Study on awareness of health insurance among the adult population of rural areas in the Wardha district of Maharashtra: a protocol

Introduction

Globally, the foundation of health insurance is substantial. However, the Indian health insurance sector lags. Every year, a substantial number of Indians, primarily women and children, die due to a shortage of healthcare facilities, particularly in rural areas which are home to the majority of Indians. Most of these rural residents live below the poverty line and cannot afford medical expenditures. Obtaining health insurance is a difficult task for these people.¹

An individual or group can pre-pay for healthcare with the help of health insurance by paying a premium. For the rural poor, health insurance provides a rapidly progressing social security strategy, whose ability to make an income is seriously threatened by chronic health issues brought on by the prevalence of diseases and lack of access to affordable healthcare.^2,3 But according to the 75th round of the National Sample Survey (NSS), only 14.1% of the rural population is covered by health insurance in its report “Key Indicators of Social Consumption in India: Health” (July 2017 – June 2018).⁴ Therefore 85.9% of individuals in rural India still lack health expenditure coverage and thus are uninsured. These findings reflect that a more significant proportion of the rural population is unaware of health insurance and its associated benefits.⁵

The predominant causes of morbidity, particularly in rural regions, are infectious, communicable, and waterborne illnesses, respiratory infections, pneumonia, and genital tract infections. Cancer, blindness, mental health issues, high blood pressure, diabetes, HIV/AIDS, accidents, and injuries are among the non-communicable diseases on the rise.⁶ Rural communities are especially vulnerable to distressing health financing due to their distinctive socioeconomic situations, like the inability to afford healthcare expenditures at an unforeseen time.⁷ For the same reason, it is necessary to give low-income families financial protection. Health insurance may be a means to lower expenditure and make it more accessible to high-quality healthcare.^8,9 Even if a population uses either private or public health systems, the policymakers want to provide health insurance to them to reduce their out-of-pocket expenditures and assist them in achieving the majority of universal health coverage.¹⁰

In India, the state and central governments offer numerous health insurance programs. Through the process of comprehensive coverage along with affordable premiums, these programs aim to offer health insurance to all Indians. The Mahatma Jyoti Rao Phule Jan Arogya Yojana (MJPJAY) (https://www.jeevandayee.gov.in/), Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) (https://nha.gov.in/PM-JAY), and Central Government Health Scheme (CGHS) (https://cghs.nic.in/) are a few of the government-sponsored health insurance plans. On April 1, 2020, the MJPJAY and ABPMJAY were introduced in the state of Maharashtra.¹¹ Health insurance is provided to beneficiaries in the insurance mode by United India Insurance Company Limited and in the assurance mode by the State Health Assurance Society. On behalf of the eligible households, the State Health Assurance Society pays an insurance premium of Rs.797/- per family annually to the insurance firm in quarterly instalments.¹²

The ultimate sustainable development goal (SDG) Target 3.8 is to achieve universal health coverage (UHC) including financial risk protection and affordable quality health care services and medicine for all. These efforts are strategies to promote health equity by reducing disparities among individuals across the globe. Hence rural individuals must be aware of and use the abovementioned health insurance programs.

Methods

Discussion

Gowda et al., did a study named ‘Awareness about health insurance in rural population of South India’ in 2014.¹³ The study objective was to evaluate the sociodemographic features of respondents and to assess the level of health insurance awareness among rural residents. 81% of the participants in this survey knew about health insurance, as per the results of this study. But this study also came to the conclusion that among them, utilization of health insurance was low and the respondents needed to be educated on behaviour change.

In 2013, Bansal et al., carried out another study with the title ‘A community-based study to assess the awareness of health insurance among rural Northern Indian population’.² The setting for this study was rural Uttar Pradesh. The study’s main objective was to determine how much rural individuals in Northern India knew about health insurance. Study outcomes suggested that 55.5% of study participants had never heard of health insurance, compared to 44.5% who were generally aware of it. Conclusions from the research revealed that among the study subjects, health insurance awareness was currently not widely prevalent.

A community-based study entitled ‘Awareness and perception of health insurance among rural population in Kancheepuram district, Tamil Nadu’ was conducted in 2019 by Raja T. K. et al.¹⁴ This study’s objective was to evaluate rural residents’ knowledge, use, and attitudes toward health insurance. Study results showed that, health insurance awareness was seen in 51% of participants, with television being the most primary source of information.

In 2015, Indumathi K et al., conducted a study entitled ‘Awareness of health insurance in a rural population of Bangalore, India’.⁸ Analysis of the study population’s awareness of health insurance as well as the study of its socioeconomic and demographic features was among the study’s primary objectives. The study’s findings indicated that while 24.3% of participants were unaware of health insurance, 75.7% of the participants had some knowledge of it. This study concluded that, it is necessary to start effective Information, Education, and Communication (IEC) programs to raise awareness of the importance of health insurance.

Conclusions

Lack of health insurance in rural areas is one of the barriers to healthcare access. Individuals without health insurance will experience impoverishment due to health-related problems. Increased health insurance awareness can also be an indicator of universal health coverage. The awareness, perception, and utilization of health insurance among people in rural communities will be evaluated in this study. With the help of this study, we can gain an understanding of this aspect in rural areas.