What Drives Public–Private Hospital Choice? Socioeconomic and Health-Insurance Determinants among Households in Kanniyakumari District, Tamil Nadu, India

Abstract

Healthcare utilisation is influenced by socioeconomic conditions, financial capacity, education, and access to health insurance. This study examines the factors associated with the choice between public and private hospitals among households in Kanniyakumari District, Tamil Nadu. A cross-sectional study was conducted among 386 households, and information was collected on demographic characteristics, socioeconomic conditions, health insurance coverage, and healthcare utilisation. Descriptive statistics and chi-square tests were used to examine differences in hospital choice, followed by multivariable logistic regression to identify independent predictors of private hospital utilisation. The findings show that 62.3% of males and 61.1% of females used private hospitals, with no significant association between gender and hospital choice. Significant differences were observed by age, household income, education, social group, ration card status, residence, and health insurance in the initial analysis. In the adjusted model, household income and education remained significant predictors. Households with a monthly income of ₹20,001–40,000 had higher odds of using private hospitals (AOR = 4.156; 95% CI: 2.273–7.598), while those with income above ₹40,000 had substantially higher odds (AOR = 17.618; 95% CI: 1.691–183.562). Higher educational attainment was also strongly associated with private hospital use. Health insurance, residence, social group, gender, and age were not significant after adjustment. The findings indicate that economic and educational differences play an important role in shaping hospital choice. Strengthening the accessibility and quality of public hospitals and improving awareness and effective use of health insurance may help reduce inequalities in healthcare access. The study provides household-level evidence on public–private hospital choice in Kanniyakumari District