Hankar ODS 2015

Oxford Development Studies
ISSN: 1360-0818 (Print) 1469-9966 (Online) Journal homepage: http://www.tandfonline.com/loi/cods20
Determinants of Health Insurance Penetration in

India: An Empirical Analysis
Anindita Chakrabarti & Anand Shankar
To cite this article: Anindita Chakrabarti & Anand Shankar (2015) Determinants of Health
Insurance Penetration in India: An Empirical Analysis, Oxford Development Studies, 43:3,
379-401, DOI: 10.1080/13600818.2015.1057116
To link to this article: http://dx.doi.org/10.1080/13600818.2015.1057116
Published online: 29 Jul 2015.
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Date: 26 July 2016, At: 00:50
Oxford Development Studies, 2015

Vol. 43, No. 3, 379401, http://dx.doi.org/10.1080/13600818.2015.1057116
Determinants of Health Insurance

Penetration in India: An Empirical Analysis
Downloaded by [Central University of Tamil Nadu] at 00:50 26 July 2016
ANINDITA CHAKRABARTI & ANAND SHANKAR

ABSTRACT Insufficient participation of the government in the provision of health care services to
the people puts tremendous pressure on households financing their health care expenditure from
private sources. Health insurance can be seen as an effective measure to circumvent this problem.
However, penetration of health insurance in India is very low. This article seeks to explore the
effect of household assets, access to media demographic and caste profile of households in
explaining the use of health insurance in India using data from the National Family Health SurveyIII. Results suggest that richer households have a higher probability of enrolling into health
insurance and access to media exerts a positive significant impact on health insurance enrolment.
Particularly vulnerable are those from the scheduled tribe background in both rural and urban
region and the Muslim community residing in urban area. Non-profit insurance scheme such as
community-based health insurance (CBHI) has limited success in drawing people from the poorest
economic status into their safety nets. Considerable regional disparity exists in terms of health
insurance enrolment pattern. Odds of enrolling in private health insurance and public health
insurance in comparison to no insurance are significantly higher for urban region. The opposite
result holds for CBHI scheme.
1. Introduction
The share of government expenditure in total healthcare expenditure in India has been
falling over the years and people have to spend more from their own pockets. The
increasing trend in out-of-pocket expenditure on healthcare has led to 24% of all
hospitalised Indians falling below the poverty line as a result of these costs (Ahuja,
2004). The poor have to use their savings, forgo current income and take out loans in
order to finance their healthcare expenditure (Duggal, 2007). This is where health
insurance, construed as any financial arrangement in which consumers can avoid or
reduce their expenditures on health services at the time of their use, can play a vital role
(Gupta & Alam, 2000). By pooling risks and separating the period between paying for
insurance and the expenditure incurred at the time of using the health service, health
insurance can shield households from uncertainty and the burden of financing their
healthcare out of their own pockets. Hence, this article attempts to estimate the factors
determining enrolment in any form of health insurance schemeboth in terms of overall
Anindita Chakrabarti (corresponding author), Economics, Leeds University Business School, University of
Leeds, Leeds, UK. Email: anindita_ch@hotmail.com. Anand Shankar, Reserve Bank of India, Mumbai, India.
Email: anandroma@gmail.com
The views expressed in this article are those of the authors and not the institutions to which they belong.
q 2015 Oxford Department of International Development
380
A. Chakrabarti & A. Shankar
enrolment and by product-specific categories. We focus on household assets, access to

media, age and caste profile as factors determining different forms of health insurance
enrolment. The urban rural gap in accessing health insurance is also assessed based on
household-specific micro data.
Our results indicate that families belonging to the poorest wealth categories have the
lowest likelihood of having any health insurance protection. Households in both rural and
urban samples with a greater number of older members do not show a significantly
different pattern of health insurance coverage from other households. Households
exposure to media, even after controlling for educational attainment and economic status,
has a significant positive influence on peoples awareness and enrolment in health
insurance schemes. Households belonging to marginalised castes, particularly those from
scheduled tribe (ST) backgrounds and with a relatively lower economic status, have a
lower likelihood of being enrolled in any health insurance scheme than other social
groups.
The rest of this article is organised as follows: Section 2 provides a brief exposition of
the existing literature; Section 3 outlines the data and explanatory variables used; Section
4 documents the results; and Section 5 concludes.
2. Health Insurance: A Literature Review
Health insurance in India broadly falls into three categories: social health insurance (SHI),
private health insurance (PHI), and community-based health insurance (CBHI) schemes.
SHI primarily consists of schemes like the central government health scheme (CGHS)
which is aimed at the employees (and their families) of the central government, and the
employees state insurance scheme (ESIS) which caters to the health needs of low-wage
earners and their dependants in the organised industrial sector. PHI schemes are offered by
private and public health insurance companies, and involve an individual buying a certain
amount of coverage for a price (called premiums) which is unaffordable for many. CBHI are
not-for-profit health insurance schemes aimed at low-income people, particularly those
working in the informal sector such as women working in dairy co-operatives members of
this scheme participate in its management.1
But how far does the existing SHI coverage benefit the general populace, particularly
the most deprived? This has been a subject of interest not only in India but also across
other developing countries such as Senegal, Rwanda and Thailand (Jutting, 2004, China,
Colombia, Mexico, Philippines, Vietnam and some OECD nations Wagstaff, 2007, 2009,
2010). A partial list of research focusing on India includes Gumber and Kulkarni (2000),
Gupta and Alam (2000), Ahuja and Jutting (2003), Ahuja (2004), Devadasan, Ranson, Van
Damme, and Criel, Van Damme, and Criel (2004), Acharya and Ranson (2005), and Bhat
and Jain (2006).
There has been an increasing trend in developing countries to switch from taxfinanced (and out-of-pocket healthcare payments) to SHI contributions for healthcare
funding. Poor enrolment in such schemes by formal sector employees recorded in
various countries, including China, Vietnam, Colombia and Kazakhstan, has raised
questions about the efficacy of SHI schemes for generating adequate health revenues
(see Wagstaff, 2010 for details). The other major concern is that while such SHI
schemes rely on formal sector employees for contributions, the majority of the
workforce is employed in the informal sector. To bring this category of population
Determinants of Health Insurance Penetration in India
381
particularly the poorinto the gambit of health insurance coverage, several measures
have been adopted. Some developing countries, including India, China, Rwanda, and
Senegal, attempt to draw in people from the poor informal sector through community
organisations such as existing micro-credit schemes (Devadasan, Ranson, Van Damme,
& Criel, 2004; Jutting, 2004). Except for China, these schemes have shown little
promise due to poor enrolment and limited coverage, with households paying
considerable out-of-pocket health expenses. Other countries (such as Colombia and
Vietnam) have designed policies targeted for the poor where their SHI membership is
funded publicly through general revenues.
These schemes suffer from problems of both exclusion and inclusion. Intended poorer
beneficiaries are at times excluded while the richer households are included. For
instance, the targeted poor in the above-mentioned countries (Colombia and Vietnam) in
some cases fail to apply for insurance even when the schemes were non-contributory
SHI ones. Furthermore, relatively rich households were found to enjoy health insurance
benefits from such SHI schemes in Mexico, Vietnam and Colombia (Wagstaff, 2010),
and community based systems in Senegal (Jutting, 2004) contrary to the aims of the
schemes.
Household heads age, education, ethnicity and regional location were the other
significant determinants in explaining health insurance coverage for the poor. In Vietnam,
for example, households with aged, illiterate heads and located in rural backward regions
have a significantly higher probability of being covered by non-contributory SHI schemes
(Wagstaff, 2007). In fact, the importance of income and education as major explanatory
variables in explaining (private) health insurance purchase decisions can be traced back to
Grossman (1972), Besley, Hall, and Preston (1999), Cameron and Trivedi (1991),
Cameron, Trivedi, Milne, and Piggott (1988), Emmerson, Frayne, and Goodman (2001)
and Propper (2000).2 Generally, in these studies income and education were found to have
a positive association with privately purchased health insurance coverage, in contrast to
non-contributory SHI schemes where the association is negative (at least for education as
seen from our previous discussion on SHI). More educated people are more aware of
health risks and hence have a higher probability of opting for PHI. The studies also
consider other important determinants such as family size and age with age exerting a
positive and significant impact on the probability of having private insurance cover
(Besley et al., 1999; Cameron et al., 1988; Propper, 2000) because of the higher perceived
risk of ill-health at older ages. However, no significant relationship was established
between family size and the likelihood of a household purchasing insurance (Cameron &
Trivedi, 1991).
Recent research has shown that the poor in India are insurable and are also able to
make periodic contributions towards such insurance (Ahuja, 2004; Ahuja & Narang,
2005; Gupta & Alam, 2000). However, the research suggests that health insurance for
the poor requires some degree of external funding or subsidy in order to sustain the
schemes. Also, existing insurance contracts need to include the cost of transportation to
the hospital, incidental costs and wages lost as these expenses often prevent the poor
from seeking medical care. The schemes need to be flexible in design and to ensure
prompt settlement of claims. The studies further suggest that nodal agencies like NGOs
and micro-finance organisations can act as intermediaries, helping to disseminate
information and to organise the poor for a more effective implementation of CBHI
schemes.
382
Empirical evidence shows that in spite of increased interest in community-financed

