National Sample Survey Data Research Articles

Education Inequality in India: An Empirical Analysis Using National Sample Survey Data

Education Inequality in India: An Empirical Analysis Using National Sample Survey Data

Health Insurance for Universal Health Coverage in India

The role of health insurance in expanding Universal Health Coverage is to ease the access to healthcare services and reduce the risk of unexpected health expenditure burden. In order to examine this role, this article assesses the contribution of enrolment in health insurance on the utilisation of healthcare services and out-of-pocket expenditure for working-age Indians. Investigation into these two issues, addressing the self-selection/endogeneity problem in buying health insurance, is uncommon in the literature. Against this end, the probability of utilising healthcare services and the incurred out-of-pocket expenditure has been estimated using National Sample Survey (2017–2018) data in India. Empirical findings reveal evidence of endogeneity in health insurance enrolment for hospitalisation, which indicates the presence of self-selection in health insurance enrolment. Addressing the endogeneity problem, this study has found a higher probability of utilising hospitalisation and lower out-of-pocket expenditure among insured individuals than others. Socio-economic and demographic variables like household income, education, gender, religion and state of residence are important to determine the utilisation of healthcare facilities. On the other hand, while out-of-pocket expenditure incurred for hospitalisation significantly varies with age, gender, social caste, religion, working status, state of residence, nature of ailment and type of hospital, household income and health status have no significant effect on out-of-pocket expenditure. Poor people are less likely to be hospitalised, and compared to males, females have a higher probability of utilising healthcare services at their reproductive age. State-level health policies and health insurance schemes play a crucial role in determining health insurance participation and utilisation of health services. JEL: C13, C21, C25, I10, I11, I13, I14, I18

Status and Trend of General Education, Technical Education, and Vocational Education by Persons with Disabilities in India: Reflection of three NSS rounds

Abstract : The present study attempts to estimate the status and trend in educational achievement, particularly in technical and vocational education among persons with disabilities in India across gender and social groups. 47th, 58th, and 76th round unitlevel National Sample Survey data were analyzed using the gender parity index, compound annual growth rate, ordered logit model, and binary logit model. Result shows that though the literacy rate among persons with disabilities in India gradually increases over time, still half of the persons with disabilities were illiterate compared to one-fifth of non-disabled peers. A large section of children with disabilities drops out. The transition of education from school level to higher education, technical and vocational education by persons with disabilities was very slow. Only 4.31 percent, 3.08 percent, and 1.08 percent of persons with disabilities received higher education, vocational education, and technical training in 2018. There was a gradual decrease in gender disparity against women with disabilities and turns in favor of women at all levels of general education. However, gender disparity persisted against females with disabilities, in the attainment of technical and vocational training. The attainment of technical education by males with disabilities was three times higher compared to females with disabilities. Strong caste discrimination still exists in all levels of educational attainment against scheduled castes and scheduled tribes. Educational achievement is negatively related to the severity of the disability, household size, and rural-urban areas, but positively to households' economic status. The study draws important policy implications to improve the education of persons with disabilities. Keywords: Caste discrimination, Gender discrimination, General education, Persons with disabilities, Technical Education, Vocational Education

Decomposing the inequalities in the catastrophic health expenditures on the hospitalization in India: empirical evidence from national sample survey data.

