chi-Square 1.781 P=0.776 14.330 P=0.001 10.139 P=0.038
Caste
SC & ST 17.02 47 50.00 30 29.87 77
OBC 20.51 78 32.04 103 27.07 181
Other 23.08 65 50.00 58 35.77 123
Chi-Square 6.92 0.140 6.362 P=0.042 11.18 P=0.025
Annual household income*
Low 6.78 59 7.69 39 7.14 98
Middle 27.36 106 31.82 88 29.38 194
High 41.67 12 75.93 54 69.70 66
Chi-Square 16.095 0.013 48.739 0.000 75.720 0.000
Total 20.53 190 40.31 191 30.45 381
* not reported cases are removed

The corresponding rate for Karnataka is little less. The coverage of households in urban
area is two times more than the rural areas in the studied area. The insurance coverage according
to NFHS-4 is more in rural areas compared to urban areas both in Dharwad district and in
Karnataka state. The reason for more coverage of HI is Yashaswini was in force 4-5 years back
and many farmers availed the benefit of the scheme and recently the scheme was withdrawn.
Socio-economic and rural urban differences in coverage of the insurance have been noticed in
the study. Insurance coverage is more among majority of population sub-groups in the urban
when compared to the rural area of the same population sub-groups. Households which are
belonging to other religion and other caste groups enrolled under any health insurance schemes is
more than the Hindu/Muslim religious groups and SC/ST and OBC groups. With respect to
annual household income, as the income of the household increases, insurance coverage has also
been increased. This pattern is common for rural, urban and all areas. Religion, caste and annual
household income and insurance coverage is statically significant in urban and all areas, whereas
in rural area, these variables do not have influence on insurance coverage.

19
4.2 Socio-economic characteristics of household Head and Insurance Coverage
Head of the household always plays a crucial role in household decision making process.
His decisions, most of the times are affected by individual characteristics such as education,
occupation etc. Table 4.2 shows Socio-economic characteristics of household head and Insurance
coverage. The Table shows that as the number of years of schooling of household head increases
coverage of insurance has also been increases. Almost similar pattern is observed in urban except
1-7 years of schooling. Association between education and insurance coverage is statically
significant in rural, urban and all areas. With respect to coverage in rural areas, there is no
consistent pattern emerging. Chi-square values show that education has association with
coverage of health insurance.

Table 4.2: Insurance coverage by education and occupation of household head

Rural Urban Total
Education Percent n Percent n Percent n
Illiterate 16.67 96 24.00 50 19.18 146
1-7 years 30.61 49 21.21 33 26.83 82
8-12 years 16.22 37 45.90 61 34.69 98
13+ years 25.00 8 69.05 42 62.00 50
DK 20.00 5 20.00 5
Chi-Square 5.028 P=0.540 26.596 P=0.000 34.716 p=0.000
Occupation
Salaried 66.67 12 76.19 42 74.07 54
Business 22.22 18 24.24 33 23.53 51
Agriculture 12.31 65 33.33 3 13.24 68
Coolie 22.22 54 22.92 48 22.55 102
Pensioner/not working 17.07 41 38.46 65 30.19 106
Total 20.53 190 40.31 191 30.45 381
Chi-Square 19.86 P=0.011 32.200 P=0.000 63.228 P=0.000

Coming to occupation of head of the household and insurance coverage, it is much higher
if the household head is employed and drawing monthly salary, compared to the head of
household is engaged in non-salaried jobs. This pattern is observed in all areas irrespective of
residence. These people may be working in the organized sector where health insurance is
covered by the employer as per the rules. Household which are headed by the farmer in rural
areas and casual labourer in urban areas are the least covered. Occupation of head of the
household is one of the important correlates for household insurance coverage irrespective of
residence.

20
4.3 Population Coverage of Health Insurance

We have also tried to assess the extent of individuals covered in the surveyed households.
Table 4.3 provides information on proportion of individuals covered under any insurance
schemes by age, gender and residence. Overall, 22 percent of the total population is covered
under any of the health insurance. There is a large gap between rural and urban coverage. Thirty
percent of urban and 14 percent of rural population have been registered under any health
insurance. With respect to insurance coverage among the age groups, much difference is not
noticed between adult population (15-59 years) and aged population (60 + years) in rural urban
and all areas. Further, the Table reveals that insurance enrolment rate is lower among rural
population compared to the urban population with respect to age and gender.

