Abstract
BackgroundHealth outcomes in India are characterized by pervasive inequities due to deeply entrenched socio-economic gradients amongst the population. Therefore, it is imperative to investigate these systematic disparities in health, however, evidence of inequities does not commensurate with its policy objectives in India. Thus, our paper aims to examine the magnitude of and trends in horizontal inequities in self-reported morbidity and untreated morbidity in India over the period of 2004 to 2017–18.MethodsThe study used cross-sectional data from nationwide healthcare surveys conducted in 2004, 2014 and 2017–18 encompassing sample size of 3,85,055; 3,35,499 and 5,57,887 individuals respectively. Erreygers concentration indices were employed to discern the magnitude and trend in horizontal inequities in self-reported morbidity and untreated morbidity. Need standardized concentration indices were further used to unravel the inter-regional and intra-regional income related inequities in outcomes of interest. Additionally, regression based decomposition approach was applied to ascertain the contributions of both legitimate and illegitimate factors in the measured inequalities.ResultsEstimates were indicative of profound inequities in self-reported morbidity as inequity indices were positive and significant for all study years, connoting better-off reporting more morbidity, given their needs. These inequities however, declined marginally from 2004(HI: 0.049, p< 0.01) to 2017–18(HI: 0.045, P< 0.01). Untreated morbidity exhibited pro-poor inequities with negative concentration indices. Albeit, significant reduction in horizontal inequity was found from 2004(HI= − 0.103, p< 0.01) to 2017–18(HI = − 0.048, p< 0.01) in treatment seeking over the years. The largest contribution of inequality for both outcomes stemmed from illegitimate variables in all the study years. Our findings also elucidated inter-state heterogeneities in inequities with high-income states like Andhra Pradesh, Kerala and West Bengal evincing inequities greater than all India estimates and Northeastern states divulged equity in reporting morbidity. Inequities in untreated morbidity converged for most states except in Punjab, Chhattisgarh and Himachal Pradesh where widening of inequities were observed from 2004 to 2017–18.ConclusionsPro-rich and pro-poor inequities in reported and untreated morbidities respectively persisted from 2004 to 2017–18 despite reforms in Indian healthcare. Magnitude of these inequities declined marginally over the years. Health policy in India should strive for targeted interventions closing inequity gap.
Highlights
Inequality in health is an empirical notion that refers to differences in health status between different groups
Social and economic inequality in healthcare remains an unprecedented challenge in India and as the nation commits to embark on the journey towards Universal Health Coverage, it becomes imperative to explore the dimension of equity to promulgate inclusive policies
This section comprises of findings from the analysis which is further disaggregated into various subsections comprising of a) Inequality and Horizontal Inequity in Self-Reported Health Status in India b) Inequality and Horizontal Inequity in Untreated Morbidity in India c) Interregional comparison of Inequality and Horizontal
Summary
Inequality in health is an empirical notion that refers to differences in health status between different groups. The term does not refer generically to just any inequalities between any population groups, but very to disparities between groups of people categorized a priori according to some important features of their underlying social position [1]. It is a multi-dimensional concept, consisting of technical and normative judgements in the choice of appropriate metrics [2]. The WHO Commission on Social Determinants of Health further asserts health inequities as the differences that are systematic, avoidable and unfair Such socioeconomic inequities are ubiquitous in the health outcomes of developing world including India, where healthcare consumption is profoundly characterized by socio-economic gradient whereby, those who are socially and economically more disadvantaged have less access to and utilize less services. Our paper aims to examine the magnitude of and trends in horizontal inequities in self-reported morbidity and untreated morbidity in India over the period of 2004 to 2017–18
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