insurance schemes as a source of health resources for the poor, there are large differences
in the socio-economic determinants of peoples participation in health insurance schemes
in India (Acharya & Ranson, 2005; Ahuja, 2005; Bhat & Jain, 2006; Devadasan, Ranson,
Van Damme, & Criel, 2004; Gumber & Kulkarni, 2000). Findings from these studies
reveal that Indian households with a higher income and ability to pay have a higher
probability of being a member of pre-payment CBHI schemes and to benefit from them.3
The studies conclusions, however, are based on localised samples (the majority of the
cases focus on Gujarat, India) and are not nationally representative. The failure of CBHI
schemes to provide broad-based coverage is due to the following reasons: lack of a
comprehensive benefits package (for example, most health insurance products surprisingly
do not cover the safe delivery of a child4); technical mismanagement leading to a heavy
administrative burden on the community; inadequate legal standing (the Insurance
Regulatory Development Act of 1999 does not acknowledge such schemes); unaffordable
premiums for the poorest of the poor; and insufficient support from the government (Ahuja
& Jutting, 2003; Devadasan, Ranson, Van Damme, & Criel, 2004).
The majority of studies based on India have focused on specific health insurance
products (mainly CBHI schemes) and their efficacy in providing safety nets for the poor,
using localised samples. However, there is a lack of literature explaining peoples
willingness to participate in health insurance schemes in India, particularly within urban
areas, or investigating types of schemes other than the CBHI. This article thus attempts to
fill the gap by estimating the factors determining current enrolment in health insurance
schemes overall and by product-specific categories. Particular emphasis is placed on
comparing the determinants across two types of voluntarily chosen health insurance
schemes: typical PHI purchased from the market vis-a`-vis the non-profit CBHI schemes.
3. Data and Explanatory Variables

We use data from the Indian National Family and Health Survey 2005 2006 (NFHS-III)
which provides information about the usage of health insurance at the household level.
This study is thus based on 52 669 observations pertaining to the rural sample and 40 591
Figure 1. Percentage of households using health insurance: major states. Source: International
Institute for Population Sciences (IIPS) and Macro International (2007) and authors calculations.
383
observations from the urban sample across 29 states of India. The use of health insurance
in the rural sample is very low: only 3 households out of every 100 households report using
any form of health insurance. Even in the urban sample only 11 out of every 100
households report using health insurance. The state-wise breakdown of use of health
insurance is shown in Figure 1. The use of health insurance is highest in Delhi with 16 out
of 100 households using health insurance; in contrast, Bihar and UP show extremely low
usage (only 1 out of every 100 households). Disaggregated data in terms of type of health
insurance coverage show a higher prevalence of most schemes in urban areas, except
CBHI (Figure 2). The higher prevalence of CBHI in rural areas is because it is targeted
towards low-income people.
The determinants of the likelihood of being currently enrolled in any health insurance
programme is estimated on the basis of a probit model where the dependent variable
is a dummy Insurance 1 if the household is currently enrolled in any form of
health insurance and Insurance 0 otherwise. In this context, we have followed the
definition provided by Gupta and Alam (2000)5 and have included reimbursement
from employers at the time of illness as a part of privately provided health insurance
since this allows for complete or partial payment for health services at the time
of use.
We have also assessed the choice of health insurance in terms of distinct product
categories on the basis of a multinomial logit (MNL) model. MNL regression estimates the
following probabilities:
exp bj * x
Py j P4
;
j0 bj * x
where P(y j) denotes the probability of choosing outcome j for all j 0, 1, 2, 3 and
4. It is important to note that outcome 0 indicates No health insurance, outcome 1
indicates Public health insurance, outcome 2 indicates Community based health
insurance, outcome 3 denotes Private health insurance and outcome 4 indicates other
health insurance. The vector x includes all the independent variables included in the
29.93
Rural
Urban
28.14
27.62
21.13
4.72
6.42
Health
Insurance
(Employer)
CBHI
2.73
7.77
12.62
9.42
2.75
Others
12.07
Comm Health
Insurance
18.07
Reimbursement
(Employer)
21.63
CGHS
35
30
25
20
15
10
5
0
ESIS
3.1 Empirical Methodology
Figure 2. Percentage of health insurance scheme. Source: International Institute for Population
Sciences (IIPS) and Macro International (2007) and authors calculations.
384
model, which is discussed in the following section, and bj is the corresponding

