Knowledge, coverage and willingness to enrol in health insurance schemes among rural households: a community-based cross-sectional study

Background: Rural households remain vulnerable to catastrophic health expenditure despite the expansion of publicly financed health insurance schemes. This study assessed awareness, coverage and willingness to enrol in health insurance among rural households. Methods: A community-based cross-sectional study was conducted in Singanagudem village, Krishna district, Andhra Pradesh, from September to November 2021. One village was randomly selected from the rural field-practice area. All 413 households were approached, and 384 participated (response rate, 93%). Data were collected using a pretested interviewer-administered schedule and analysed descriptively. Results: Overall, 70.3% of households were aware of health insurance, whereas 91.1% held a valid insurance card. Dr YSR Aarogyasri was the predominant scheme among insured households (95.1%), and 85.7% reported family coverage. Among 34 uninsured households, 52.9% were willing to enrol. Fear of medical expenses was the most common reason for willingness (38.9%), whereas lack of trust was the most common reason for unwillingness (50%). Conclusions: Health insurance coverage was high, but awareness was lower than card possession. Strengthening insurance literacy through frontline health workers may improve informed and equitable use of benefits.