ArticleCureus2026
Social Determinants and Barriers to Health Insurance Utilization Among the Rural Population: A Mixed-Methods Study in a Rural Field Practice Area of Tiruvallur District, Tamil Nadu.
Article in Cureus, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundHealth insurance plays a crucial role in reducing out-of-pocket healthcare expenditure, improving access to healthcare services particularly in rural populations. The disparities in health insurance schemes still exist in India despite the presence of publicly funded health insurance schemes, more especially among the socially disadvantaged groups. This study aimed to assess the level of health insurance utilization and its association with selected social determinants and to explore perceived barriers and facilitators influencing utilization using a mixed-methods approach.
methodsThe study was done in the rural field practice area of Tiruvallur district, Tamil Nadu, through a community-based mixed-methods approach. The quantitative arm comprised 200 adults aged ≥18 years with a history of hospitalization within the past year using a systematic random sampling technique. The information for the study was collected through household interviews by using a structured questionnaire and analyzed using IBM SPSS Statistics for Windows, Version 25.0 (IBM Corp., Armonk, New York, United States), with the help of descriptive statistics and chi-squared tests. The qualitative component consisted of 30 purposively selected participants and caregivers who took part in in-depth interviews until thematic saturation was reached. Thematic analysis was done to come up with the key barriers to health insurance utilization.
resultsOut of 200 respondents, only 56 people (28%) reported using health insurance services, and 144 people (72%) did not use available insurance. The government-sponsored schemes accounted for the highest utilization (75%). Awareness of insurance schemes was reported by 112 participants (56%). Significant associations were observed between utilization of insurance and education level (p=0.001), socioeconomic status (p=0.002), awareness (p<0.001), occupation (p=0.01), type of illness (p=0.003), and distance to the healthcare facilities (p=0.02). Limited awareness, administrative complexities, indirect costs, sociocultural influences, and health system constraints were the major barriers as per qualitative findings.
conclusionHealth insurance utilization in rural settings remains limited due to several social and systemic factors. Community awareness, the simplification of administrative procedures, and improved healthcare accessibility are essential to help realize its effective utilization and thus support efforts toward universal health coverage.
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