Abstract
ObjectiveThe study attempts (a) to compute the degree of socio-economic inequity in health care utilization and (b) to decompose and analyze the drivers of socio-economic inequity in health care utilization among adults (20–59 years) in India during the periods 2014 and 2017–18.Data sourceThe analysis has been done by using the unit level data of Social Consumption: Health (Schedule number 25.0), of National sample Survey (NSS), corresponding to the 71st and 75th rounds.MethodsOdds ratios were computed through logistic regression analysis to examine the effect of the socio-economic status on the health seeking behaviour of the ailing adult population in India. Concentration Indices (CIs) were calculated to quantify the magnitude of socio-economic inequity in health care utilization. Further, the CIs were decomposed to find out the share of the major contributory factors in the overall inequity.ResultsThe regression results revealed that socio-economic status continues to show a strong association with treatment seeking behavior among the adults in India. The positive estimates of CIs across both the rounds of NSS suggested that health care utilization among the adults continues to be concentrated within the higher socio-economic status, although the magnitude of inequity in health care utilization has shrunk from 0.0336 in 2014 to 0.0230 in 2017–18. However, the relative contribution of poor economic status to the overall explained inequities in health care utilisation observed a rise in its share from 31% in 2014 to 45% in 2017–18.ConclusionTo reduce inequities in health care utilization, policies should address issues related to both supply and demand sides. Revamping the public health infrastructure is the foremost necessary condition from the supply side to ensure equitable health care access to the poor. Therefore, it is warranted that India ramps up investments and raises the budgetary allocation in the health care infrastructure and human resources, much beyond the current spending of 1.28% of its GDP as public expenditure on health. Further, to reduce the existing socio-economic inequities from the demand side, there is an urgent need to strengthen the redistributive mechanisms by tightening the various social security networks through efficient targeting and broadening the outreach capacity to the vulnerable and marginalized sections of the population.
Highlights
Health is a “critically significant constituent of human capabilities”, i.e. an integral enabling factor for a person to thrive as a human being and health equity is central to social justice [1]
The regression results revealed that socio-economic status continues to show a strong association with treatment seeking behavior among the adults in India
The positive estimates of Concentration Indices (CIs) across both the rounds of National sample Survey (NSS) suggested that health care utilization among the adults continues to be concentrated within the higher socio-economic status, the magnitude of inequity in health care utilization has shrunk from 0.0336 in 2014 to 0.0230 in 2017–18
Summary
Health is a “critically significant constituent of human capabilities”, i.e. an integral enabling factor for a person to thrive as a human being and health equity is central to social justice [1]. Since the decade of 1990s, policy oriented research in health inequities has emerged as an increasingly popular domain of investigation worldwide with national governments, policy-makers and international organizations like the World Bank and the World Health Organization starting to put equity among the top priorities in their agendas [3,4,5]. This is reflected in the Millennium Development Goals (Goals- 4, 5 and 6) that laid primary thrust on the improvement in the health outcomes of the world’s poor and subsequently in the Goal-3 of Sustainable Development Goals that focused on ensuring equity in health [6, 7]. The development in health inequity literature [16,17,18,19] has motivated researchers in India to estimate the inequities in health status and distribution of health care services across the various socio-economic groups [20,21,22,23,24,25]
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