Inequities in Health Insurance Coverage among Tribal Populations in India: Evidence from a Multi-State
Anjali Kumari1, Chaya R Hazarika1, Yogita Sharma1
1Division of Socio-Behavioural, Health Systems and Implementation Research, Indian Council of Medical Research, Ansari Nagar, New Delhi, 110 029, India.
Journal of Racial and Ethnic Health Disparities
|June 23, 2026
Summary
Health insurance coverage remains low for India's tribal populations, leaving them vulnerable to high healthcare costs. Significant disparities exist across states, highlighting the need for targeted outreach and support to improve access for these disadvantaged communities.
Area of Science:
- Public Health
- Health Economics
- Sociology
Background:
- Indian tribal populations face socio-economic disadvantages, limiting their access to health insurance.
- Lack of health insurance exposes tribal households to significant out-of-pocket and catastrophic healthcare expenditures.
- Despite overall increases in health insurance coverage in India, indigenous communities remain underserved.
Purpose of the Study:
- To determine the prevalence of health insurance coverage among tribal communities in India.
- To identify factors associated with health insurance coverage within these populations.
- To highlight geographical variations and inequities in insurance access.
Main Methods:
- A cross-sectional study was conducted in 19 tribal-dominated districts across 12 Indian states.
- A multi-stage sampling method selected 35,870 households for data collection.
- Data on socio-demographics, healthcare access, and insurance status were gathered using a pre-tested questionnaire.
Main Results:
- Health insurance coverage varied significantly by state, with Andhra Pradesh and Uttarakhand showing high rates (~93%) and Himachal Pradesh (1%) and Madhya Pradesh (4%) showing very low rates.
- Multiple logistic regression identified geographical location, gender, age, tribe type, education, occupation, income, health worker contact, and regular healthcare source as significant factors (p < 0.001).
- Substantial inter-state variations and persistent inequities in health insurance coverage were observed among tribal populations.
Conclusions:
- Significant disparities in health insurance coverage persist among India's tribal populations, indicating ongoing inequities.
- Awareness campaigns, enrollment assistance, and enhanced outreach via frontline health workers are crucial for achieving equitable insurance coverage.
- Addressing socio-economic determinants and geographical variations is essential for improving health security in tribal communities.
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