|Year : 2015 | Volume
| Issue : 1 | Page : 41-43
A community-based study to assess the awareness of health insurance among rural Northern Indian population
Ashish Bansal1, Shewtank Goel2, Abhishek Singh3, Anurag Ambroz Singh4, Anil Kumar Goel5, Sulabha M Naik6, Virender K Chhoker7, Shelesh Goel8
1 Department of Pathology, Major S. D. Singh Medical College and Hospital, Fathehgarh, India
2 Department of Microbiology, Major S. D. Singh Medical College and Hospital, Fathehgarh, India
3 Department of Community Medicine, Shaheed Hassan Khan Mewati Government Medical College, Nalhar, India
4 General Medicine, Shaheed Hassan Khan Mewati Government Medical College, Nalhar, India
5 Department of Paediatrics, Shaheed Hassan Khan Mewati Government Medical College, Nalhar, India
6 Department of Otorhinolaryngology, Shaheed Hassan Khan Mewati Government Medical College, Nalhar, India
7 Department of Forensic Medicine, Santosh Medical College, Ghaziabad, Uttar Pradesh, India
8 Department of Community Medicine, GFIMSR, Ballabgarh, Haryana, India
|Date of Web Publication||17-Dec-2014|
Department of Community Medicine, Shaheed Hassan Khan Mewati Government Medical College, Nalhar, Haryana
Source of Support: None, Conflict of Interest: None
Background : Even after more than 60 years of independence, inequalities in access to health care are widely prevalent in Indian communities. As per National Family Health Survey-3 only 5% household are covered under any health scheme or insurance. Objectives : The present study was planned to conduct with an objective to assess the awareness of health insurance among rural northern Indian population. Materials and Methods : The present cross-sectional survey was undertaken among 422 eligible subjects in the rural field practice area of Department of Community Medicine of a Tertiary Care Centre located in rural Uttar Pradesh, during June 2013 to August 2013. Results : Overall 44.5% of the study subjects were aware of health insurance, while remaining 55.5% had not heard about it. Gender wise males were more aware than females (51.3% vs. 32.4%). Participants belonging to higher socioeconomic class were more aware (67%) compared to those of the lower class. A good number of respondents believed that health insurance is for tax gain (35.30%) and coverage of medical expenses (41.23%). 77.4% of respondents believed in governmental health insurance agencies rather than private insurance companies. Conclusion : The findings of the study highlight that it is need of the hour to launch information, education and communication activities in order to make rural communities aware of the need of health insurance to meet the ever rising medical expenses in view of unpredictable illness and injuries.
Keywords: Awareness, community, health insurance, rural
|How to cite this article:|
Bansal A, Goel S, Singh A, Singh AA, Goel AK, Naik SM, Chhoker VK, Goel S. A community-based study to assess the awareness of health insurance among rural Northern Indian population. Int J Health Syst Disaster Manage 2015;3:41-3
|How to cite this URL:|
Bansal A, Goel S, Singh A, Singh AA, Goel AK, Naik SM, Chhoker VK, Goel S. A community-based study to assess the awareness of health insurance among rural Northern Indian population. Int J Health Syst Disaster Manage [serial online] 2015 [cited 2022 Jun 29];3:41-3. Available from: https://www.ijhsdm.org/text.asp?2015/3/1/41/147203
| Introduction|| |
Even after more than 60 years of independence, inequalities in access to health care is widely prevalent in Indian communities. These inequalities in access to health care are related to socioeconomic status, geography, and gender, and are compounded by high out-of-pocket expenditures, with more than 3/4 th of the increasing financial burden of health care being met by households.  The rise in health care demand has increased the cost of health care system to the extent that specialized care is beyond the reach of common man, only 10% of the Indians have some form of health insurance, mostly inadequate.  As per National Family Health Survey-3, only 5% household are covered under any health scheme or insurance. 
The rural populations are more susceptible to risks such as illness, injury, accident and death because of their unique social and economic circumstances such as the inability to bear hospital expanses at an unpredictable moment. There is a need to provide financial shield to poor families for the same reason. Health insurance could be a way of removing the financial barriers and improving accessibility to quality medical care. Health insurance is an instrument wherein "an individual or group" purchase health care coverage in advance by paying a fee called a premium. ,
Health insurance is a rapidly emerging social security instrument for the rural poor, for whom, chronic health problems, arising due to prevalence of diseases and inaccessibility to an affordable health care system is a major threat to their income earning capacity. Insurance is one of the risk management strategies.  The need for an insurance system that works on the basic principle of pooling of risks of unexpected costs of persons falling ill and needing hospitalization by charging premium from a wider population base of the same community.  Therefore, the present study was planned with an objective to assess the awareness of health insurance among rural northern Indian population.
| Materials and Methods|| |
The present cross-sectional survey was undertaken in the rural field practice area of Department of Community Medicine, Major S.D. Singh (MSDS) Medical College and Hospital, Fatehgarh, Uttar Pradesh, from June 2013 to August 2013. The sample size was calculated with an anticipated prevalence of awareness toward health insurance among study subjects as 50%, 5% absolute precision, 95% confidence interval and 10% nonresponse error as 422 participants.
Study subjects were selected from nine villages coming under the rural field practice area of MSDS Medical College. It has been adopted by this tertiary medical center for rural training of under graduate students in community medicine and for providing health services to the villagers. Subjects, aged ≥25 years and willing to participate were included in the survey. Only one eligible person per household was allowed. Information was collected using a structured questionnaire. It was ensured that respondents understand the meaning of questions well. The questionnaire was pilot tested on 20 subjects and amended for clarity with the addition of some answer options and was modified accordingly. All interviews were conducted by single person. Ethical Committee approved the study. Informed consent was obtained from the study participants.
