Background Health insurance landscape in India has undergone rapid transformation due to expansion of both centrally and state-funded health insurance schemes, most notable being the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojna (AB-PMJAY). Health insurance affects both preventive and curative care and a key determinants of life expectancy. This paper estimated longevity and premature mortality by health insurance coverage in India. Methods We have used the latest round of the National Family and Health Survey data (NFHS-5) conducted in 2019–2021. NFHS-5 collects detailed information of household demographics, housing condition, consumer durables, health insurance coverage, mortality of household members and the birth histories of women in the sampled household. Information of mortality was utilized to estimate person-years and deaths across the age groups. Abridged lifetables were constructed using Chiang’s life table approach. Results In India, 40% of individuals were insured, largely by social health insurance. The life expectancy at birth (LEB) was higher among the insured (LEB: 70.0 years, 95%CI: 69.6–70.3) than non-insured (LEB: 67.7 years, 95%CI: 67.4–68.0). Among the insured, LEB was highest among private health insured (LEB: 74.2 years, 95%CI: 72.4, 76.0), followed by those with employer-based (LEB: 71.5 years, 95%CI: 70.5, 72.5) and social (LEB: 69.6 years, 95%CI: 69.2, 69.9) health insurance. The premature mortality (probability of dying by age 70 denoted as 70<InlineEquation ID="IEq1"> <InlineMediaObject> <ImageObject Color="BlackWhite" FileRef="12982_2025_726_Article_IEq1.gif" Format="GIF" Height="12" Rendition="HTML" Resolution="72" Type="Linedraw" Width="16" /> </InlineMediaObject> <EquationSource Format="TEX">\(\:{q}_{0}\)</EquationSource> </InlineEquation>) was lower among the insured (0.345) than non-insured individuals (0.387). Similarly, the 70<InlineEquation ID="IEq2"> <InlineMediaObject> <ImageObject Color="BlackWhite" FileRef="12982_2025_726_Article_IEq2.gif" Format="GIF" Height="12" Rendition="HTML" Resolution="72" Type="Linedraw" Width="16" /> </InlineMediaObject> <EquationSource Format="TEX">\(\:{q}_{0}\:\)</EquationSource> </InlineEquation>was 0.267 for private health insurance compared to 0.353 and 0.314 for social and employer health insurance respectively. Conclusion In India, observed differences in premature mortality and life expectancy favor the insured across socio-economic groups. Future research is needed to establish the causal relationship between health insurance and mortality.

Life expectancy and premature mortality among insured and non-insured in India, 2019–21

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2025年6月10日

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Ankita Roy,
Jyoti Das,
Sanjay K Mohanty

摘要

Background

Health insurance landscape in India has undergone rapid transformation due to expansion of both centrally and state-funded health insurance schemes, most notable being the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojna (AB-PMJAY). Health insurance affects both preventive and curative care and a key determinants of life expectancy. This paper estimated longevity and premature mortality by health insurance coverage in India.

Methods

We have used the latest round of the National Family and Health Survey data (NFHS-5) conducted in 2019–2021. NFHS-5 collects detailed information of household demographics, housing condition, consumer durables, health insurance coverage, mortality of household members and the birth histories of women in the sampled household. Information of mortality was utilized to estimate person-years and deaths across the age groups. Abridged lifetables were constructed using Chiang’s life table approach.

Results

In India, 40% of individuals were insured, largely by social health insurance. The life expectancy at birth (LEB) was higher among the insured (LEB: 70.0 years, 95%CI: 69.6–70.3) than non-insured (LEB: 67.7 years, 95%CI: 67.4–68.0). Among the insured, LEB was highest among private health insured (LEB: 74.2 years, 95%CI: 72.4, 76.0), followed by those with employer-based (LEB: 71.5 years, 95%CI: 70.5, 72.5) and social (LEB: 69.6 years, 95%CI: 69.2, 69.9) health insurance. The premature mortality (probability of dying by age 70 denoted as ₇₀ \(\:{q}_{0}\) ) was lower among the insured (0.345) than non-insured individuals (0.387). Similarly, the ₇₀ \(\:{q}_{0}\:\) was 0.267 for private health insurance compared to 0.353 and 0.314 for social and employer health insurance respectively.

Conclusion

In India, observed differences in premature mortality and life expectancy favor the insured across socio-economic groups. Future research is needed to establish the causal relationship between health insurance and mortality.