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Inequities in curative health-care utilization among the adult population (20–59 years) in India: A comparative analysis of NSS 71st (2014) and 75th (2017–18) rounds

Shreya Banerjee , Indrani Roy Chowdhury
Published: 25 November 2020
PLoS ONE , Volume 15; doi:10.1371/journal.pone.0241994

Abstract: Objective The 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 source The 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. Methods Odds 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. Results 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 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. Conclusion To 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.
Keywords: health economics / Public and occupational health / adults / literacy / Behavioral and social aspects of health / India / Socioeconomic aspects of health / health care utilization

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