Service Quality, Customer Satisfaction, Health Insurance Literacy, and Perceived Health Outcomes Among Policyholders in Darjeeling and Jalpaiguri Districts of West Bengal, India: An Empirical Investigation

Abstract

Health insurance literacy (HIL) determines whether formal coverage translates into financial protection and improved health for policyholders. In India, out-of-pocket spending accounts for approximately 59.6% of all health expenditure, a burden that low HIL directly worsens by leaving insured persons unable to navigate their coverage. This study examines how HIL relates to health service utilisation, service quality, customer satisfaction, perceived quality of care, and overall health outcomes among policyholders in the Darjeeling and Jalpaiguri districts of West Bengal. Data were collected through a structured questionnaire from 470 respondents, of whom 367 were insured and 103 were uninsured. Statistical analysis used Spearman's rank correlation, Pearson chi-square with Cramér's V, independent samples t-tests, and one-way ANOVA with Tukey HSD comparisons. All four hypotheses were supported. HIL was positively associated with health service utilisation (ρ = 0.49, p < 0.001; χ²(4) = 100.28, Cramér's V = 0.37). Service quality showed a strong link with customer satisfaction (ρ = 0.88, p < 0.001; χ²(4) = 470.48, Cramér's V = 0.80). HIL also correlated positively with perceived quality of health services (ρ = 0.46, p < 0.001) and with overall health outcomes (ρ = 0.42, p < 0.001), with financial risk protection as the most immediate benefit. Education and income were significant moderators throughout. The findings support a sequential model, HIL → health service utilisation → perceived service quality → customer satisfaction → overall health outcomes, with implications for insurers, IRDAI, and health policy in North Bengal..