Assessment of Health Insurance Utilization and the Associated Barriers in a Rural-to-Semi-Urban Setting in Idukki, Kerala, India: A Cross-Sectional Study

IntroductionHealth insurance coverage in developing regions often exhibits disparities between urban and rural populations, along with a notable gap between policy enrollment and actual utilization.Local-level evaluations are essential to determine whether broad regional trends accurately reflect realities at the community level.This study aimed to assess the enrollment status, utilization patterns, and associated barriers regarding health insurance in a rural-to-semi-urban locality surrounding a municipality in Kerala, India. MethodsA cross-sectional study was conducted across two panchayats near the Thodupuzha municipality, in the Idukki district of Kerala, India.Using a cluster sampling technique, a sample size of 106 households was targeted, resulting in 106 successfully selected households.Data were gathered via a structured questionnaire administered primarily to the heads of the families.The primary objective was to evaluate health insurance enrollment and utilization.Secondary parameters, including service availment, policy renewal, user satisfaction, difficulties faced, and specific concerns regarding health insurance schemes, were also documented and analyzed. ResultsOf the 106 participant households, 101 respondents (95.2%) demonstrated awareness of health insurance.Overall, 65 households (61.32%) reported prior or current enrollment, while 41 households (38.68%) had never been enrolled.Complete household coverage (all members enrolled) was observed in 28 households (26.4%), whereas only the head of the family was enrolled in 6 households (5.7%).At the time of the study, 58 (54.7% of the total 106) families had active coverage.Among the currently enrolled cohort, only 32 households (30.2% of the total sample) had successfully utilized health insurance benefits. ConclusionThis cross-sectional study demonstrated high community awareness and moderate cumulative enrollment regarding health insurance in a semi-urban setting in Kerala.However, actual utilization remained low relative to enrollment rates, alongside variable user satisfaction.These findings highlight a critical implementation gap between having health insurance coverage and translating it into accessible healthcare utilization, emphasizing the need for targeted awareness campaigns and administrative simplification at the local governance level.