A detailed questionnaire was framed in consultation with the experts of the field for the purpose of capturing sociodemographic information of the study participants, motive/purpose of taking health insurance, benefits of taking health insurance, sources of information about health insurance, preferences of health insurance etc., The questionnaire was designed in English initially and later translated in Hindi and retranslated to English to check the validity of questions contained.
All the questionnaires were manually checked and edited for completeness and consistency and were then coded for computer entry. After compilation of collected data, analysis was done using Statistical Package for Social Sciences (SPSS), version 20 (IBM, Chicago, IL, USA). The results were expressed as proportions. Chi-square (χ2) test was applied to test the difference across the groups, and P < 0.05 was considered statistically significant.
| Results|| |
Overall 188 (44.5%) of the study subjects were aware of health insurance, while remaining 234 (55.5%) had not heard about it. Gender wise, males were more aware than females (51.3% vs. 32.4%). Participants belonging to higher socioeconomic class were more aware (67%) compared to those of the lower class. Level of awareness improved with their education status. Persons living in joint families were more aware regarding health insurance. Religion wise Hindus (49%) were having maximum awareness followed by Sikhs and Muslims. Relatives/friends and newspapers (media), were the most common (60%) source of information about health insurance followed by insurance agents.
A good number of respondents believed that health insurance is for tax gain (35.30%) and coverage of medical expenses (41.23%). Interestingly, almost 8% of study subjects took health insurance because of pressure from the employer [Table 1].
|Table 1: Motive/purpose and benefi ts of taking health insurance as|
perceived by respondents
Click here to view
[Figure 1] illustrates that more number of respondents (77.4%) believe in governmental health insurance agencies rather than private insurance companies.
Similarly, [Figure 2] illustrates that a major chunk of respondents (class 3-5) do prefer insurance by governmental companies.
|Figure 2: Preference of health insurance type according to socioeconomic class|
Click here to view
| Discussion|| |
The present study is an effort in the area of health insurance to assess the individuals' awareness level and to know determinants of awareness. The prevalence of the awareness of health insurance among 422 rural study subjects was 44.5%. Our findings confirm the views of Kumar from Rajasthan.  Study on awareness about health insurance carried out at Jaipur city of Rajasthan state in India showed 43.4% were aware of health insurance. Another study on the awareness and attitude of the general public toward health insurance among people of Mangalore city showed 64% of the respondents were aware of health insurance. 
In the present study, the awareness was found to be low probably because of the fact that we conducted a survey among the rural population. Majority of the population belonged the lower socioeconomic status and top of that the study population was from Uttar Pradesh, one of the Empowered Action Group states.
Various socioeconomic factors do have an impact on the awareness level. Results of studies carried out elsewhere were also in agreement with the findings of the present study. Another study from Hyderabad also observed that awareness increases with an increase in the educational qualification. 
Awareness in the present study was seen mainly through media and friends. Media seemed to have played an important role in the dissemination of information. Another survey from Gujarat reported that the need for education for rural and urban population alike on the concept of health insurance is a crucial aspect on extending awareness about health insurance on a large-scale.  It can be stated that the socioeconomic status and education do play an important role in awareness on health insurance. An effective information, education and communication (IEC) activities will improve the understanding of the people about insurance.
| Conclusion|| |
The findings of the study highlight the current status of low prevalence of awareness toward health insurance among study subjects. Definitely there is an alarming need to improve the awareness with regard to their knowledge about health insurance covering the medical expenses in the rural communities. It is a need of the hour to launch IEC activities in order to make them aware of the need of health insurance to meet the ever rising medical expenses in view of unpredictable illness and injuries.
| References|| |
Balarajan Y, Selvaraj S, Subramanian SV. Health care and equity in India. Lancet 2011;377:505-15.
Reshmi B, Raghunath R, Unnikrishnan B. Awareness of health insurance among inpatients at a tertiary care hospital in Coastal Karnataka. Indian J Community Med 2010;35:445-6.
Shijith VP, Sekher TV. Who Gets Health Insurance Coverage in India? New Findings from Nation-Wide Surveys. Available from: http://www.iussp.org/sites/default/files/event_call_for_papers/shijith_health%20insurance.pdf. [Last accessed on 2014 Dec 02].
Sunderlal, Adarsh, Pankaj. Textbook of Community Medicine. 3 rd
ed. New Delhi: CBC Publishers and Distributors Pvt. Ltd.; 2011. p. 17-9.
Bawa SK. Awareness and willingness to pay for health insurance: An empirical study with reference to Punjab India. Int J Humanit Soc Sci 2011;1:100-8.
Gumber A, Kulkarni V. Health Insurance for informal sector: A case study of Gujarat. Econ Polit Wkly 2000;35:3607-13.
Mathiyazhagan K. Willingness to pay for rural health insurance through community participation in India. Int J Health Plann Manage 1998;13:47-67.
Kumar S. Awareness about health insurance and willingness to pay. J Acad Hosp Adm 1999;36:139-46.
Reshmi B, Nair NS, Sabu KM, Unnikrishan B. Awareness of health insurance in a south Indian population: A community based study. Health and Popul Perspect Issues 2008;30:177-88.
Jangati Y. Awareness of health insurance in Andhra Pradesh, Hyderabad. Int J Sci Res Publ 2012;2:1-6.
[Figure 1], [Figure 2]