4.3: Coverage of health insurance by demographic characteristics of individual and

residence

Characteristics Rural Urban Total

Age Percent n Percent n Percent n

0-14 8.82 272 24.10 249 16.12 521

15-59 16.14 632 32.04 593 23.84 1225

60+ 14.93 134 33.67 98 22.84 232

Sex

Male 13.82 521 30.58 448 21.57 969

Female 14.31 517 29.55 494 21.76 1011

Total 14.07 1038 30.11 942 21.69 1980

4.4 Type of Insurance covered

As we discussed earlier, there are many insurance products available in the market.
Dominant players are Governments, public sector companies, cooperative sectors and private
companies. We have attempted to understand which type of product is more preferred and
which policies are

21
 4.4 Coverage of health insurance by type

Type of health insurance* Percent

Central govt. health scheme(CGHS) 5.25
State govt. employees reimbursement scheme 4.46
Yeshaswini 2.1
Rashtriya Swastya Bima Yojana (RSBY)/ Arogya Karnataka 6.03
Employees State Insurance scheme (ESIS) 9.19
Vajpayee Arogyashree Scheme (VAS) 0.26
Rajiv Arogya Bhagya Scheme (RABS) 0.00
Cooperative Health Insurance Scheme (CHIS) 0.79
Medi-claim (LIC) 0.26
Private Health Insurance 4.2
N 381
* multiple response

less preferred by the households in the studied area. Table 4.4 presents percentage of households
by the type of insurance covered. The ESIS in the study area emerged as a dominant product (9
percent), followed by RSBY/Arogya Karnataka (6 percent) and CGHS (5 percent). The ESIS
coverage is more compared to other schemes because some of the selected villages fall under the
urban fringe and a few selected wards are slum-like area where people are working more in the
organized sectors for which SEIS is applicable as per the rule. And these two schemes are
compulsory and partial contributory schemes. The employees’ interest is not taken into
consideration to enrol under these two schemes. The table indicates that majority of households
have enrolled under the government health insurance schemes. The private health insurance
which is purely voluntary, is purchased by only 4 percent households. The important point
emerging from the table is that even the free voluntary scheme such as RSBY is not that popular
in the studied area. The reason being that the Government of Karnataka introduced Arogya
Karnataka scheme last year under which RSBY was merged. Besides, they have formed a trust
called “Suvarna Karnataka” trough which these government schemes were implemented. People
have got confused as they were unaware of under which scheme they are supposed to be
enrolled. The study conducted in Tamil Nadu has found that coverage of government sponsored
health insurance schemes are more compared to the private health insurance policies and further
observed that coverage is more in the urban compared to the rural areas (Gayatri 2019).

22
4.5 Knowledge on coverage of diseases under the enrolled health insurance
scheme
Basically, diseases covered and other benefits available from the HI depends on type of
the product, premium amount etc. Some HI covers only major diseases like cardiology,
neurology, and cancer etc. on the other hand, there are policies which cover almost all diseases
including OPD. We wanted to know whether the study participants are aware of these services
of HI. Therefore, we enquired with the respondents whether they have knowledge on the number
of diseases covered under any health insurance schemes. Table 4.5 presents knowledge of
respondents’ diseases/health problems which are covered under the insured scheme by socio-
economic characteristics. More than half of respondents do not have knowledge on diseases
covered. The knowledge gap is found to be more among the Hindu and Muslim households,
among SC & ST and OBC categories and among households having low and middle annual
household income. Regarding differential knowledge about disease coverage of HI, there is no
definite pattern visible. Religion, annual household income and knowledge on diseases covered
under the HI are statistically significant.

