Determinants of Health Insurance uptake in Bihar: Evidence from the National Sample Survey

Background: Public investment in health in India remains low, resulting in a heavy reliance on Out-of-Pocket (OOP) expenditure for healthcare. High OOP spending adversely affects household welfare and living standards and exposes families to the risk of financial catastrophe. To mitigate these risks, both central and state governments have introduced multiple health insurance schemes; however, evidence on their effectiveness in reaching vulnerable populations remains limited.Objective: This study examines the extent to which health insurance schemes have reached households across different income groups in Bihar. It further analyses variations in insurance coverage and preferences across socio-demographic groups.Materials and Methods: The study uses healthcare data from the 75th round of the National Sample Survey (NSS). A binary logistic regression model is employed to identify the socio-economic and demographic determinants of health insurance coverage.Results: The findings reveal substantial disparities in health insurance coverage across socio-demographic groups. Wealth and education emerge as prominent determinants of insurance enrolment in both rural and urban areas. Age-related patterns indicate that older individuals are more likely to be insured, suggesting a more strategic response to anticipated health risks.Conclusion: Despite the presence of multiple public health insurance initiatives, significant inequalities in coverage persist in Bihar. The results highlight the need for targeted policy interventions to improve insurance penetration among economically and socially disadvantaged households.