INTRODUCTION:

“Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”(WHO).

Maintaining good health enhances work efficiency and contributes to increased savings, ultimately fostering the upliftment and well-being of individuals and communities. Rising healthcare costs are contributing to a decrease in savings and increasing vulnerability, which may perpetuate a cycle of poverty. (2016)Increasing healthcare spending alone doesn't necessarily lead to better health outcomes; instead, improving the quality of the financial system and its associated mechanisms is essential. Many developing countries strive to maintain health spending despite fiscal pressure, yet funding for essential health services remains inadequate to save lives, create jobs, and promote growth(Low-Income Countries Spend Just $117.) India’s health system is characterized by very high private out-of-pocket spending, weak protection for low-income households, and poor quality even within existing health plans, so major reform with stronger health insurance is needed(Ellis et al., 2000). Health insurance is now essential to protect people from rising, often unaffordable medical costs, but many still miss out because they lack proper information about it (Chaturvedi and Agnihotri, 2017).

Health insurance is a system that helps finance medical expenses through contributions or taxes paid into a shared fund, which covers all or part of certain health services. Key components include upfront premium payments, pooled resources, and eligibility based on contributions or employment status. Coverage can vary from limited to comprehensive, offering full or partial payments for medical costs, as well as benefits for sickness or parental leave. Private health insurance is typically managed by companies and generally covers hospital and major medical expenses. In contrast, government insurance is funded by mandatory contributions and provides programs such as Medicare and Medicaid in the U.S. This system differs from state-run models like the UK's National Health Service. Managed care frameworks, including Health Maintenance Organisations (HMOs) and Preferred Provider Organisations (PPOs), seek to control costs while providing varying degrees of provider choice and cost-sharing for insured individuals.(Health Insurance | Britannica Money, 2025)

In India, 41% of households have at least one member covered by health insurance. Coverage reaches 29.8% among women and 33.3% among men. These figures highlight persistent gaps in national health insurance coverage(NFHS-5 INDIA_REPORT.). While in Chhattisgarh, 71% of households have at least one member covered by health insurance, with rural coverage slightly higher (72%) than urban (69%). The main health insurance programs include the Rashtriya Swasthya Bima Yojana (RSBY), the State Health Insurance Scheme, and the Central Government Health Scheme (CGHS). Among people aged 15-49, about 67% of women and 70% of men have some form of health insurance (NFHS-5_Chhattisgarh (2), n.d.).

OBJECTIVE:

1. A comprehensive analysis of health insurance coverage in India, including its various types and structures.

2. To conduct an analysis of health insurance coverage in Chhattisgarh.

3. To Study Government allocation for health financing and health insurance schemes.

RESEARCH METHODOLOGY:

This study examines the trends in Health Insurance Coverage in India over the past twenty years and how it has evolved over time. The research relies on secondary data sourced from the National Family Health Surveys (NFHS-1, NFHS-2, NFHS-3, NFHS-4, and NFHS-5), National Health Accounts (NHA), government budget documents, and economic surveys. The study is descriptive in nature and seeks to evaluate the types of Health Insurance coverage as well as the differences between Rural and Urban areas, with a particular focus on Chhattisgarh and its health coverage.

DISCUSSION:

Table 1- Health Insurance cover in India (%) 2005-06

	Urban	Rural	Total
Employee state insurance scheme (ESIS)	28.8	19.9	26.1
Central government health scheme (CGHS)	21.3	17.6	20.2
Community health insurance pro gramme	2.5	11.9	5.4
Other health insurance through employer	6.2	5.2	5.9
Medical reimbursement from employer	12.9	8.7	11.6
Other privately purchased commercial health insurance	27.2	28.1	27.5
Other	2.6	8.5	4.4
Missing	1.3	2	1.5
Total	10.4	2.2	4.9
Source NFHS-3 2005-06

Table 2- Health Insurance cover in India (%) 2015-16

	Urban	Rural	Total
Employee State Insurance (ESIS)	10.6	1.9	4.9
Central Government Health Scheme (CGHS)	8	3.3	4.9
State health scheme	45.8	50.1	48.7
Rashtriya Swasthya Bima Yojana (RSBY)	19.5	41.4	33.9
Community health programme	0.9	0.5	0.6
Other insurance through employer	3.8	0.7	1.8
Medical reimbursement through employer	3.7	0.5	1.6
Medical commercial health insurance	8.5	1.8	4.1
Other	4.1	3.4	3.6
Total	20.2	28.9	28.7
Source NFHS-4 2015-16

Table 3- Health Insurance cover in India ( %) (2019-21)

	Urban	Rural	Total
Employee State Insurance (ESIS)	7.8	1.8	3.7
Central Government Health Scheme (CGHS)	10.8	8.7	8
State health scheme	42.4	47.8	46.1
Rashtriya Swasthya Bima Yojana (RSBY)	12.7	17	15.7
Community health programme	0.5	0.3	0.3
Other insurance through employer	2.6	0.4	1.1
Medical reimbursement through employer	2	0.2	0.7
Medical commercial health insurance	8	1.3	3.4
Other	19.6	29.3	26.3
Total	38.1	42.4	41
Source NFHS-5 2020-21

The tables presented illustrate the status of health insurance in India. Table 1 highlights the health insurance coverage in India for the year 2005-06, revealing that only 4.9% of the population had access to health insurance, with notable differences between urban and rural areas. In urban regions, 10.2% of people had health insurance, compared to just 2.2% in rural areas. The highest percentage of individuals held privately purchased health insurance at 27.5%, followed closely by the Employees' State Insurance Scheme (ESIS) at approximately 26%, with a higher prevalence in urban areas. The Central Government Health Scheme accounted for 20.2% of coverage, again showing a pattern of higher enrollment in urban areas (21.3%) compared to rural areas (17.6%). In contrast, the Community Health Program had a greater enrollment from rural areas, at 11.9%, compared to just 2.5% in urban areas.

