# Does health insurance coverage improve cardiometabolic risk factor levels? Quasi-experimental evidence from India

## TL;DR

This study finds that health insurance in India is linked to better heart and metabolic health, likely because it increases healthcare visits.

## Contribution

The study provides new empirical evidence on how health insurance affects chronic disease outcomes using a quasi-experimental design in India.

## Key findings

- Insured individuals had lower blood pressure, cholesterol, and HbA1c levels compared to the uninsured.
- Healthcare visits partially explain the benefits of insurance on cardiometabolic risk factors.
- Insurance coverage was associated with higher self-reported health status.

## Abstract

Chronic conditions cause notable health and economic burdens. While health insurance enables access to healthcare, its effects on chronic care outcomes remain under-explored.

To examine the association between health insurance coverage and cardiometabolic risk factors among people with chronic conditions in India.

Data from the Centre for Cardiometabolic Risk Reduction in South Asia (CARRS) and Solan studies, including 2,926 adults with chronic conditions were analyzed using propensity score weighting to evaluate the associations between health insurance and cardiometabolic risk factors (HbA1c, low-density lipoprotein cholesterol [LDLc], and blood pressure [BP]) and self-reported health status (measured using European Quality of Life Visual Analogue Scale [EQ-VAS]). Mediation analysis evaluated healthcare visits as a potential mediator.

Among 2,926 respondents meeting criteria, mean (SD) age was 54.6 years (11.8), and 1630 (55.7%) were women. Health insurance coverage was low (6.5%) and more prevalent among men, higher-income groups, and rural vs urban residents. Insured participants had lower mean diastolic BP (84.8 vs 86.0 mmHg), mean LDLc (113.3 vs 117.2 mg/dl), mean HbA1c (6.9% vs 7.5%), and higher health status (EQ-VAS: 74.6 vs 69.1) than uninsured participants, respectively (p < 0.05). Mediation analysis showed healthcare visits strongly mediated the relationship between insurance and BP and partially mediated effects on LDLc, HbA1c, and self-rated health.

Health insurance coverage was associated with better cardiometabolic risk profiles and health status, largely mediated by increased healthcare utilization. Expanding insurance coverage to include outpatient chronic care services should be prioritized to improve health outcomes in low- and middle-income countries.

Main findings: Insurance coverage among people with chronic conditions in India is low, yet it is associated with better cardiometabolic risk factor levels and self-rated health, mediated by increased healthcare utilization.Added knowledge: This study provides empirical evidence on the strong association of insurance status on health outcomes using a quasi-experimental design (propensity score weighting).Global health impact for policy and action: Expanding insurance coverage to include outpatient chronic care is vital for improving chronic care quality and reducing premature chronic disease mortality.

Main findings: Insurance coverage among people with chronic conditions in India is low, yet it is associated with better cardiometabolic risk factor levels and self-rated health, mediated by increased healthcare utilization.

Added knowledge: This study provides empirical evidence on the strong association of insurance status on health outcomes using a quasi-experimental design (propensity score weighting).

Global health impact for policy and action: Expanding insurance coverage to include outpatient chronic care is vital for improving chronic care quality and reducing premature chronic disease mortality.