Table 4.5: Respondents' knowledge on diseases covered by socio-economic characteristics

of households
All Some Not
Characteristics DK Total
diseases diseases insured
Religion
Hindu 17.89 31.23 23.16 27.72 285
Muslim 5.48 27.40 27.40 39.72 73
Other 47.83 26.09 8.70 17.38 23
Chi-Square 18.611 P=0.001
Caste
SC and ST 23.38 22.08 23.38 31.16 77
OBC 11.60 30.94 23.76 33.70 181
Other 21.95 34.15 21.95 22.19 123
Chi-Square 7.71 P=0.103
Annual household Income*
Low 7.14 26.53 22.45 43.88 98
Middle 15.40 9.97 4.64 69.58 194
High 36.36 22.73 30.30 10.61 66
Chi-Square 17.942 P=0.006
Total 17.32 30.18 23.10 29.40 381
*Income not reported cases are excluded

23
4.6 Socio-economic characteristics of uninsured households

As we have observed in the previous Tables (table 3.1 and 4.1) that 70 percent of
households are having knowledge of health insurance and 30 of the households have registered
under any of the health insurance schemes. A huge chunk of households are left uncovered
despite being aware of HI. Therefore, it is also important to know the kind of households in
which no member has been enrolled under any HI schemes to make a strategy to bring such
households under the insurance coverage. The socio-economic characteristics of such households
are given in Table 4.6. Overall, 57 percent of households are having knowledge but have not
been enrolled/purchased any HI scheme. Such households are more in rural areas compared to
the urban. With respect to religion, both Hindu and Muslim households which are uninsured
under any of the insurance schemes despite having awareness level is high whereas, reverse
picture is found in rural area. Religion is a significant correlate for non-coverage of insurance in
urban area. Regarding social groups both rural and urban area households have different picture,
such kind of households are found to be more among OBG category in urban area and among
households belonged to the general category in rural area. Annual household income and non-
coverage of insurance among households having awareness has inverse relationship irrespective
of the residence. Almost similar pattern is noticed in all areas with respect to educational level
of head of the households, but no definite pattern is emerging in rural areas. The non-coverage of
health insurance is considerably low among households headed by the salaried person and
having insurance knowledge, but it is considerably high if household head is doing other job.
Religion, household income, years of schooling of the head of the household, occupation of head
of the household and non-coverage of insurance is significantly associated in urban area. And
also, income, education and occupation of head of households have similar association with the
non-insurance coverage in spite of having knowledge on insurance in all these areas. Neither the
household characteristics nor the characteristics of the household head were successful in
establishing any kind of linkage between the non-coverage of HI and level of knowledge of
insurance in rural area.

24
 Table 4.6: Socio-economic characteristics of uninsured households

Characteristics Rural n Urban n Total n

Religion
Hindu 67.33 101 51.43 105 59.22 206
Muslim 44.44 9 60.00 35 56.82 44
Other 71.43 7 8.33 12 31.58 19
Chi-Square 2.937 0.568 9.819 0.007 6.779 0.148
Caste
SC & ST 68.97 29 37.50 24 54.72 53
OBC 59.09 44 57.89 76 58.33 120
General 70.45 44 44.23 52 56.25 96
Chi-Square 2.902 0.574 4.087 0.13 1.984 .739
Annual household income
Low 88.14 59 92.31 39 89.80 98
Medium 70.15 106 68.18 88 69.59 194
Low 58.33 12 24.07 54 30.30 66
Chi-Square 14.314 0.026 54.30 0.000 67.516 0.000
Illiterate 63.64 44 64.52 31 64.00 75
1-7 years 55.56 36 68.18 22 60.34 58
8-12 years 80.65 31 49.09 55 60.47 86
13+ years 66.67 6 27.50 40 32.61 46
Chi-Square 5.464 0.486 14.640 0.006 15.558 0.049
Occupation of household head
Salaried 33.33 12 20.00 40 23.08 52
Business 61.54 13 68.00 25 65.79 38
Agriculture 78.05 41 50.00 2 76.74 43
Coolie 63.33 30 69.70 33 66.67 63
Pensioner/not working 66.67 21 51.92 52 56.16 73
Chi-Square 11.786 0.161 22.838 0.000 40.155 0.000
Total 65.81 117 50.00 152 56.88 269

4.7 Reason for not being registered under any insurance Schemes

The earlier discussion has shown that a significant proportion of households have not
enrolled or purchased any health insurance scheme. Therefore we tried to explore the reason for
non-enrolment under any HI as it would help in designing some programmes to bring the left out
households into the fold of suitable insurance programmes. The major reason for non-coverage
of health insurance is ‘lack of knowledge’ on health insurance. Forty-four percent of the

25
informants have reported this reason. This is a more common reason for non-coverage of
insurance both in rural and urban areas. Another interesting reason shared by the respondents is
‘no need at present’. It means that only at the emergency situation, they will be purchasing the
suitable insurance products. Rural people have more of this kind of notion (9 percent). Around
4-5 percent of the study participants irrespective of residence have expressed economic reasons –
i. e., ‘do not have money to pay the premium’ and ‘no time to register the name as it involve
many process. Less than 3 percent of respondents told ‘not interested, no ration card, no time and
not eligible etc. There are low premium policies and government sponsored schemes which are
on zero payment to enrol are not known to these groups.

