Inclusion of the poor in government-sponsored health insurance in Kerala

Purpose This study investigates the extent to which below-poverty-line (BPL) households were included in Government-Sponsored Health Insurance (GSHI) in Kerala and whether any structural issues exist within the beneficiary targeting of GSHI. Design/methodology/approach The study utilized the fourth and fifth rounds of the National Family Health Survey and the published documents of the Government of Kerala. The growth of GSHI was examined through key performance indicators (KPIs). The proportion of households covered by GSHI and BPL cards was examined, and the concentration of poor households was estimated using the Erreygers Index. A disaggregated analysis was also performed across various socio-economic groups. Findings The KPIs related to GSHI experienced significant growth between 2008 and 2022. Notably, between 2016 and 2019, GSHI increased by 9.3 percentage points in Kerala. However, there was no corresponding rise in the concentration of poor households covered by GSHI during this period. In 2019, 35.4% of BPL households were still excluded from GSHI in Kerala. The findings suggest that expanding GSHI coverage to these excluded households would enhance the overall population coverage and increase the representation of poor households in GSHI across all socio-economic groups, particularly among the vulnerable groups. Originality/value The study identifies a potential structural issue regarding beneficiary targeting within GSHI in Kerala, possibly stemming from separate targeting mechanisms employed by the union and state governments. This previously unexplored dimension of health governance in Kerala is analysed using large-scale datasets, adding to the study’s uniqueness.