Abstract
Equity in healthcare has been a long-term guiding principle of health policy in India. We estimate the change in horizontal inequities in healthcare use over two decades comparing the older population (60 years or more) with the younger population (under 60 years). We used data from the nationwide healthcare surveys conducted in India by the National Sample Survey Organization in 1995–96 and 2014 with sample sizes 633 405 and 335 499, respectively. Bivariate and multivariate logit regression analyses were used to study the socioeconomic differentials in self-reported morbidity (SRM), outpatient care and untreated morbidity. Deviations in the degree to which healthcare was distributed according to need were measured by horizontal inequity index (HI). In each consumption quintile the older population had four times higher SRM and outpatient care rate than the younger population in 2014. In 1995–96, the pro-rich inequity in outpatient care was higher for the older (HI: 0.085; 95% CI: 0.066, 0.103) than the younger population (0.039; 0.034, 0.043), but by 2014 this inequity became similar. Untreated morbidity was concentrated among the poor; more so for the older (−0.320; −0.391, −0.249) than the younger (−0.176; −0.211, −0.141) population in 2014. The use of public facilities increased most in the poorest and poor quintiles; the increase was higher for the older than the younger population in the poorest (1.19 times) and poor (1.71 times) quintiles. The use of public facilities was disproportionately higher for the poor in 2014 than in 1995–96 for the older (−0.189; −0.234, −0.145 vs − 0.065; −0.129, −0.001) and the younger (−0.145; −0.175, −0.115 vs − 0.056; −0.086, −0.026) population. The older population has much higher morbidity and is often more disadvantaged in obtaining treatment. Health policy in India should pay special attention to equity in access to healthcare for the older population.
Highlights
Equity in healthcare utilization has increasingly being acknowledged by both developed and developing countries as an important intermediate step to achieve the goal of equity in health (Grasdal and Monstad 2011)
Bivariate and multivariate logit regression analyses were used to study the socioeconomic differentials in self-reported morbidity (SRM), outpatient care and untreated morbidity
In 1995–96, the pro-rich inequity in outpatient care was higher for the older (HI: 0.085; 95% concentration index (CI): 0.066, 0.103) than the younger population (0.039; 0.034, 0.043), but by 2014 this inequity became similar
Summary
Equity in healthcare utilization has increasingly being acknowledged by both developed and developing countries as an important intermediate step to achieve the goal of equity in health (Grasdal and Monstad 2011). Details of the sampling design, survey instruments, and initial findings can be found in the national reports (Ministry of Statistics and Programme Implementation 1998, 2015) Both the surveys collected information on treatment status of each spell of ailment reported in a 15-days reference period for a nationally representative sample of 633 405 and 335 499 individuals of all ages (including deceased members) in NSSO 1995–96 and NSSO 2014 surveys, respectively. We examined horizontal inequity (the extent to which people in equal need for healthcare receive equal treatment, irrespective of their income) in outpatient care, untreated morbidity and use of public facilities for outpatient care comparing the older population aged 60 years or more and the population under 60 years at two time points: 1995–96 and 2014. To quantify the magnitude of inequity in healthcare utilization we calculated the concentration index for the need-standardized use (ybIis) which was termed as HI (Wagstaff and van Doorslaer 2000).
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