coefficient vector for each of the outcomes j. To make the system identifiable, in the
MNL framework, one of the coefficients is set to 0.6 In our case we have set the
coefficient vector b0 to 0 or, in other words, No health insurance is treated as the base
category. Consequently,
Py 0
P4
j1
expb*
j x
for j 0
and
Py j
expb*
j x
P4
1 j1 exp b*j
for j 1; 2; 3; and 4:
This, in turn, leads to the following odds relative to the reference group, namely, No
Health Insurance:
Py j
exp b*
j x for j 1; 2; 3; and 4:
Py 0
The coefficient vector b*j captures the association between the independent variables and
the odds of the household member being currently enrolled in a particular type of health
insurance scheme. The detailed econometric methodology underlying the probit and MNL
models can be seen in Greene (2008).
3.2 Explanatory Variables
Given our focus, and based on literature drawn about other countries, we use a set of
explanatory variables primarily to estimate the relationship between household wealth,
exposure to media, age and ethnicitywith the probability of current enrolment in any
health insurance product. Descriptive statistics for the rural and urban samples are reported
in Appendix Table A1.
3.2.1 Household wealth. The NFHS III Survey does not provide any information on
household income or monthly expenditure, but elicits data on a wide variety of household
assets and assigns a unique wealth index to each household based on its possessions [the
methodology used to construct the index is similar to that proposed by Filmer and
Pritchett (2001)].7 We use two dummy variables, namely, household high asset (upper
31% of households) and household medium asset (middle 24%) based on the reported
wealth index where each of the dummies will take the value 1 if the household falls
under that category and 0 otherwise. Households belonging to the lowest 45% in terms of
the asset index are treated as the base group. This is a better reflection of a households
economic status for three reasons. Firstly, the former dummy variables created on the
basis of households assets are more accurate measures than ones based on income/
expenditure due to a lower chance of misreporting. Secondly, there is a one-to-one
correspondence between classification of households using the asset index and that based
on reported consumption expenditurewhich is another proxy often used in lieu of
income (see Filmer & Pritchett, 2001 for details). Finally, given the seasonal fluctuations
385
in income, indices based on a households possession of assets can act as a better

indicator of the households economic ability to meet the recurring payment of an
insurance premium.
3.2.2 Media exposure variables. Lack of information has been cited as a major barrier to
people taking up health insurance products, particularly for those engaged in low-paying
jobs in the informal sector (Bhat & Jain, 2006; Gumber & Kulkarni, 2000; Gupta, 2000).
Given this point, we incorporate three dummy variables to capture the effect of newspaper,
radio and television media as ways of communicating information about health insurance
products: each binary variable takes a value of 1 if any woman in the age group 15 49
years in the household confirms they have read a newspaper/listened to radio/watched
television at least once a week and 0 otherwise.8
3.2.3 Age profile variables. We include these variables to see whether the age profile
within a household has any effect on the decision to use health insurance. We have
controlled for those members of a family who are likely to be in a greater need for
medical services (due to potential health risks) and are also typically from the nonworking population. Hence, we have incorporated the following: the number of
members in the household (HH) who are above 60, the number of children in the HH in
the age group 0 5, and the number of children in the HH between ages 6 to 15. 9 In
addition, we used an interaction dummy to see if households with the highest level of
assets and at least one member aged above 60 have a different insurance enrolment
pattern.
3.2.4 Caste variables. Families belonging to the marginalised castes [scheduled caste
(SC), ST category and other backward caste (OBC) category] have shown a poor record of
educational achievement and health status as compared to the general population, due to
their geographical isolation, problems in having contact with other community members,
and poverty (Chanana, 1993; Filmer & Pritchett, 2001). How far caste background
contributes to explaining health insurance participation is a matter of interest. In the
context of India where historically caste classification was based on the occupation of the
household head and was continued through the family lineage, caste may be strongly
related to household wealth. As such, we have also used a set of interaction dummies to
account for the different caste-wealth combinations.
3.2.5 Other control variables. The decision of households to use any form of health
insurance could also depend, inter alia, upon the gender, age, education and ethnicity of
the household head (Wagstaff, 2007). Household head profile has been included here to
see if families with a more educated head or those belonging to the higher age groups have
a greater likelihood of seeking health insurance protection. As seen from the existing
literature (Bhat & Jain, 2006), the decision by households to use health insurance also
depends on the occupation of its members. Thus, we use these variables as control
variables.
386

Table 1. Determinants of health insurance coverage: probit estimates
Urban
Rural
Combined
Marginal
Marginal
Marginal
effects p-value# effects p-value effects p-value#
Household Asset Variables

Dummy for HH with Medium Asset
(base grp: Low Asset)
Dummy for HH asset High Asset
Media Exposure Variables
Newspaper (Dummy 1 if member
reads newspaper)
Radio (Dummy 1 if member
listens to radio)
Television (Dummy 1 if member
watches television)
0.048
0.000
0.023
0.000
0.033
0.000
0.111
0.000
0.053
0.000
0.088
0.000
0.011
0.001
0.003
0.030
0.006
0.000
0.008
0.010
0.001
0.537
0.004
0.012
0.010
0.021
0.007
0.000
0.008
0.000
0.807
2 0.002
0.394
20.003
0.176
0.627
0.002
0.247
0.002
0.287
0.155
0.000
0.701
20.001
0.529
0.193
0.000
0.573
0.001
0.192
2 0.016
0.011
2 0.010
0.031
0.023
2 0.010
2 0.034
0.000
2 0.006
0.275
0.717
0.519
0.118
0.209
0.720
0.156
0.991
0.663
2 0.004
2 0.001
0.001
0.010
0.014
2 0.001
2 0.004
0.003
2 0.002
0.215
0.753
0.713
0.097
0.043
0.909
0.431
0.528
0.675
20.008
20.003
0.000
0.016
0.014
0.001
20.013
0.000
20.008
0.077
0.652
0.959
0.026
0.040
0.930
0.041
0.995
0.094
0.019
2 0.022
0.001
0.001
0.003
0.811
0.007
0.002
2 0.003
0.001
0.621
0.197
0.011
20.009
20.001
0.000
0.009
0.579
0.002
0.000
0.005
0.013
0.093
0.000
0.002
0.000
0.001
0.000
0.000
0.000
0.002
0.000
0.003
0.000
0.000
0.000
0.020
0.168
0.003
0.439
0.012
0.023
Age Profile Variables

