Does equity in healthcare spending exist among Indian states? Explaining regional variations from national sample survey data

Abstract

BackgroundEquity and justice in healthcare payment form an integral part of health policy and planning. In the majority of low and middle-income countries (LMICs), healthcare inequalities are further aggravated by Out of Pocket Expenditure (OOPE). This paper examines the pattern of health equity and regional disparities in healthcare spending among Indian states by applying Andersen’s behavioural model of healthcare utilization.MethodsThe present study uses data from the 66th quinquennial round of Consumer Expenditure Survey, of the National Sample Survey Organization (NSSO), conducted in 2009–10 by Ministry of Statistics and Programme Implementation (MoSPI), Government of India (GoI). To measure equity and regional disparities in healthcare expenditure, states have been categorized under three heads on the basis of monthly OOPE i.e., Category A (OOPE > =INR 100); Category B (OOPE between INR 50 to 99) and Category C (OOPE < INR 50). Multiple Generalised Linear Regression Model (GLRM) has been employed to explore the effect of various socio-economic covariates on the level of OOPE.ResultsThe gap in the ratio of average healthcare spending between the poorest and richest households was maximum in Category A states (richest/poorest = 14.60), followed by Category B (richest/poorest 11.70) and Category C (richest/poorest 11.40). Results also indicate geographical concentration of lower level healthcare spending among Indian states (e.g., Odisha, Chhattisgarh and all the north-eastern states). Results from the multivariate analysis suggest that people residing in urban areas, having higher economic status, belonging to non-Muslim communities, non-Scheduled Tribes (STs), and non-poor households spend more on healthcare than their counterparts.ConclusionsIn spite of various efforts by the government to reduce the burden of healthcare spending, widespread inequalities in healthcare expenditure are prevalent. Households with high healthcare needs (SCs/STs, and the poor) are in a more disadvantaged position in terms of spending on health care. It has also been observed that spending on healthcare was comparatively lower among backward or isolated states. No doubt, the overall social security measures should be enhanced, but at the same time, looking at the regional differences, more priority should be assigned to the disadvantaged states to reduce the burden of OOPE. It is proposed that there is need to increase government spending, especially for the disadvantaged states and population, to minimise the burden of OOPE.

Variations in catastrophic health expenditure across the states of India: 2004 to 2014

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Catastrophic health expenditure and impoverishment effects of out-of-pocket expenses: A comparative study of tannery and non-tannery workers of Kanpur, India

“…The study found that people residing in urban areas, having higher economic status, belonging to non-Muslim communities, non-scheduled tribes (STs), and non-poor HHs spend more on healthcare than their counterparts. [ 5 ]…”

Joined-Up Thinking in Global Health Education

“…Healthcare governance and ethics should be moral imperatives for anyone working in the healthcare environment, including policymakers, administrators and healthcare leaders. For instance, low-middle income countries such as India, have fragmented healthcare systems, and policy initiatives can fail for any number of reasons, including chronic underfunding, weak systems of governance and ethical codes that are not upheld and do not translate into practice [6,7]. However, this need not be the case and it should be possible to adopt a multi-lateral approach to healthcare regulation and governance, building systems for vertical and horizontal integration into local leadership frameworks.…”