Health Insurance Literacy and Health Outcomes: An Insured–Uninsured Study in North Bengal

Abstract

India’s expansion of health insurance through schemes such as Ayushman Bharat and Swasthya Sathi has not automatically produced better comprehension, utilisation, or health outcomes. This study examines health insurance literacy (HIL) as a determinant of perceived quality of care and overall health outcomes, and maps the awareness profile of uninsured individuals to identify barriers to enrolment. Data were collected through a structured questionnaire from 470 respondents in Darjeeling and Jalpaiguri districts of West Bengal, 367 insured and 103 uninsured. Descriptive statistics, Pearson correlation, and multiple regression were used. Among insured respondents, HIL scores ranged from 3.54 to 3.84 on a five-point scale, with independent policy renewal the weakest dimension (M = 3.54, SD = 1.06). HIL predicted perceived quality of care (R = 0.743, R² = 0.552, F = 126.785, p < 0.001), with understanding of terms (β = 0.356), awareness of policy types (β = 0.301), and confidence in plan comparison (β = 0.287) as significant predictors. HIL also explained 49–50% of variance in health outcomes (R = 0.698–0.707, B = 0.731–0.735, p < 0.001). Among the uninsured, awareness scores ranged from 3.47 to 3.77, with document language the most reported barrier (M = 3.47, SD = 1.08). Despite this, 67.6% expressed willingness to purchase insurance if it were affordable and easy to understand. The coverage-to-outcome gap in these districts is, in large part, a literacy and communication gap.