Interaction Dummy to control for
0.002
HHs at highest asset level with
number of aged above 60 members
Number of members in HH above
2 0.003
age 60
Number of members in HH between 2 0.003
ages 0 to 5
Number of members in HH between
0.002
ages 6 to 15
Caste Profile
Dummy for Scheduled Caste
Dummy for Scheduled Tribe
Dummy for Other Backward Caste
Scheduled Caste*Medium Asset
Scheduled Caste*High Asset
Scheduled Tribe*Medium Asset
Scheduled Tribe*High Asset
OBC*Medium Asset
OBC*High Asset
Control Variables
Dummy for Hindu Religion
Dummy for Muslim Religion
Dummy for Female-headed
household
Age of household head
Age square
No. of years of education of
household head
Dummy 1 if any male married
man in the household works in the
agricultural sector, 0 otherwise
387
Table 1. Continued
Urban
Rural
Combined
Marginal
Marginal
Marginal
effects p-value# effects p-value effects p-value#
man works in the non-agricultural
sector, 0 otherwise
Dummy 1 if any woman (aged
15 49 years) in the household
works in the agricultural sector, 0
otherwise
15 49 years) works in the nonagricultural sector, 0 otherwise
Regional Dummy (base grp. Rural)
No of observations
Pseudo R square
Log pseudolikelihood
0.031
0.000
0.005
0.206
0.015
0.000
0.024
0.055
0.003
0.047
0.008
0.006
0.000
0.983
0.004
0.028
0.002
0.291
N.A.
N.A.
40591
0.1294
211406.73
N.A.
N.A.
52699
0.1377
2 6206.2421
0.005
0.027
93260
0.1662
2 17717.63
#Standard Errors are robust to hetroscedasticity at the cluster level. The marginal effect is for the discrete
change of dummy variable from 0 to 1.
4. Empirical Results from the Probit Model: Rural and Urban Sample
Probit regressions for the rural, urban and combined samples have been run separately and
the marginal effects are presented in Table 1.
4.1 Determinants of Current Health Insurance Enrolment in Rural and Urban India:
Probit Estimates
4.1.1 Household wealth. For both rural and urban samples, the marginal effect reveals a
significant positive association between a households economic status and the probability
of it being currently enrolled in any health insurance scheme. The impact is also
incremental. Households in urban (rural) areas classified as a medium asset group have a
4.8 (2.3) percent higher probability of being covered by any insurance programme as
compared to those with poorer asset holdings. The corresponding marginal effect rises to
11.1 (5.3) percent when comparing across the highest asset and lowest asset groups. This
suggests that the existing insurance schemes are leaving out the poorest of the poor
amongst both rural and urban communities.
4.1.2 Media variables. Our results indicate that the media, by facilitating access to
information about health insurance, can play an important role (in both urban and rural
areas); and this is important as we have explicitly controlled for the educational
background and economic status of the household. The marginal effect of the media
variables is small for the rural sample, and is generally smallest for radio (insignificant
in the rural sample) relative to television or newspaper. For example, if any adult
woman in an urban household reads a newspaper (watches television) at least once a
week, then there is a 1.1 (1.0) percentage point higher probability of that household
388
having a member covered by health insurance. This is in line with Gumber and
Kulkarni (2000) and Gupta (2000) who advocate that a primary reason behind the
lacklustre performance of the insurance market can be traced to ill-informed potential
consumers. The majority of individuals surveyed in Delhi by Gupta (2000) showed very
little knowledge about existing health insurance products, and hence were reluctant
either to enrol voluntarily in some form of health coverage or to move away from the
established public health insurance companies (e.g. Mediclaim policies offered by
General Insurance Company in India) to try the new private entrants in the market. Our
media variables used to proxy for general awareness/knowledge of individuals show
that individuals more exposed to information/media have a higher likelihood of being
enrolled even after we control for their education and wealth status.10 This has
important implications for both public sector enterprises and private entities selling
health insurance policies in India. Adoption of better advertising and marketing
strategies by such insurance providers could draw in more insurable individuals,
allowing them to hedge against uncertainty and risk. Unfortunately, the absence of
greater details about the media-specific variables does not allow us to conduct a more
in-depth study on this aspect.
4.1.3 Age profile. The variables controlling for the age distribution of household
members have no significant effect on the probability of use of health insurance in either
urban or rural samples. Also insignificant was the interaction dummy to check whether
households belonging to the highest asset profile and with a greater number of elderly
people (more prone to seek health care) exhibited a different pattern of utilisation. This is
contrary to the existing literature which in general finds a positive association between age
and demand for health insurance (Besley et al., 1999; Cameron et al., 1988; Propper, 2000;
Wagstaff, 2007).
4.1.4 Caste variables. Households belonging to a marginalised caste in the urban sample
(SC, ST and OBC) did not display any significantly different probability of current
enrolment in health insurance programmes compared with the general caste category. The
associated caste-wealth interaction dummies were also non-significant.11 Results for the
rural sample show that SC with higher economic status have a significantly higher
probability of insurance enrolment as compared to the general caste and SC belonging to
the poorer income category (marginal effect is 1% for medium asset and 1.4% for high
asset interaction dummies).
4.1.5 Control variables. The education of the household head has a positive significant
association with the probability of household enrolment in health insurance for both
samples, although the marginal effects are small (marginal effect is 0.005 in the urban
sample and 0.001 in the rural sample). This indicates that the probability of having any
health insurance increases by 2.5% if the household head has completed secondary
education (Class X) instead of just primary education (Class V) in the urban sample, and
by 0.5% in the rural sample. Muslim-headed households have 2.2% points lower
likelihood of participation in insurance programmes in urban areas as compared with other
minority religious groups such as Sikhs, Jains, etc. The occupational pattern of the
members of a household matters in urban India, with the highest marginal effect reported
for households having male members engaged in skilled non-agricultural activities
389
(3.1%). The result also holds true for select cases in the rural sample but with negligible
marginal effects.
It is important to note that in all the regressions, we have included state dummies to
control for an unobserved state effect, with Karnataka chosen as the base state. The reason
behind this choice is because Karnataka displayed the highest enrolment in health
insurance programmes amongst the 15 major states in India and is second only to Delhi
(see Figure 1). The coefficients of most states dummies were negative for both rural and
urban samples, implying that relative to Karnataka households in all other states have a
lower chance of being enrolled in a health insurance scheme.12 We have re-estimated the
above-mentioned models excluding all explanatory variables and state dummies which
were insignificant. This does not have any impact on the sign nor on the level of
significance of the variables. The Likelihood Ratio Test for the model suggests against
dropping the insignificant variables.13
We also estimated the model based on the combined sample after including a
regional dummy for the urban case. The positive significant coefficient of the dummy
suggests that after controlling for socio-economic determinants, households in the
urban sample have a significantly higher probability of enrolment in a health insurance
programme.
4.2 Determinants of Types of Health Insurance Coverage: Multinomial Logit Model
(MNL) Estimates
The MNL model allows us to estimate the magnitude of the impact of the asset, media,
demographic and caste variables for each type of health insurance. We consider the
following categories of health insurance: public health insurance comprising the CGHS
and ESIS schemes, CBHI, and PHI (bought from either private or public sector insurance
companies), and others without health insurance acting as the base category.14 The results
are reported in Table 215 Our results are discussed in detail for CBHI and commercially
purchased (private) health insurance as these are the two forms voluntarily chosen by
individuals. Membership of the CGHS and ESIS schemes is determined by the nature of
occupation of the household members (as mentioned earlier in the literature review
section).
4.2.1 Household wealth. The economic status of the household in both rural and urban
areas emerges as an important factor when the choice is between private (and public)
health insurance vis-a`-vis no insurance at all. The impact of household wealth is also
incremental as seen from the successively higher relative risk ratio (RRR) for PHI in both
samples. The wealth gap is less evident when comparing the CBHI scheme with having no
health insurance; in both urban and rural samples none of the asset variables is significant
except for households with a medium asset profile in the rural sample who display a
significantly higher RRR than the poorer category.
4.2.2 Media variable. Households having members who read a newspaper or watch
television at least once a week have a significantly higher likelihood of enrolment in
both privately purchased health insurance schemes and CBHI in rural India. The impact
is larger for community-based schemes (the RRR is 1.409 for newspaper and 1.968 for
television) compared with PHI (corresponding RRR is 1.322 and 1.459). Hurdles faced
390