Table 2 illustrates the overall coverage increases, which stand at 28.7%. In urban areas, coverage is recorded at 20.2%, while rural areas show an increase of nearly 29%. A significant portion of insured individuals, 49%, are enrolled in the state health insurance scheme, with 46% from urban areas and 51% from rural areas. The RSBY launched in 2008, reported that by 2015-16, it covered 34% of insured families, demonstrating higher coverage in rural areas, 41% compared to urban one, which was 20% of insured families. In contrast, commercial health insurance accounted for only 4% of the coverage.

Table 3 illustrates the situation for the year 2020-21, highlighting that 41% of families had at least one member enrolled in a health insurance scheme. In urban areas, the percentage of insured individuals was 38%, while in rural areas it was slightly higher at 42.4%. The majority of people were covered under state health schemes, which accounted for approximately 46% of beneficiaries, with 42% coming from urban regions. The RSBY provided coverage to 16% of the insured, with a higher prevalence in rural areas compared to urban settings. In contrast, central government health schemes only covered 8% of individuals.

Chart 1: State-wise coverage of Health Insurance in India

Siource NFHS-4 and NFHS-5

Chart 1 illustrates the state-wise coverage of health insurance in India, revealing that overall coverage increased from 29% in 2015-16 to 41% in 2020-21. Most states have shown a rise in coverage percentages. Chart 2 further depicts the trend in health insurance coverage across India, highlighting both urban and rural areas. According to NFHS data, men consistently had higher coverage rates compared to women in both settings. In 2015-16, 20.4% of women and 23% of men were covered, which improved to 30% for women and 34% for men by 2019-21. Notably, coverage rates were higher in rural areas than in urban ones, thanks in part to state health schemes and the RSBY initiative. Additionally, the share of private health insurance is notably greater in urban areas than in rural ones.

Chart 2: Health insurance Coverage in india

Source NFHS

Chart 2 illustrates that in the years 2015-16, approximately 69% of families in the state had health insurance, a figure that increased to 71% by 2020-21, positioning the state as one of the top performers in India. Chart 3 highlights the disparities in coverage between rural and urban areas, revealing that following the implementation of the Rashtriya Swasthya Bima Yojana (RSBY) and state health initiatives, rural regions have achieved higher coverage rates than their urban counterparts. The state has successfully operated its own health insurance scheme, and in conjunction with RSBY, this has significantly enhanced coverage, despite the relatively low number of individuals possessing private or commercial health insurance.

Chart 3

Source NFHS-4NFHS-5 (NFHS-5 Chhattisgarh (2).)

Table 4 Coverage of Health Insurance in percentage in Chhattisgarh 2019-21

Type of Coverage	Urban	Rural	Total
Employees' State Insurance Scheme (ESIS)	3	0.8	1.3
Central Government Health Scheme (CGHS)	3.7	1.6	2
State health insurance scheme	7.3	10	9.4
Rashtriya Swasthya Bima Yojana (RSBY)	72.1	76.9	75.9
Other	17.2	13.5	14.3
Source NFHS-5 Chhattisgarh

The highest coverage is found through the RSBY and state health insurance schemes, with rural beneficiaries being higher compared to beneficiaries from urban areas.

LIMITATIONS OF THE STUDY:

The study utilises NFHS data, with the most recent NFHS-5 data covering health information up to 2021. However, this dataset does not include information on the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana AB-PMJAY, the world’s largest health financing scheme. This program offers up to Rs. 500,000 per year per family, without any limitation on family members, and provides cashless treatment in empanelled hospitals across the country. It boasts broader coverage than earlier initiatives such as RSBY.

CONCLUSION:

The assessment of health insurance in India over the past twenty years shows significant progress, largely driven by government initiatives rather than private insurance. According to the National Family Health Survey, coverage increased from 4.9% in 2005-06 to 41% in 2019-21, but this growth has been uneven, with rural areas benefiting more from schemes like the Rashtriya Swasthya Bima Yojana (RSBY). Private and employer-based insurance remains limited in rural regions, highlighting ongoing disparities. There is substantial variation among states, with effective policies in Rajasthan, Andhra Pradesh, and Chhattisgarh, while Bihar and Uttar Pradesh face systemic challenges. Chhattisgarh achieves over 70% household insurance coverage, showcasing the importance of public insurance for low-income groups. Despite these advancements, issues persist in ensuring equity, raising awareness of schemes, and improving service quality. Future policies should focus on reducing disparities, integrating programs, and creating a more inclusive health insurance system to move towards universal health coverage and ensure accessible healthcare for all.

REFERENCE:

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Received on 13.08.2025 Revised on 22.10.2025

Accepted on 30.11.2025 Published on 10.12.2025

Available online from December 26, 2025

International Journal of Technology. 2025; 15(2):69-74.

DOI: 10.52711/2231-3915.2025.00013

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License.