Inequity in hospitalization care: a study on utilization of healthcare services in West Bengal, India

Abstract

Background: Out of eight commonly agreed Millennium Development Goals (MDG), six are related to the attainment of Universal Health Coverage (UHC) throughout the globe. This universalization of health status suggests policies to narrow the gap in access and benefit sharing between different socially and economically underprivileged classes with that of the better placed ones and a consequent expansion of subsidized healthcare appears to be a common feature for most of the developing nations. The National Health Policy in India (2002) suggests expansion of market-based care for the affording class and subsidized care for the deserving class of the society. So, the benefit distribution of this limited public support in health sector is important to examine to study the welfare consequences of the policy. This paper examines the nature of utilization to inpatient care by different socio-economic groups across regions and gender in West Bengal (WB), India. The benefit incidence of public subsidies across these socio-economic groups has also been verified for different types of services like medicines, diagnostics and professional care etc. Methods: National Sample Survey Organization (NSSO) has collected information on all hospitalized cases (60 th round, 2004) with a recall period of 365 days from the sampled households through stratified random sampling technique. The data has been used to assess utilization of healthcare services during hospitalization and the distribution of public subsidies among the patients of different socio-economic background; a Benefit Incidence Analysis (BIA) has also been carried out. Results: Analysis shows that though the rate of utilization of public hospitals is quite high, other complementary services like medicine, doctor and diagnostic tests are mostly purchased from private market. This leads to high Out-of-Pocket (OOP) expenditure. Moreover, BIA reveals that the public subsidies are mostly enjoyed by the relatively better placed patients, both socially and economically. The worse situation is observed for gender related inequality in access and benefit from public subsidies in the state. Conclusion: Focused policies are required to ensure proper distribution of public subsidies to arrest high OOP expenditure. Drastic change in policy targeting is needed to secure equity without compromising efficiency.

Comparison of Healthcare Utilization and Out-of-pocket Expenditure for Severe Disease by Health Security System: based on End-stage Renal Disease in South Korea

“…Thus, subjects with a serious disease like ESRD with the NHI faced a much greater economic burden than those with MA. Subjects with high OOP expenditure are more likely to face the risk of CHI [25][26][27][28]. CHE was compared between subjects with MA (n=68) and…”

Comparison of Out-of-Pocket Expenditure and Catastrophic Health Expenditure for Severe Disease by Health Security System: based on End-stage Renal Disease in South Korea

“…Thus, subjects with a serious disease like ESRD with the NHI faced a much greater economic burden than those with MA. Furthermore, subjects with high OOP expenditure are more likely to face the risk of CHE [25][26][27][28]. CHE was compared between subjects with NHI under the median of household income decile and with MA.…”

Understanding equity of institutional delivery in public health centre in India: An assessment using Benefit Incidence Analysis

“…Further, NFHS 4 does not provide any information on the actual cost of delivery care at the public health centre. Hence in line with previous literature, we have used OOP payment on delivery care in private health centres as the proxy for the actual cost of delivery care in public health centres [44][45].…”

“…A recent study found a pro-rich distribution of public subsidy for inpatient care of non-communicable diseases (NCDs) among elderly [43]. In West Bengal, the bene t of public subsidy was highest for individuals belonging to lower-middle group in rural areas and upper-middle income group in urban areas [44]. In 2004, for inpatient care, the share of public subsidy was maximum for poorest section (41.5%) in Tamil Nadu, lower middle in West Bengal (32.3%) and richest section (38.9%) in Rajasthan.…”