Who Benefits from India’s Publicly Funded Health Insurance Schemes? Unraveling Intersecting Gender and Socioeconomic Inequalities

Publicly funded health insurance schemes (PFHIS) in India aim to alleviate financial burdens for impoverished families seeking hospital-based care. This chapter explores socioeconomic differentials in access to and utilization of these schemes through the lens of gender and intersectionality. The study analyzes the 75th round of National Sample Survey data (2017–2018), conducting binomial logistic regressions to estimate the likelihood of enrolment and use of insurance to cover the cost of hospitalization by sex intersecting with caste and economic class. Twelve intersecting subgroups based on sex-caste-class affiliations are considered, using nonpoor upper-caste men as the reference group while controlling for age, household headship, chronic diseases, and income-earning status. Although PFHIS targeted the poor, enrolment was more likely among the nonpoor. Economic class differentiated enrolment chances for Scheduled Castes (SCs) and Scheduled Tribes (STs), favoring non-poor individuals. Other Backward Castes (OBCs) display discrimination, with nonpoor OBCs at the top and poor OBCs alongside poor upper-caste individuals. Access to hospitalization with insurance coverage depends on intrahousehold gender dynamics and caste, with economic class playing a secondary role. Poor, upper-caste men have the highest likelihood of coverage in rural and urban areas. Gender dynamics favor nonpoor SCs/STs in rural areas and women in urban areas. Poor SCs/STs are less likely to receive coverage in urban areas but fare better in rural areas. OBCs, both poor and nonpoor, experience significant rural-urban disparities. Leveraging PFHIS benefits depends on inter-household caste-class politics, with the relevance of gender emerging postenrolment.