Sustainable Development Goal (SDG) Target 3.8.2 entails financial protection against catastrophic health expenditure (CHE) by reducing out-of-pocket expenditure (OOPE) on healthcare. India is characterized by one of the highest OOPE on healthcare, in conjunction with the pervasive socio-economic disparities entrenched in the population. As a corollary, India has embarked on the trajectory of ensuring financial risk protection, particularly for the poor, with the launch of various flagship initiatives. Overall, the evidence on wealth-related inequities in the incidence of CHE in low- and middle-Income countries has been heterogenous. Thus, this study was conducted to estimate the income-related inequalities in the incidence of CHE on hospitalization and glean the individual contributions of wider socio-economic determinants in influencing these inequalities in India. The study employed cross-sectional data from the nationally represented survey on morbidity and healthcare (75th round of National Sample Survey Organization) conducted during 2017-2018, which circumscribed a sample size of 1,13,823 households and 5,57,887 individuals. The inequalities and need-adjusted inequities in the incidence of CHE on hospitalization care were assessed via the Erreygers corrected concentration index. Need-standardized concentration indices were further used to unravel the inter- and intra-regional income-related inequities in the outcome of interest. The factors associated with the incidence of CHE were explored using multivariate logistic regression within the framework of Andersen's model of behavioral health. Additionally, regression-based decomposition was performed to delineate the individual contributions of legitimate and illegitimate factors in the measured inequalities of CHE. Our findings revealed pervasive wealth-related inequalities in the CHE for hospitalization care in India, with a profound gap between the poorest and richest income quintiles. The negative value of the concentration index (EI: -0.19) indicated that the inequalities were significantly concentrated among the poor. Furthermore, the need-adjusted inequalities also demonstrated the pro-poor concentration (EI: -0.26), denoting the unfair systemic inequalities in the CHE, which are disadvantageous to the poor. Multivariate logistic results indicated that households with older adult, smaller size, vulnerable caste affiliation, poorest income quintile, no insurance cover, hospitalization in a private facility, longer stay duration in the hospital, and residence in the region at a lower level of epidemiological transition level were associated with increased likelihood of incurring CHE on hospitalization. The decomposition analysis unraveled that the contribution of non-need/illegitimate factors (127.1%) in driving the inequality was positive and relatively high vis-à-vis negative low contribution of need/legitimate factors (35.3%). However, most of the unfair inequalities were accounted for by socio-structural factors such as the size of the household and enabling factors such as income group and utilization pattern. The study underscored the skewed distribution of CHE as the poor were found to incur more CHE on hospitalization care despite the targeted programs by the government. Concomitantly, most of the inequality was driven by illegitimate factors amenable to policy change. Thus, policy interventions such as increasing the awareness, enrollment, and utilization of Publicly Financed Health Insurance schemes, strengthening the public hospitals to provide improved quality of specialized care and referral mechanisms, and increasing the overall budgetary share of healthcare to improve the institutional capacities are suggested.

Perceived Utility of Jan Aushadhi Outlets and Awareness of Generic Medicines at the Andaman and Nicobar Islands: A Cross-Sectional Study.

Despite being the leading exporter of generic medicines to the world, affordable medicines are still beyond the reach of most patients in India.Analysis of the National Sample Survey data showed that in one year, more than 55 million Indians became poor only because they had to spend their own money to purchase medicines. The Jan Aushadhi Scheme launched by the Government of India is an ambitious step to make quality generic drugs affordable to the common man of the country. This study aimed to assess the knowledge, attitude, and perceptions of patients at a tertiary care teaching hospital in the Andaman and Nicobar Islands about Jan Aushadhi Kendras and generic medicines. The study was a questionnaire-based cross-sectional study. A prevalidated self-made questionnaire was distributed to 200 patients visiting the OPD of different clinical departments in the hospital. Participants' knowledge, attitude, and perception of Jan Aushadhi Kendras and generic medicines were evaluated. Analysis of collected data was done using descriptive statistical measures such as mean and percentages. It was found that most of the participants were not fully aware of the Jan Aushadhi Scheme and the facts about generic medicines. The majority of the participants were under the notion that generics were not similar in quality to the branded ones. The study observed that the patients had a very poor understanding of the Jan Aushadhi Scheme and generic medicines with the majority being ignorant and having incorrect information. To fill this gap, a more proactive approach by the healthcare workers and authorities is needed to disseminate the scheme-related facts, dispel the myths regarding generics, and accept the program wholeheartedly by the common man.

Hospitalisation expenditure on tuberculosis among tribal populations in India: A repeated cross-sectional analysis of national sample survey data, 2004 to 2018

ObjectiveTribal population in India (8.6% of the total population) have a greater prevalence of tuberculosis compared to the national average. The article aims to study out-of-pocket expenditure (OOPE), hardship financing, and impoverishment effects of TB hospitalisation treatment among tribal populations in India. MethodsData of three rounds of National Sample Surveys (NSS) 60th (2004–05), 71st (2013–14) and 75th (2017–18) rounds were analyzed. Descriptive statistics, bivariate estimates and multivariate models were performed to calculate the OOPE, healthcare burden (HCB), catastrophic health expenditure (CHE), hardship financing and impoverishment effects using standard definitions at February 2023 price values. Propensity score matching (PSM) was used to examine the effect of health insurance coverage on catastrophic health expenditure, and impoverishment. ResultsOver two-thirds of the TB cases are seen in the economically productive age group (14–59 years). Substantial OOPE and its impact on HCB, CHE, and poverty impact observed among 15–35 age group across all three rounds. Illiterate patients and those availing private hospitals for TB treatment had higher OOPE, HCB, hardship financing, CHE, and poverty impact. 38.5% (2014) and 33.2% (2018) are covered with any kind of public healthcare coverage, PSM analysis shows households with health insurance have lower incidence of CHE and impoverishment effects due to TB hospitalisation expenditure. ConclusionsThe current study aids in comprehending the patterns in the financial burden of TB on tribal households during the previous 15 years and gives policy makers information for efficient resource allocation management for TB among Indian tribal communities.