Table 2. Determinants of health insurance coverage: MNML estimates
Urban
RRR
p-value
Rural
RRR
p-value
Combined
RRR
p-value
Outcome 1: Public H.I

reads newspaper)
listens to radio)
watches television)
age 60
ages 0 to 5
ages 6 to 15
Caste Profile Variables
OBC*Medium Asset
OBC*High Asset
Control Variables
household
Age square
household head
sector, 0 otherwise
2.006
0.014
3.040
0.000
2.849
0.000
5.476
0.000
5.734
0.000
7.016
0.000
0.953
0.458
1.013
0.909
0.961
0.483
1.014
0.834
0.996
0.971
1.011
0.850
1.074
0.441
1.272
0.046
1.154
0.053
1.047
0.794
1.065
0.656
0.962
0.682
0.794
0.177
0.980
0.867
0.907
0.285
0.915
0.026
1.063
0.271
0.968
0.343
1.001
0.961
1.074
0.143
1.028
0.298
0.734
1.132
0.410
2.098
2.161
1.100
0.868
2.177
2.161
0.404
0.837
0.044
0.088
0.042
0.887
0.818
0.073
0.084
0.726
1.208
0.884
1.831
1.874
0.884
0.799
1.144
1.046
0.400
0.589
0.702
0.182
0.161
0.793
0.619
0.711
0.903
0.721
1.059
0.710
1.949
2.128
1.106
0.900
1.313
1.263
0.227
0.847
0.186
0.035
0.008
0.786
0.748
0.316
0.381
1.796
0.878
0.941
0.000
0.463
0.586
1.427
0.923
0.885
0.071
0.805
0.438
1.650
0.826
0.923
0.000
0.217
0.375
1.031
1.000
1.068
0.073
0.351
0.000
1.086
0.999
1.075
0.003
0.011
0.000
1.050
1.000
1.070
0.001
0.014
0.000
0.886
0.659
0.633
0.110
0.761
0.150
1.531
0.030
1.099
0.705
1.381
0.036
391
Table 2. Continued
Urban

otherwise
Rural
Combined
RRR
p-value
RRR
p-value
RRR
p-value
1.480
0.135
1.125
0.451
1.183
0.209
0.949
0.475
1.073
0.578
0.971
0.647
N.A.
N.A.
N.A.
N.A.
1.258
0.015
Outcome 2: CBHI
0.792
0.572
2.747
0.033
1.931
0.069
1.210
0.750
2.533
0.088
1.990
0.165
1.451
0.030
1.409
0.092
1.234
0.160
1.087
0.600
0.900
0.618
0.885
0.441
1.732
0.103
1.968
0.002
2.090
0.000
1.078
0.856
1.115
0.692
0.974
0.899
0.843
0.659
1.248
0.194
1.233
0.170
1.211
0.074
0.979
0.824
1.050
0.559
1.095
0.128
0.897
0.105
0.952
0.351

OBC*Medium Asset
OBC*High Asset
0.261
0.345
0.659
4.545
2.186
0.602
1.508
1.379
1.602
0.143
0.381
0.552
0.104
0.440
0.731
0.741
0.677
0.507
0.966
0.872
1.246
0.987
0.000
0.153
0.604
1.348
1.201
0.947
0.819
0.599
0.986
0.000
0.112
0.679
0.579
0.750
0.712
0.682
0.994
1.462
0.537
0.159
0.891
1.391
1.349
0.468
0.486
0.988
0.522
0.479
0.104
0.881
0.435
0.493
Control Variables
1.096
0.490
0.744
0.086
1.553
2.544
0.184
0.064
1.735
1.143
0.049
0.765

reads newspaper)
listens to radio)
watches television)
age 60
ages 0 to 5
ages 6 to 15
(Continued)
392

Table 2. Continued
Urban

household
Age square
household head
sector, 0 otherwise
otherwise
Rural
Combined
RRR
p-value
RRR
p-value
RRR
p-value
1.176
0.538
0.694
0.393
0.679
0.200
1.000
1.000
1.091
0.995
0.741
0.000
1.107
0.999
1.096
0.074
0.137
0.001
1.069
0.999
1.089
0.101
0.183
0.000
2.599
0.187
2.652
0.104
3.772
0.013
1.503
0.480
0.727
0.588
1.062
0.905
1.062
0.906
1.471
0.155
1.232
0.407
0.897
0.544
2.377
0.000
1.633
0.005
N.A.
N.A.
N.A.
N.A.
0.621
0.107
Outcome 3: Private HI
reads newspaper)
listens to radio)
watches television)
age 60
ages 0 to 5
ages 6 to 15
4.042
0.000
2.628
0.000
2.700
0.000
11.239
0.000
5.567
0.000
7.160
0.000
1.410
0.000
1.322
0.008
1.407
0.000
1.240
0.000
1.024
0.817
1.187
0.001
1.288
0.024
1.459
0.005
1.318
0.001
1.011
0.936
0.742
0.061
0.897
0.257
1.109
0.453
1.185
0.166
1.195
0.047
0.970
0.457
0.973
0.753
0.967
0.410
1.040
0.187
0.995
0.878
1.021
0.355
1.046
1.770
1.999
0.930
0.442
0.095
0.871
0.845
1.297
0.631
0.575
0.321
0.842
0.883
1.330
0.485
0.654
0.192
393
Table 2. Continued
Urban

