Economic Burden of Non-Communicable Diseases and Challenges of Health Insurance Coverage: Insights from Primary Survey

Abstract

India’s health system ranks as one of the world’s most heavily dependent on out-of-pocket expenditures (OOPE). According to WHO (2018), roughly 63 percent of health expenditure in India is out-of-pocket. As per the National Sample Survey-75th round of the health survey, approximately 80 percent of the population is without any health insurance coverage. India has witnessed a sharp increase in the share of NCDs in the total disease burden from 30 percent in 1990 to 56 percent in 2016, also percentage of death due to NCDs in India has increased from 37 percent in 1991 to 61 percent during the same period. The rising burden of disease has increased the total share of out-of-pocket expenditure on health, consequently leading to catastrophic health expenditure, impoverishment, and distress financing. The extent of poverty is deeper than the estimated national figure due to high OOPE and negligible health insurance coverage in the era of rising disease burden. Against this backdrop, this study examines the association between health insurance on healthcare utilization and the burden of OOPE among people with reported NCDs. The findings of the study are based on the primary data analysis collected through a web-based survey. Through descriptive and regression analyses, the study presents evidence on awareness, and decision-making process in the insurance uptake, therefore, providing a behavioral approach for policy design to expand insurance coverage.