Unfair by Design: The War on Drugs, Race, and the Legitimacy of the Criminal Justice System

ABSTRACT: Over the past 30 years federal and state policies have increasingly pursued a harsh, "tough on crime" position. With the "war on drugs" and allied changes in sentencing practices and policing policies, the US has witnessed a sharp increase in the proportion of citizens incarcerated or under some form of supervision by the state. This transformation has fallen with special severity on African Americans, especially low-income black males. To many analysts, the deepening racialization of the chances of criminal incarceration was at least a foreseeable, if not predictable and intended, consequence of these policy changes. The purpose of this essay, based on new focus group research and newly designed national sample survey data, is to assess the perceptions and consequences of these changes for African Americans' judgments about the legitimacy of the criminal justice system.

To Reform and to Procure: An Analysis of the Role of the State and the Market in Indian Agriculture

Since the early 2000s, some Indian states started allowing private traders to buy directly from farmers outside the state-regulated market system. The experience of these states can shed light on the impact of market-oriented reforms and the role of public procurement. Using individual-level National Sample Survey Data on agricultural wages and a new dataset on state-level average real farm income per cultivator for 18 major Indian states between 1987–2012, this paper shows, using both a difference-in-difference and a triple difference framework, that marketing reforms alone did not contribute to higher farm incomes and agricultural wages. However, when these reforms were coupled with public procurement at the minimum support price, farm incomes and agricultural wages significantly improved. Our results suggest that market-reforms and public procurement at minimum support prices were complements which together contributed to raising rural incomes in states like Haryana, Madhya Pradesh, and Andhra Pradesh.

Trends, patterns and socioeconomic determinants of child and adolescent labour in India: Empirical analysis using national sample survey data

AbstractIndian official data points out a progressive decline in child labour during last three decades.Nevertheless, there are several gaps that need to be addressed for targed policy intervention. This paper highlights the key socioeconomic vulnerabilities among children in rural and urban India and also summarize the key focus areas to be prioritized. We posit that children's entry into the labour force is driven by varied access to resources such as education, societal status and gender. The children in Scheduled Castes and Scheduled Tribes households are the most vulnerable. We recommend prioritizing easy‐to‐access quality education among the key strategies for eradicating child labour.

Determinants of Health Expenditure Among the Informal Workers of India: Is It Always Catastrophic?

The Indian labour market is dominated by informal workers. Out-of-pocket healthcare payments are the principal source of healthcare financing for those workers. This article will try to investigate the determinants of health expenditures across heterogeneous groups of informal workers in India based on the 68th round of National Sample Survey data on Employment and Unemployment for 2011–2012. Across different types of informal workers, mean health expenditure has been highest among ‘employees of informal sectors’. The determining factors for the health expenditure are social group, household head and the number of dependencies. It is also found that health expenditure is not always catastrophic among informal workers. The result obtained is that health expenditure has been catastrophic for almost 30% of informal workers across various heterogeneous groups. Using the probit model, the influencing factors responsible for the incidence of catastrophic health expenditure are age and sex of the household head, the number of senior citizens in the family, possession of assets and expenditure on fuel and electricity.

HSD33 Horizontal Inequities in the Healthcare Expenditures for Communicable Disease: An Evidence from the National Sample Survey Data

HSD33 Horizontal Inequities in the Healthcare Expenditures for Communicable Disease: An Evidence from the National Sample Survey Data

Inequality and Caste-Based Crime in India

Using data from the National Crime Records Bureau and National Sample Survey data, this paper uses a spatial regression technique to examine the effect of intercaste inequality on caste-based violence in India. Our results show that when the socioeconomic gap between the upper and lower castes decreases, upper caste violence against the lower castes increases. This result is interpreted as the upper castes reacting to changes in threat perception caused by changes in the relative positions of these two groups.

The labour market dilemma of young urban women in India: An outcome of family welfare optimization

This paper uses a theoretical model to explain the patterns and determinants of labour market participation behaviour of young urban women in India. Based on the National Sample Survey (NSS) data and through probit regression results, it argues that the labour market participation decision of young women is an outcome of the joint utility maximization behaviour of their family. The standard of living of the family, market wage, other family characteristics, including the number of children, adult women in the family, elderly members, and occupation, and gender of the head, etc., are significantly determining their labour market participation; apart from women’s individual characteristics like age (experience) and level of education and training. The empirical result also reflects that the “discouraged worker effect” is stronger than the “added worker phenomenon”. Hence, measures to create jobs in modern services could help boost the stagnant female labour force participation in urban India.

