Inequities in Health Insurance Coverage among Tribal Populations in India: Evidence from a Multi-State Cross-Sectional Study.

Despite growing coverage of health insurance among the Indian population, the indigenous (tribal) populations, who are socio-economically disadvantaged, are yet to be covered. This leaves many households vulnerable to out-of-pocket and catastrophic healthcare expenditures. The present study reports the prevalence of health insurance coverage and its associated factors among the tribal communities in India. A cross-sectional study was conducted across 19 tribal-dominated districts in 12 states of India. A sample of 35,870 households was selected using a multi-stage sampling method. A pre-tested, interviewer-administered questionnaire was used to collect data on socio-demographic characteristics, healthcare access, health worker contact, and coverage under health insurance schemes. Andhra Pradesh and Uttarakhand states show higher proportions (~ 93%) of health insurance coverage, followed by Meghalaya (78%) and Assam (70%). In contrast, Himachal Pradesh (1%) and Madhya Pradesh (4%) have very poor health insurance coverage. Multiple logistic regression analysis reveals a significant geographical variation across states. Other variables, such as gender, age, tribe type, education, occupation, annual income, health worker's visit to the village, regular source of health care, and village type, were found to be significant factors associated with households having insurance coverage (p < 0.001). These study findings indicate considerable inter-state variation and persisting inequities in health insurance coverage among tribal populations. Strengthening awareness, enrolment support, and outreach through frontline health workers is essential to improve equitable coverage in these communities.