Table 4.7: Reason for non-enrolment of any health insurance by residence

Reason Rural Urban Total

No knowledge 52.11 36.65 44.36
Not interested 2.63 3.14 2.87
No ration card 0.53 1.57 1.05
No need at present 9.47 4.19 6.82
No time 4.21 5.24 4.72
Economic cause/Not able to pay 4.21 3.14 3.67
Process of getting 0.00 3.14 1.57
Not eligible 0.00 0.52 0.26
DK 5.79 2.10 3..93
N 190 191 381

4.8 Are you interested in enrolling in any health insurance in future?

Many people might not have enrolled under any health insurance schemes due to various
reasons, but in future they may be interested to purchase or register under any of the existing
schemes. To understand the respondents’ future intention, we enquired with them whether they
have interested in purchasing any insurance schemes. Forty-eight percent of respondent replied
positively. Such households were found to be more in rural area (49 percent) compared to urban
areas (47 percent). Some households are not yet decided about the purchase of HI. Around 20
percent of the rural households expressed this response, whereas 6 percent of urban respondents
replayed the same (Table 4.8).

26
 Table 4.8: Are you interested to enrol in any health insurance scheme in future?

Rural Urban Total

Yes 48.85 46.60 47.77
NO 11.05 6.81 8.92
DK 19.95 6.28 12.60
N 190 191 381

5. Utilization of Health Insurance

The basic purpose of the health insurance is to share the healthcare expenditure of the
insured individual/family either partially or fully by the insurer according to the terms and
condition set at the time of purchasing the policy. To assess the extent of utilization of insurance
by the insured families/individuals, we have gathered information from the respondents on the
medical expenditure incurred on healthcare (hospitalization and out-patient service) and extent of
coverage of health cost etc.

5.1 Insurance coverage of hospitalized individuals

Any member of the interviewed households who was admitted to the hospital at least for
one day due to any health problems during last one year prior to the survey is considered as
hospitalization. Hospitalization rate is number of persons of any age hospitalized any time during
last one year for every 100 persons. Overall, 6.9 persons for every 100 persons were hospitalized
during the last one year in the studied area. Corresponding rate for rural and urban areas are 7.91
and 5.84 respectively (table not given). There are some findings showing that hospitalization rate
is more among insured than the non-insured because of the out of pocket payment. These
expenses for the insured individuals is borne by the insurer and in case of non-insurer, the
individual has to pay from his pocket. Hence due to high cost hospitalization some non-insured
individuals hesitate to admit to hospital even though it is essential. Our study is showing the
reverse picture. Overall, 23 percent of individuals are insured among the total hospitalized. The
corresponding proportions in rural and urban areas are 18 percent and 40 percent respectively
(Table 5.1).

27
 Table 5.1: Hospitalization rate by residence

Not Total
Residence Insured insured hospitalized
Rural 18.29 81.71 82
Urban 39.91 69.09 55
Total 23.36 76.64 137

5.2 Extent of insurance coverage of hospitalized persons by residence

Extent of insurance coverage in terms of cost varies according the insurance policies.
Some products cover all types of expenses and some products ensures only limited services.
Hence, it is important to know to what extent the hospitalization expenses are shared by the
policy for its beneficiaries. The extent of hospitalization cost coverage for insured persons is
presented in Table 5.2. Among the 32 insured hospitalized persons, 10 individuals have received
full free treatment and 13 patients have received partially free treatment in the studied area. In
urban area, number of insured hospitalized individuals whose hospitalization cost was fully
covered is more when compared to rural hospitalized individuals. The reverse picture is found to
be true in case of partially covered. It is noticed that some hospitalized insured persons, both in
rural and urban areas have paid fully for their treatment because they have obtained the
healthcare services from the non-empanelled health institutions. The table reveals that cost of
hospitalization is covered by the insurance to majority of the insured persons.

