Bridging the health insurance awareness gap: knowledge, perceptions, and utilization among patients at a tertiary care hospital in India

Abstract

Background: Despite the fact that there are several health insurance schemes available in India, the level of coverage and utilization is suboptimal. Awareness about insurance does not necessarily translate into ownership and utilization. Objective: To evaluate the awareness, ownership, and use of health insurance among patients in a tertiary care hospital in India and to determine the sociodemographic and information determinants that affect these outcomes. Methods: A cross-sectional survey was carried out among 5,335 adult patients in a tertiary care hospital in Pune, Maharashtra, India (December 2024 to February 2025) using a pre-tested questionnaire. Data on demographics, insurance status, perceived barriers, and sources of information were collected. Descriptive statistics, chi-square tests, and logistic regression analyses were performed. Results: Among the 5,335 participants, 60.9% were aware of health insurance, 19.9% owned one, 15.8% had ever used insurance for healthcare. Older participants were less likely to be aware of health insurance (aOR = 0.992; 95% CI: 0.985–0.998). Among the aware, females were less likely to own insurance compared to males (aOR = 0.81; 95% CI: 0.68–0.96). The commonest barriers cited were lack of awareness (49.1%) and high premium costs (28.3%). Online sources were the preferred source of health insurance information. Conclusion: There are still large gaps between awareness and utilization of insurance coverage for patients in tertiary care hospitals in India. Age- and gender-specific education and simplified enrollment procedures, utilizing digital platforms, could be effective in improving insurance utilization.