Assessing the impact of measurement error in household consumption on estimates of catastrophic health expenditure in India

The National Sample Survey (NSS) collects reliable data on morbidity, health care, and health spending through its annual multi-subject and multi-round health surveys. Evidences from these surveys have been extensively used for research and policy. While these surveys collect comprehensive information on morbidity, hospitalisation, health expenditure, information on household consumption expenditure (which is used to explain the economic gradient in health outcomes) is collected through a single question. Literature suggests that having a single question on consumption expenditure results in measurement errors. In this paper, we examine the effect of measurement errors of household consumption expenditure on estimates of catastrophic health expenditure (CHE) in India using data from the 68th round of the consumption survey (2011–12) and the 71st round of the health survey (2014), carried out by the National Sample Survey (NSS). The consumption survey canvassed a detailed schedule on consumption and interviewed 101,651 households, whereas the health survey interviewed 65,932 households from across the country. Descriptive statistics, estimates of CHE, and logistic regression models were used in the analysis. We used both the budget share approach and the capacity-to-pay approach for estimating CHE. The NSS health survey was found to have underestimated monthly per capita consumption expenditure (MPCE) in India by 32%, with the level of underestimation being significant across the states. Using the budget share approach, the CHE of India in 2014–15 was estimated at 23.4% without adjusting for the underestimation of consumption and 21.1% after adjusting for it. Similarly, using the capacity-to-pay approach, CHE was estimated to be 13.4% without adjustment and 10.4% with adjustment. The estimates differed considerably across the states. In general, it was observed that the use of a single question on consumption overestimated CHE in India. The pattern was similar regarding the intensity of CHE. The predictors of CHE were similar using both the methods, but the unadjusted estimates of CHE showed significantly higher predicted probabilities of incurring CHE across household characteristics. It is recommended to include disaggregated questions on household consumption in the future rounds of the NSS-based health surveys. Researchers using NSS data need to be aware of the effect of measurement errors of consumption expenditure on estimates of catastrophic expenditure. Adjusting for the underestimation of MPCE may improve the estimation of CHE in India.

Health Insurance as a Tool for Selecting Private Hospitalization and Mitigating Financial Burden in India: An Analysis of National Sample Survey Data

Health Insurance as a Tool for Selecting Private Hospitalization and Mitigating Financial Burden in India: An Analysis of National Sample Survey Data

Measuring the financial impact of disabilities in India (an analysis of national sample survey data).

People with disabilities are vulnerable because of the many challenges they face attitudinal, physical, and financial. The National Policy for Persons with Disabilities (2006) recognizes that Persons with Disabilities are valuable human resources for the country and seeks to create an environment that provides equal opportunities, and protection of their rights, and full. There are limited studies on health care burden due to disabilities of various types. The present study examines the socioeconomic and state-wise differences in the prevalence of disabilities and related household financial burden in India. Data for this study was obtained from the National Sample Survey (NSS), 76th round Persons with Disabilities in India Survey 2018. The survey covered a sample of 1,18,152 households, 5,76,569 individuals, of which 1,06,894 of had any disability. This study performed descriptive statistics, and bivariate estimates. The finding of the analysis showed that prevalence of disability of any kind was 22 persons per 1000. Around, one-fifth (20.32%) of the household's monthly consumption expenditure was spent on out-of-pocket expenditure for disability. More than half (57.1%) of the households were pushed to catastrophic health expenditure due to one of the members being disabled. Almost one-fifth (19.1%) of the households who were above the poverty line before one of members was treated for disability were pushed below the poverty line after the expenditure of the treatment and average percentage shortfall in income from the poverty line was 11.0 percent due to disability treatment care expenditure. The study provides an insight on the socioeconomic differentials in out-of-pocket expenditure, catastrophic expenditure for treatment of any kind of disability. To attain SDG goal 3 that advocates healthy life and promote well-being for all at all ages, there is a need to recognize the disadvantaged and due to disability.