Table 5.2: Extent of coverage of hospitalization cost of insured persons by residence

Fully Partially Not Total

Residence covered covered covered
Rural 3 8 4 15
Urban 7 5 5 17
Total 10 13 9 32*
* One was in hospital hence not considered

5.3 Clients satisfaction and problem faced

Satisfaction and problems faced by insured persons in getting insurance benefits is given
in Figure 5.1. Ten out of fifteen rural insured hospitalized individuals and 2 out of 17 urban
insured hospitalized persons have expressed satisfaction in getting the insurance benefits. More

28
number of urban hospitalized insured persons mentioned the problems in getting the benefits of
health insurance than the rural hospitalized and insured persons.

Figure 5.1: Satisfaction& problem faced

20%

15%
12%
10%

5%

2%

Rural Urban Total

Satisfied Faced Problem

5.4 Extent of coverage of outpatient cost of insured persons by residence

Although health insurance covers mainly hospitalization cost but some schemes cover
both outpatient and inpatients cost. Therefore, extent of coverage of outpatient cost of insured
persons by residence is discussed below. There are 360 persons who have fallen sick and have
got treatment from healthcare centre during the reference period. Of the total sick, only 66
persons were enrolled under any of the health insurance scheme. Of the sick insured persons,
only 13 patients have received free treatment in the studied area. Number of persons who
received free treatment are more in the urban (11) area than the rural area (2). With respect to
cost of the outpatients, rural patients had spent slightly more than the urban patients. The average
cost of outpatients in rural and urban are Rs. 1661 and 1454.16 rupees respectively. It indicates
that insured persons have not received much cash benefits for outpatient treatment from the
enrolled scheme.

29
6. Conclusions

The study points out that there is a large gap at the level of awareness and the extent of
coverage of health insurance between rural and urban as well as among the different population
sub-groups. Though quite a good number of respondents heard about the health insurance, but
large number of the informants irrespective of household and individual characteristics and
residence do not possess the knowledge on some essential components such as kinds of health
insurance that are existing in the market, eligibility criteria for enrolment, place of registration,
type of diseases covered, place of treatment etc. This is because no scientific method of
knowledge delivering system exists. As observed in the study, majority of the respondents have
received information on health insurance from the informal source i.e., friends, relatives, and
colleges. This is an unreliable source because there are lot of scope for passing incomplete and
erotic information. Many times they themselves lack correct awareness. The scientific way of
delivering the knowledge is largely missing in the studied area. The knowledge should be given
in a scientific way. The focus group awareness programmes may be held. Group meetings from
experts at work place, at village level, for SC/ST groups, BPL families and illiterates may be
organised. Type of health insurance, eligibility criteria, premium amount, sum assured,
advantages of insurance etc. might form the essential components of such meetings. Mass media
can also be utilized for enhancing the knowledge among the public. Although knowledge and
coverage is better in the urban areas compared to the rural, but both knowledge level and extent
of coverage of health insurance is not substantial in the urban. Hence both the rural and urban
households deserve to receive the information. The coverage of health insurance is much less
despite the level of awareness on advantageous of insurance is fairly good. This may be because
of the people think in a different way; spending money for health insurance premium is a waste
as it will not be returned after maturity and whenever the emergency situation raises like
someone in the household has seriously fallen ill or a woman has become pregnant, then only
one can register in the schemes. Besides, awareness and coverage of health insurance schemes
which are meant for BPL families like RSBY or Arogya Karnataka is low, because of lack of
knowledge. Some households are having RSBY or Arogya Karnataka card, but many of them do
not know how to utilize the same. It is found in the survey that majority of the households which
are having such cards did fully paid the hospitalization charges when their household member

30
was admitted to hospital. Underutilization of the given facility can be attributable to lack of
knowledge among the BPL families on health insurance card. The knowledge on the
RSBY/Arogya Karnataka schemes and utilization of the card etc. should have been spread by the
insurance companies, but they have not done the job. Comprehensive knowledge on health
insurance and its utilization can only help in improving the coverage of insurance among the
people including BPL households and save the people from health related financial shocks.

31
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