OBC*Medium Asset
OBC*High Asset
Control Variables
household
Age square
household head
sector, 0 otherwise
otherwise
Rural
Combined
RRR
p-value
RRR
p-value
RRR
p-value
0.730
0.623
0.475
0.228
0.370
0.349
0.563
0.352
0.332
0.053
0.032
0.012
1.388
1.417
1.435
0.583
0.899
0.714
0.370
0.385
0.393
0.262
0.740
0.276
1.063
0.857
1.115
0.482
0.683
0.550
0.828
0.562
0.746
0.027
0.129
0.009
1.043
0.527
1.092
0.713
0.001
0.371
1.412
1.080
0.927
0.060
0.777
0.658
1.142
0.656
1.047
0.169
0.006
0.592
1.022
1.000
1.105
0.183
0.266
0.000
1.067
0.999
1.062
0.016
0.042
0.000
1.036
1.000
1.096
0.009
0.030
0.000
1.484
0.188
1.514
0.281
1.504
0.066
2.005
0.003
1.899
0.079
2.010
0.000
1.435
0.154
1.219
0.110
1.346
0.007
1.084
0.179
1.127
0.327
1.089
0.116
N.A.
N.A.
N.A.
N.A.
1.271
0.006
Outcome 4: Others
reads newspaper)
listens to radio)
watches television)
NA
NA
1.912
0.200
1.642
0.250
NA
NA
1.513
0.492
2.290
0.072
NA
NA
1.110
0.686
1.430
0.043
NA
NA
1.378
0.098
1.376
0.026
NA
NA
1.459
0.166
1.301
0.263
NA
NA
1.107
0.729
1.059
0.790
(Continued)
394

Table 2. Continued
Urban

age 60
ages 0 to 5
ages 6 to 15
OBC*Medium Asset
OBC*High Asset
Control Variables
household
Age square
household head
sector, 0 otherwise
otherwise
No of observations
Pseudo R square
Log pseudolikelihood
Rural
Combined
RRR
p-value
RRR
p-value
RRR
p-value
NA
NA
0.963
0.854
0.879
0.470
NA
NA
1.106
0.405
1.138
0.176
NA
NA
1.039
0.665
1.056
0.392
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.512
0.510
0.808
1.355
4.826
0.386
2.696
1.289
1.439
0.266
0.281
0.679
0.697
0.070
0.327
0.238
0.705
0.586
0.502
0.488
0.861
1.660
1.954
0.475
1.313
1.310
1.040
0.211
0.212
0.747
0.437
0.317
0.367
0.685
0.641
0.939
NA
NA
NA
NA
NA
NA
1.119
0.751
0.678
0.738
0.524
0.364
0.921
0.663
1.035
0.742
0.213
0.897
NA
NA
NA
NA
NA
NA
1.080
0.999
1.051
0.057
0.106
0.030
1.046
1.000
1.071
0.157
0.331
0.000
NA
NA
1.127
0.880
1.265
0.697
NA
NA
0.796
0.766
1.014
0.980
NA
NA
1.187
0.493
1.302
0.280
NA
NA
1.696
0.084
1.143
0.525
NA
NA
40591
0.1209
2 14572.139
NA
NA
52669
0.1397
2 7857.827
0.530
0.002
93260
0.1562
2 22737.357
395
by potential consumers in understanding the complexities of health insurance