Progress towards universal health coverage in the context of mental disorders in India: evidence from national sample survey data

BackgroundUniversal health coverage (UHC) has emerged as one of the important health policy discourses under the current sustainable development goals in the world. UHC in individual disease conditions is a must for attaining overall UHC. This study measures progress towards UHC in terms of access to health care and financial protection among individuals with mental disorders in India.MethodsData from the 75th Round National Sample Survey (NSS), 2017-18, was used, which is the latest round on health in India. Data collected from 555,115 individuals (rural: 325,232; urban: 229,232), from randomly selected 8077 villages and 6181 urban areas, included 283 outpatient and 374 hospitalization cases due to mental disorders in India. Logistic regression models were used for analyses.ResultsSelf-reporting of mental disorders was considerably lower than the actual disease burden in India. However, self-reporting of ailment was 1.73 times higher (95% CI: 1.18–2.52, p < 0.05) among the richest income group population compared to the poorest in India. The private sector was a major service provider of mental health services with a larger share for outpatient (66.1%) than inpatient care (59.2%). Over 63% of individuals with a mental disorder who reported private sector hospitalization noted unavailability or poor service quality at public facilities. Only 23% of individuals hospitalized had health insurance coverage at All India level. However, health insurance coverage among poorest economic class was a meagre 3.4%. Average out-of-pocket expenditure during hospitalization (public: 123 USD; private: 576 USD) and outpatient care (public: 8 USD; private: 37 USD) was significantly higher in the private sector than in the public sector. Chances of facing catastrophic health expenditure at 10% threshold were 23.33 times (95% CI: 10.85–50.17; p < 0.001) higher under private sector than public sector during hospitalization. Expenditure on medicine, as the share of total medical expenditure, was highest for hospitalization (public: 45%, private:39.5%) and outpatient care (public: 74.1%, private:39.7%).ConclusionsSocial determinants play a vital role in access to healthcare and financial protection among individuals with mental disorders in India. For achieving UHC in mental disorders, India needs to address the gaps in access and financial protection for individuals with mental disorders.Trial registrationNot applicable.

Understanding household and food system determinants of chicken and egg consumption in India

Poultry is one of the fastest-growing agricultural sectors in India and its demand is said to be rising. There is a perception that higher incomes, growing population, urbanisation, and increased productivity in the industry have influenced Indian poultry consumption. However, consumer surveys have shown that the average poultry consumption in India has remained low. With this in mind, the paper analysed household determinants of chicken and egg consumption within the Indian population, using two rounds of National Sample Survey data (1993–1994 and 2011–2012). By conducting a spatiotemporal analysis of household consumption and expenditure survey and by using truncated Double Hurdle and Unconditional Quantile regressions (UQR) models, this study explored socio-economic and food system determinants of chicken and egg consumption in India. Key results highlight that while consumption has increased marginally over twenty years, supply-side determinants, such as price and poultry production concentration, influenced heterogenous consumption patterns in India. We also find evidence that historically marginalised groups consumed more chicken and eggs in comparison to non-marginalised groups and preliminary evidence suggests how household gender dynamics influence different consumption patterns. Adequate consumption of poultry is important to improve nutrient-deficient diets of vulnerable groups in India. Our findings on demand side determinants of poultry products are crucial to support consumer tailored actions to improve nutritional outcomes along with the Indian poultry sector policy planning.

HPR61 Horizontal Inequities in the Healthcare Expenditures on Ambulatory and Inpatient Care for Elderly in India: An Evidence from the National Sample Survey Data

India has an increasing number of elderly people. Burden of out-of-pocket health expenditures (OOPHE) in India have been continuously increasing. This research analyzes the Horizontal Inequities in OOPHE and Catastrophic Health Expenditure (CHE) incurred during the outpatient and inpatient care among older adults in India.

Gender Wage Gap among Rural Non-farm Sector Employees in India: Evidence from Nationally Representative Survey

This article examines the gender-wise work participation rate and evaluates the wage disparity between male and female workers employed as either regular or casual employees in rural non-farm sectors. Based on the National Sample Survey data of 2004–2005 and 2019–2020, it is found that the gender inequality (against women) in employment opportunity is not only prevalent in the rural non-farm labour market but also on the rise during the last one and a half decades. The perceived difference in human capabilities between women and men and the non-availability of enough job opportunities could be a major driver of this inequality, apart from the existing social stigma in hiring the women in the rural labour market. This is reflected by the rise in the mean wage difference between two genders during 2004–2005 and 2019–2020. Both the mean and the quantile decomposition results suggest that a higher percentage of gender wage differentials is due to endowment components or labour productivity differences. Because of the existence of the ‘sticky floor’ phenomenon, the wage disparity is relatively larger at the bottom end of the earning distribution. But it reduces when we stride towards higher quintiles on the wage distribution. Hence, it is argued that policies aimed at enhancing the skill endowment of rural women can substantially reduce both the non-farm sector gender wage gap and the inequality in access to non-farm employment.