Health Insurance: Awareness, Utilization, and its Determinants among the Urban Poor in Delhi, India

This study reports the awareness, access, and utilization of health insurance by the urban poor in Delhi, India. The study included 2998 households from 85 urban clusters spread across Delhi. The data were collected through a pretested, interviewer-administered questionnaire. Logistic regression was performed for determinants of health insurance possession. Only 19% knew about health insurance; 18% had health insurance (8% Employees State Insurance Scheme – ESIS – 8% Central Government Health Scheme – CGHS – 1.4%; Rashtriya Swasthya Bima Yojana (RSBY) – 9.4% of the eligible households). In case of health needs, 95% of CGHS, 71% ESIS beneficiaries, and 9.5% of RSBY beneficiaries utilized the schemes for episodic and chronic illnesses. For hospitalization needs, 54% of RSBY, 86% of ESIS, 100% CGHS utilized respective services. Residential area, migration period, possession of ration card, household size, and occupation of the head of the household were significantly associated with possession of RSBY. RSBY played a limited role in meeting the healthcare needs of the people, thus may not be capable of contributing significantly in the efforts of achieving equity in healthcare for the poor. Relatively, ESIS and CGHS served the healthcare needs of the beneficiaries better. Expansion of ESIS to the informal workers may be considered. HIGHLIGHTS: • Urban poor have limited awareness and access to health insurance. • The mandatory health insurance schemes better served the healthcare needs. • RSBY played a limited role in meeting the healthcare needs of the people. • The type of slum, migration duration, and ration card were associated with RSBY enrolment.