Knowledge, coverage and willingness to enrol in health insurance schemes among rural households: a community-based cross-sectional study

Jada Bharani Parasuram; Tinnaluri Mahesh Kamal Babu; Savithri Bhavaraju; Molakala Vishnu Meghana

doi:10.18203/2394-6040.ijcmph20264107

Authors

Jada Bharani Parasuram Department of Community Medicine, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Chinna Avutapalli, Gannavaram Mandal, Andhra Pradesh, India
Tinnaluri Mahesh Kamal Babu Department of Community Medicine, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Chinna Avutapalli, Gannavaram Mandal, Andhra Pradesh, India
Savithri Bhavaraju Department of Community Medicine, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Chinna Avutapalli, Gannavaram Mandal, Andhra Pradesh, India
Molakala Vishnu Meghana Department of Paediatrics, GSL Medical College, Lakshmipuram, Rajamahendravaram, Andhra Pradesh, India

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20264107

Keywords:

Awareness, Health insurance, Insurance coverage, Rural health, Willingness to enrol

Abstract

Background: Rural households remain vulnerable to catastrophic health expenditure despite the expansion of publicly financed health insurance schemes. This study assessed awareness, coverage and willingness to enrol in health insurance among rural households.

Methods: A community-based cross-sectional study was conducted in Singanagudem village, Krishna district, Andhra Pradesh, from September to November 2021. One village was randomly selected from the rural field-practice area. All 413 households were approached, and 384 participated (response rate, 93%). Data were collected using a pretested interviewer-administered schedule and analysed descriptively.

Results: Overall, 70.3% of households were aware of health insurance, whereas 91.1% held a valid insurance card. Dr YSR Aarogyasri was the predominant scheme among insured households (95.1%), and 85.7% reported family coverage. Among 34 uninsured households, 52.9% were willing to enrol. Fear of medical expenses was the most common reason for willingness (38.9%), whereas lack of trust was the most common reason for unwillingness (50%).

Conclusions: Health insurance coverage was high, but awareness was lower than card possession. Strengthening insurance literacy through frontline health workers may improve informed and equitable use of benefits.

References

World Health Organization. Global Health Expenditure Database. Available at: https://apps.who.int/nha/database. Accessed 31 August 2026.

Ministry of Health and Family Welfare. Government of India. National Health Accounts Estimates for India 2019-20, 2023. Available at: https://www.mohfw.gov.in/sites/default/files/5NHA_19-20_dt%2019%20April%202023_web_version _1.pdf. Accessed 31 August 2026.

Sriram S, Khan MM. Effect of health insurance program for the poor on out-of-pocket inpatient care cost in India: evidence from a nationally representative cross-sectional survey. BMC Health Serv Res. 2020;20:839.

Ministry of Statistics and Programme Implementation. National Statistical Office. Household Social Consumption on Health in India: NSS 75th Round, July 2017-June 2018. NSS Report No. 586, 2020. Available at: https://www.mospi.gov.in/sites/default/files/publication_reports/NSS%20Report%20no.%20586%20Health%20in%20India.pdf. Accessed 31 August 2026.

World Bank. Health Equity and Financial Protection Datasheet: India, 2012. Available at: https://documents1.worldbank.org/curated/en/938741468269379882/pdf/720820BRI0Revi0Box0377304B00PUBLIC0.pdf. Accessed 31 August 2026.

Devadasan N, Ranson K, Van Damme W, Criel B. Community health insurance in India: an overview. Econ Polit Wkly. 2004;39(28):3179-83.

Ahlin T, Nichter M, Pillai G. Health insurance in India: what do we know and why is ethnographic research needed? Anthropol Med. 2016;23(1):102-24.

Government of Andhra Pradesh. YSR Aarogyasri. Available at: https://konaseema.ap.gov.in/ysr-arogyasree/. Accessed 31 August 2026.

Prinja S, Chauhan AS, Karan A, Kaur G, Kumar R. Impact of publicly financed health insurance schemes on healthcare utilization and financial risk protection in India: a systematic review. PLoS One. 2017;12(2):e0170996.

Selvaraj S, Karan AK. Why publicly-financed health insurance schemes are ineffective in providing financial risk protection. Econ Polit Wkly. 2012;47(11):60-8.

Madhukumar S, Sudeepa D, Gaikwad V. Awareness and perception regarding health insurance in Bangalore rural population. Int J Med Publ Heal. 2012;2(2):18-22.

Manuja LM, Viswanatha PG, Nagendra K. Health insurance coverage and its awareness among population in the rural field practice area of Adichunchanagiri Institute of Medical Sciences, B G Nagara, Karnataka. Int J Community Med Public Health. 2019;6(3):1065-70.

Raja TK, Kumar BM, Muthukumar T, Mohan AP. Awareness and perception of health insurance among rural population in Kancheepuram district, Tamil Nadu. Int J Commu Med Publ Heal. 2019;6(9):3808-12.

Aderibigbe SA, Aganaba D, Osagbemi GK, Aderibigbe AA. Knowledge, practice, and willingness to participate in community health insurance scheme among households in Nigerian capital city. Sudan J Med Sci. 2017;12(1):9-18.

Jehu-Appiah C, Aryeetey G, Agyepong I, Spaan E, Baltussen R. Household perceptions and their implications for enrolment in the National Health Insurance Scheme in Ghana. Health Policy Plan. 2012;27(3):222-33.