State-Level Health Insurance Coverage, Educational Attainment and Cataract Surgical Rate in India: An Ecological Study of States and Union Territories, 2023-24

Background: Cataract remains a leading cause of avoidable blindness in India. It is possible that differences in coverage by health insurance and levels of education may have an impact on cataract surgery utilisation; but the relationship between these factors and Cataract Surgical Rate (CSR) at the state level has not been studied well enough yet. The objective was to analyze the association of health insurance coverage and educational status of the households with CSR in the States and Union Territories of India. Methods: The cross-sectional ecological study utilized secondary data of 35 States and Union Territories in India (except for Manipur because of lack of data) in 2023-24. The data on the proportion of households having health insurance, percent of females and males with at least 10 years of schooling were collected from the NFHS-6, while the number of cataract surgeries from NPCBVI Annual Report. The CSR is the number of surgeries carried out per million population. Descriptive statistics and Pearson’s correlation were done. Results: There were wide variations in health insurance cover, education level of females and males, and CSR among the States and UTs. There was no significant relationship between the health insurance cover and CSR (r = 0.085, p = 0.626). A weak but non-significant positive relationship existed between women’s education level and CSR (r = 0.291, p = 0.090), while the education level of males was significantly weakly positively correlated to CSR (r = 0.347, p = 0.041). Conclusion: For the state/UT-level data, there was no significant relationship between household health insurance coverage and CSR; however, there was a weak positive relationship found for male education levels. This implies that CSR maybe influenced by multiple factors apart from household health insurance and educational levels that affect CSR.