programmes are one of the reasons for their reluctance to enrol in such schemes
(Devadasan, Ranson, Van Damme, & Criel, 2004). Given this point, it is not surprising
that families/households more exposed to the media, and hence greater information,
have a higher probability of insurance enrolment, particularly in CBHI schemes where
the community plays a major role in the management of the scheme. All three media
variables were found to be positively and significantly associated for PHI in urban India
(RRR is 1.410 for newspaper, 1.240 for radio and 1.288 for television), and print media
for CBHI enrolment in the urban sector.16
4.2.3 Age profile. Similar to the probit estimates, the age profile of household members
does not play an important role in enrolment in health insurance schemes in either urban or
rural samples. This indicates that households with a larger dependent population over the
age of 60 do not have a higher probability of insurance enrolmentin either private or
non-profit oriented CBHI schemes. The only exception is the interaction dummy for PHI
in rural India (RRR is 0.742). Exclusion policies practiced by PHI enterprises may explain
this negative significant result: households with a higher asset level as well as a higher
number of senior citizens have a significantly lower probability of enrolment possibly due
to their non-eligibility and having pre-existing health conditions, even if they can afford to
pay the premiums.
4.2.4 Caste variables. SC (and OBC) households in the urban sample display
significantly higher odds of public health insurance enrolment, provided they belong to
middle and high economic status groups as compared to the general caste and SC (OBC)
groups with a poor asset profile. No such result was evident for other insurance outcomes
for the SC group. However, the opposite result was obtained for OBC when the choice is
between enrolment in PHI versus having no insurance: the interaction dummy variables
capturing the interface of OBC with high and medium asset profiles are negative and
significant. The ST dummy along with the ST-asset interaction dummies were nonsignificant for all outcomes in the urban sample, except for outcome 3 (PHI). In outcome 3,
ST from high asset households have significantly lower odds of being enrolled in PHI than
general caste and medium/low asset ST families.
None of the SC, ST and OBC dummies, along with the different caste-wealth interaction
dummies, were significant across the outcomes in the rural sample. However, a Wald test
to check whether each caste-asset combination is jointly different from 0 is rejected for the
majority of the groupings for each outcome.17
4.2.5 Control variables. Households subscribing to the Islamic faith have significantly
lower odds of PHI and CBHI enrolment in the urban sample, but are non-significant for
other outcomes. In the rural sample, CBHI enrolment for Muslim families is significantly
higher than other minority groups. The household heads educational level displays a
positive significant relationship with health insurance enrolment for all outcomes and in
both urban and rural samples, even after controlling for wealth-ethnic status and access to
media.18 The regional dummy in the combined sample is used to see if households in the
urban sample display a significantly different enrolment pattern from the rural sample after
controlling for all other socio-economic determinants. The associated RRR show that the
odds of enrolling in PHI (25.8%) and in public health insurance (27.1%), vis-a`-vis having
396
no insurance, are significantly higher for the urban sample. The odds of being currently
enrolled in a CBHI programme is lower for the urban sample as compared to the rural, but
significant at the 10.7% level only.
5. Conclusion
Health insurance penetration in India is very low. Thus, in this article we have
endeavoured to research the effects of household wealth, access to information through
media, and the age and caste profile on the probability of people being currently enrolled
in any health insurance programme. The economic status of households emerged as the
dominant factor in explaining health insurance enrolment differentials in both urban and
rural regions. The impact of this factor is also incremental in the sense that the gap in
enrolment rises across successively higher asset profiles (compared with low economic
status households). Economic disparity across households continues to be an important
factor in determining enrolment in privately purchased health insurance (and CGHS/
ESIS schemes), even after controlling for social stratification and access to information;
the impact of this is also incremental. The wealth gap is less evident when comparing
enrolment in CBHI schemes with having no health insurancein both urban and rural
samples none of the asset variables was significant, except for households with a medium
asset profile in the rural sample. The wealth impact so far as CBHI is concerned is
contrary to what is found in the existing literature on India (Acharya & Ranson, 2005;
Ahuja, 2005; Bhat & Jain, 2006; Devadasan, Ranson, Van Damme, & Criel, 2004;
Gumber & Kulkarni, 2000) where households with higher income also have a higher
probability of being a member of CBHI schemes. This discrepancy of results can be due
to the fact that unlike the existing studies which were based on small, localised samples,
our results are drawn from a nation-wide survey. Moreover, the magnitude of the
(positive) impact of income-/asset-related variables is over-estimated in the existing
literature because the economic status variable inadvertently also captured the
importance of access to information. This problem has been avoided in our study
because we explicitly account for media-related factors.
Households which had at least one female member aged 15 49 who watched television
or read a newspaper displayed a significantly higher probability of health insurance
enrolment, particularly in urban areas. Looking into product-specific enrolment we find
that media variables matter more in PHI and CBHI schemes (particularly in urban areas).
Given these two outcomes depend on an individuals voluntary choice, it is not surprising
that access to information matters more in these cases.
Households who reported having a higher number of older members did not have a
higher enrolment pattern. This is true even if they belong in a higher asset classification,
and for all health insurance outcomes. In fact, rural sample households belonging to the
highest asset profile and with a greater number of elderly people showed significantly
lower odds of enrolment in PHI than other households. These results are as expected in the
PHI case because of the higher costs in obtaining health insurance for senior citizens and
the exclusion policies practiced by insurance companies. However, the non-significant
RRR shows that the CBHIa non-profit schemeis also not effective in attracting
households with a more dependent population into their safety nets. Such dimensions have
not been explored in the context of India before.
397
Mixed results were obtained in terms of the caste variables which varied between the
two urban and rural samples. SC and OBC households with relatively prosperous
backgrounds had a significantly higher probability of being enrolled in a CGHS or ESIS
scheme in urban areas. The opposite effect was found for OBC in the case of PHI.
Affirmative action policies such as government job reservations perhaps explain the
positive result for SC and OBC groups in terms of public health insurance schemes.
However, when comparing between having PHI vis-a`-vis having no insurance,
marginalised castes are at a disadvantage even if they hold a better economic status.
Particularly disadvantaged were the ST households who had a lower probability of private
insurance enrolment. In this context, CBHI schemes, while intended to target the
disadvantaged, were not effective in drawing them into their safety nets. In the rural
sample, caste impact was weak. This can be explained by the fact that the existing CGHS
and ESIS schemes which cater to public sector employees and low wage earners in the
formal (organised) manufacturing sector are predominantly urban-based, because the
occupational patterns in rural India are primarily focused on agriculture-related activities
and informal, unorganised manufacturing. Hence, marginalised castes in rural areas,
unlike their urban counterparts, did not have any significantly higher odds of being
enrolled in CGHS and ESIS schemes even if they were from a relatively affluent
background. The empirical results also indicate that there is no significant difference
between enrolment in privately purchased health insurance schemes across the
marginalised and general category population in the rural sample. This may not be due
to the lack of affordability (note that the caste-wealth interaction dummies were also
insignificant in the rural sample), but more due to the poor outreach of private commercial
health insurance providers in the rural area. Unfortunately, we could not control for access
to health insurance facilities in our sample due to the lack of availability of these data.
The education of the household head has a positive significant association with the
probability of household enrolment in health insurance schemes in both the urban and
samples (the marginal effects are greater in rural areas), and is relevant for all types of
health insurance schemes: public, private and CBHI schemes. The result corresponds
with the existing literature on privately purchased health insurance schemes (Besley
et al., 1999; Cameron & Trivedi, 1991; Cameron et al., 1988; Emmerson et al., 2001;
Propper, 2000). However, this is contrary to what was found for Vietnam (Wagstaff,
2007) where enrolment in non-contributory SHI schemes was found to be higher if the
household head was illiterate. In our case, we find that for both urban and rural CBHI
schemes the probability of being enrolled increases with the increase in the number of
education years of the household head. This divergence in results can be explained by the
fact that CBHI schemes in India were borne out of an initiative taken by local, nongovernment-organisations and co-operatives (with or without financial support from the
government). Hence, unlike the SHI system in some other developing countries where
uneducated families are specifically targeted by governments to receive (noncontributory) health insurance, participation in the CBHI programmes in India is left
to the choice of individual families. Additional years of education, which increase access
to information and make individuals more aware of future health risks, increase the odds
of enrolment in a CBHI scheme. Muslim-headed households have a lower probability of
PHI enrolment in urban areas but a higher enrolment in CBHI schemes in rural areas
compared with other minority groups. This is true even after we control for economic
status. Considerable regional disparity exists in terms of health insurance enrolment
398
patterns. The odds of enrolling in PHI and public health insurance vis-a`-vis having no
insurance is significantly higher in the urban sample. The opposite result is true for CBHI
schemes. These findings are not surprising given that the majority of CBHI programmes
concentrate on rural pockets while most of the public and privately owned health
insurance firms concentrate on urban areas.
Disclosure Statement
No potential conflict of interest was reported by the authors.
Notes
5
6
7
10
CBHI in India can be grouped into different categories based on how reimbursements are made to the
insurer and on the nature of the organisation which provides the insurance. In the pre-payment CBHI
system, the insurer gets reimbursed prior to providing the treatment to the insured.
Results from the studies by Cameron et al. (1988) and Cameron and Trivedi (1991) are based on
samples drawn from Australia, while Besley et al. (1999), Emmerson et al. (2001) and Propper (2000)
used samples based on the UK. Grossman (1972) provides the theoretical framework for analysing the
impact of income and education on an individuals demand for health (and thus for privately purchased
health insurance).
The opposite result was obtained for Vietnam (Wagstaff, 2007) where being classified as officially
poor significantly increases the chance of having a free health card or having health insurance for the
poor.
Non-coverage of child delivery in a safe formal institution by CBHI schemes is surprising because
such health insurance schemes are not-for-profit health insurances policies designed specifically to
hedge health-related uncertainties and expenses for the poor. In India, particularly in rural regions, a
sizable population uses traditional child delivery systems which tend to result in both child and
maternal death due to the high expenses and travel costs incurred in public and private hospitals.
The definition is provided in the introductory section of this paper.
It doesnt matter which one since they each yield the same probabilities.
The NFHS-III wealth index is based on the following 33 assets and housing characteristics: household
electrification; type of windows; drinking water source; type of toilet facility; type of flooring; material
of exterior walls; type of roofing; cooking fuel; house ownership; number of household members per
sleeping room; ownership of a bank or post-office account; and ownership of a mattress, a pressure
cooker, a chair, a cot/bed, a table, an electric fan, a radio/transistor, a black and white television, a
colour television, a sewing machine, a mobile telephone, any other telephone, a computer, a
refrigerator, a watch or clock, a bicycle, a motorcycle or scooter, an animal-drawn cart, a car, a water
pump, a thresher, and a tractor.
We were constrained to concentrate on women in the age group 15 49 years as the questionnaires in
the NFHS are generally geared towards them.
Cameron et al. (1988) includes age as an explanatory variable in their demand for health insurance
equation using the following classifications: 11 age groups from 1519 years to 70 plus years. Our
choice of age groups was driven by the following consideration: the age group 0 5 years was chosen to
incorporate dependent children, 515 years to control for dependent adolescents, and 60 plus years to
capture dependent senior citizen members in the household. Accordingly, a number of household
members in these age categories has been included as explanatory variables in our study.
Please note that media variables may be partially capturing the effect of the households income/
education level. We ran auxiliary estimations to isolate the impact of the media variables from
capturing the effect of the households income/education level. We estimate three different residuals
for three media variables, namely, newspaper, television and radio, assuming that the media variables
depend on the households income/education level using the discrete outcomes for each of the media
variables. Following Terza, Basu, and Rathouz (2008), we use the predicted residuals from the
estimated models. The results using media variables remained the same given the orthogonality
properties of the residual.

