Impact of Health Insurance Coverage on Health Care Utilization During COVID-19 Pandemic: A Propensity Score Matched Survey Analysis in a Target Region in India

Background: Health insurance is considered as a mechanism to accelerate the progress towards universal health coverage and ensure financial risk protection for households throughout the country. There is a growing body of evidence reporting that the health insurance coverage can significantly improve the access and utilization of healthcare services. Hence, we attempted to determine the impact of health insurance on the utilization of healthcare services during COVID-19 pandemic.

Methods: A community-based cross-sectional study was conducted in rural Tamil Nadu. The primary data collection was conducted during November 2021. We employed a multi-stage stratified random sampling technique. Propensity score matching analysis was performed using radius matching method at 0.05 calliper to estimate the following parameters: average treatment effect (ATE), average treatment effect on treated (ATT), and average treatment effect on untreated (ATU).

Results: In total, 2390 participants were included. Almost two-third belonged to 18-45 years with almost equal distribution of males and females. Only 13.6% were covered by health insurance. Healthcare utilization was significantly higher among participants with health insurance (55.2%) compared to participants without coverage (42.5%). The ATT values in intervention and control group were 0.55 and 0.46 (p < 0.001). Similarly, the ATU values in intervention and control group were 0.42 and 0.51. The ATE value was 0.08.

Conclusion: Our study shows that the health insurance coverage had significant impact on utilization of healthcare services during COVID-19 pandemic. Further longitudinal research exploring the effect of different forms of health insurance for improving access and utilization of healthcare services can be undertaken.