What the evidence says
The most direct evidence on district-boundary mechanisms comes from a descriptive network analysis of inter-district hospital-seeking behavior. Crossing an administrative district boundary associates with an increase in travel distance to reach a tertiary hospital: the average "bypass premium" for reaching a tertiary hospital is 10.24 km, and 73.54% of that (7.53 km) is attributed to passive structural friction from the boundary itself, while the remaining 26.46% (2.71 km) reflects an active, quality-driven premium. The source explicitly frames this as "outcome-level structural accounting" rather than causal attribution, and it does not measure whether this added distance changes any health or insurance outcome.
The same analysis finds that boundary-crossing associates with a compositional shift in where patients seek care. For flows that cross a district boundary, the tertiary hospital share increases to 53.40% of inter-district flows versus 26.80% of intra-district flows, while the primary care hospital share decreases to 21.10% versus 47.0%. The hospital-seeking "upgrade rate" — patients choosing a higher-tier facility — reaches 65.40% for inter-district flows versus 44.70% for intra-district flows. The source notes that multiple mechanisms could produce this pattern (capacity constraints, specialty mismatch, referral policy, patient awareness) and that mobility data alone cannot separate them.
Secondary hospitals show no measured effect from crossing a boundary: their market share is 26.20% for intra-district flows versus 25.60% for inter-district flows, a difference the source calls "functional neutrality" and reports as not significant using bootstrap testing.
On insurance specifically, one cross-sectional study finds that the association between antenatal-care (ANC) quality and insurance uptake depends on local health-facility density. In low-density areas (the south), higher ANC quality is marginally associated with increased insurance uptake, at 0.30 percentage points per unit increase in the ANC quality index. In high-density areas (the north), no significant association is found, with a point estimate of −0.08 percentage points. The source flags small effect sizes and marginal statistical significance, and its cross-sectional design precludes causal interpretation.
Separately, a scoping review of redlining research reports that studies "nearly universally" find an association between historical redlining and health-relevant outcomes, but states that heterogeneity in study design prevents direct comparison of results. No direction, magnitude, or specific outcome is given beyond this abstract-level summary.
Across these sources, no claim measures a direct causal path from district-boundary structure to insurance coverage or to a health outcome. What exists is: boundary-crossing associates with more travel distance and a shift toward higher-tier hospitals (Guo Q), and health-facility density moderates a weak ANC-quality/insurance-uptake association (James N). The link between these boundary-driven travel and hospital-choice patterns and any downstream insurance or health outcome is not measured in the sources here.