11
12
13
14
15
16
17
18
399
However, the Wald test for ST and ST interacted with Medium and High Asset Categories being
jointly equivalent to 0 is rejected at 1.24% level of significance (with chi2 (3) 10.88). The
corresponding test for the OBC group is also rejected at 0.31% level of significance (with chi2
(3) 13.84). This suggests that the dummy variables to control for ST and OBC categories and also
the interaction dummy variables used to account for the caste and wealth interfaces should not be
dropped. Results are available upon request.
These results are not reported here but are available upon request.
For the rural sample, the likelihood ratio test (with chi2 (26) equal to 38.92) can be rejected at 4.96%
level of significance. For the urban sample, the likelihood ratio test (with chi2 (27) equal to 65.79) can
be rejected at 0.00% level of significance. For the combined sample, the likelihood ratio test (with chi2
(21) equal to 43.64) can be rejected at 0.00% level of significance.
We conducted a Wald test to check whether the alternative categories can be combined, and the
Hausman test to see whether the Independence of Irrelevant Alternatives hold true. Our obtained
results show that our model specification holds. Details are available upon request.
We had to combine CBHI with Others due to a paucity of data in the urban sample, while the other
categories are the same as those discussed in the methodology section.
Similar to the probit model, to isolate the impact of the three media variables form household economic
status and education level we ran the MNL model using newspaperresi, radioresi and
televisionresi. The abovementioned results also hold true for the MNL model using alternative
media variables. The results are not reported here but are available upon request.
The results are not reported but are available upon request.
Along with these explanatory variables, the state-specific effect was controlled by a set of dummies for
all those states which had data across all types of health insurance coverage. Results are not reported in
this paper.
References
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401
Appendix
Table A1. Summary statistics of explanatory variables used in rural and urban samples
Rural
Explanatory variables
Household Asset Index
Newspaper (Dummy 1 if member reads
newspaper)
Radio (Dummy 1 if member listens
to radio)
Television (Dummy 1 if member watches
television)
Proportion of HH with aged above
60 members
Proportion of HH with aged 0 to 5
members
Proportion of HH with aged 6 to 15
members
Dummy for Female-headed households
Dummy 1 if any male
married man in the
household works in the
Dummy 1 if any male
married man works in
the non-agricultural sector, 0
otherwise
Dummy 1 if any woman
(aged 15 49 years) in the
household works in the
Dummy 1 if any woman
(aged 15 49 years) works in
the non-agricultural sector, 0
otherwise
No. of years of
education of household head
Urban
Mean
SD
Mean
SD
243134.47
0.177
81696.49
0.382
67224.43
0.451
83225.29
0.498
0.3
0.458
0.34
0.474
0.483
0.5
0.842
0.365
.315
0.464
0.261
0.439
0.498
0.500
0.396
0.489
0.675
0.468
0.596
0.491
0.133
46.244
0.739
0.112
0.172
0.174
0.333
0.02
0.339
13.393
0.439
0.315
0.377
0.38
0.471
0.14
0.139
46.51
0.7
0.165
0.158
0.084
0.301
0.023
0.346
12.646
0.458
0.371
0.365
0.277
0.459
0.148
0.415
0.493
0.049
0.217
0.515
0.5
0.695
0.46
0.333
0.471
0.027
0.163
4.586
4.631
7.922
5.324

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Determinants of Health Insurance

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ANINDITA CHAKRABARTI & ANAND SHANKAR

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A. Chakrabarti & A. Shankar

enrolment and by product-specific categories. We focus on household assets, access to

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Determinants of Health Insurance Penetration in India

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A. Chakrabarti & A. Shankar

Empirical evidence shows that in spite of increased interest in community-financed

3. Data and Explanatory Variables

Determinants of Health Insurance Penetration in India

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3.1 Empirical Methodology

A. Chakrabarti & A. Shankar

model, which is discussed in the following section, and bj is the corresponding

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Determinants of Health Insurance Penetration in India

in income, indices based on a households possession of assets can act as a better

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A. Chakrabarti & A. Shankar

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Household Asset Variables

Age Profile Variables

Determinants of Health Insurance Penetration in India

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A. Chakrabarti & A. Shankar

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Determinants of Health Insurance Penetration in India

A. Chakrabarti & A. Shankar

Outcome 1: Public H.I

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Household Asset Variables

Determinants of Health Insurance Penetration in India

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Dummy 1 if any woman (aged

Caste Profile Variables

Media Exposure Variables

A. Chakrabarti & A. Shankar

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Dummy for Female-headed

Determinants of Health Insurance Penetration in India

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Scheduled Caste*Medium Asset

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Number of members in HH above

Determinants of Health Insurance Penetration in India