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Published in: BMC Public Health 1/2019

Open Access 01-12-2019 | Care | Research article

Equity in distribution of public subsidy for noncommunicable diseases among the elderly in India: an application of benefit incidence analysis

Authors: Montu Bose, Somdutta Banerjee

Published in: BMC Public Health | Issue 1/2019

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Abstract

Background

Rapid ageing of the population and increasing non-communicable diseases (NCDs) among the elderly is one of the major public health challenges in India. To achieve the Universal Health Coverage, ever-growing elderly population should have access to needed healthcare, and they should not face any affordability related challenge. As most of the elderly suffers from NCDs and achieving health-equity is a priority, this paper aims to - study the utilization pattern of healthcare services for treatment of NCDs among the elderly; estimate the burden of out-of-pocket expenditure for the treatment of NCDs among the elderly and analyze the extent of equity in distribution of public subsidy for the NCDs among the elderly.

Methods

National Sample Survey data (71st round) has been used for the study. Exploratory data analysis and benefit incidence analysis have been applied to estimate the utilization, out-of-pocket expenditure and distribution of public subsidy among economic classes. Concentration curves and indices are also estimated.

Results

Results show that public-sector hospitalization for NCDs among the elderly has a pro-rich trend in rural India. However, in urban sector, for both inpatient and outpatient care the poorest class has substantial share in utilization of public facilities. Same result is also observed for rural outpatient care. Analysis shows that out-of-pocket expenditure is very high for both medicine and medical care even in public facilities for all economic groups. It is also observed that medicine has the highest share in total medical expenses during treatment of NCDs among the elderly in both the region. Benefit incidence analysis shows that the public subsidy has a pro-rich distribution for inpatient care treatment in both the sectors. In case of outpatient care, subsidy share is the maximum among the richest in the urban sector and in the rural region the poorest class gets the maximum subsidy benefit.

Conclusions

It is evident that a substantial share of the public subsidies is still going to the richer sections for the treatment of NCDs among the elderly. Evidences also suggest that procuring medicines and targeted policies for the elderly are needed to improve utilization and equity in the public healthcare system.
Appendix
Available only for authorised users
Footnotes
1
The details methodology is available at NSS 71st round report: Social Consumption in India Health [25]
 
2
It is evident from National Health Accounts reports of India that the major contributor of total health spending is the OOP expenditure. And out-patient care has the maximum share in total OOP expenditure followed by the inpatient care. However, NSS collects information with two different recall period to minimize the bias in the data. Additionally, for out-patient care NSS reports the OOP expenditure for all the visits together within the reference period. Therefore, we study both the care separately to analyze the extent of OOP expenditure and benefit share.
 
3
The usual expenditure includes – usual monthly expenditure for household purposes, monthly average expenditure amount (dividing the total expenditure by 12) for durable goods purchased during last one year and approximate monthly values of wage in kind, home-grown stock and free stock.
 
4
Following the equivalence method suggest by Deaton (2003), we have also formed the MPCE classes and cross-checked the ranking of the MPCE groups for various indicators used in the paper [29]. However, there was no substantial change in the ranking of the MPCE classes in terms of utilization, OOP payment and benefit share.
 
5
The sample size for the North-eastern states and the UTs are very small in the NSS data. Therefore, we have clubbed all the North-eastern states (Sikkim, Nagaland, Mizoram, Tripura, Arunachal Pradesh and Meghalaya) and all the UTs (Chandigarh, Daman & Diu, Dadra & Nagar Haveli, Lakshadweep, Puducherry and Andaman & Nicobar Island) for the study.
 
6
Medical cost includes package, consultancy, medicine, diagnostic test, bed charge (only for inpatient), other medical expenses like attendant charges, physiotherapy, personal medical appliances, blood, oxygen, etc.
 
7
Horizontal equity: treating people with equal need equally; vertical equity: treating people with unequal need unequally.
 
8
Following Wagstaff (2012), we have replaced all the negative values with zero here [36].
 
9
It has to be mentioned here that to study the relative position and share in total subsidy benefit is the objective of the benefit incidence analysis. Estimation of actual benefit is not the purpose of the method.
 
10
The paper discusses about the Fair Price Medicine Shops (FPMS) of West Bengal. As per the contracts with the Government, the FPMS should at least keep all the medicines of the EDL and sell them at a discounted price to any patient carrying a valid prescription.
 
11
To measure the socioeconomic status of a household there are several indicators available in the literature. Many literature use wealth index or income as a measure of economic status of a household. However, NSS only reports monthly consumption expenditure of the households as a measure of economic indicator of a household.
 
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Metadata
Title
Equity in distribution of public subsidy for noncommunicable diseases among the elderly in India: an application of benefit incidence analysis
Authors
Montu Bose
Somdutta Banerjee
Publication date
01-12-2019
Publisher
BioMed Central
Keyword
Care
Published in
BMC Public Health / Issue 1/2019
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-019-8089-y

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