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International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2017

Open Access 01-12-2017 | Research

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

Authors: Rinshu Dwivedi, Jalandhar Pradhan

Published in: International Journal for Equity in Health | Issue 1/2017

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Abstract

Background

Equity 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.

Methods

The 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.

Results

The 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.

Conclusions

In 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.
Appendix
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Footnotes
1
OOPE are non-reimbursable fees which a patient or family is responsible for paying directly to health practitioners or suppliers, without intervention of a third party.
 
2
Informal sector economic activities include all forms of non-standard atypical, alternative, irregular and precarious forms of work, and includes all persons in employment who, by law or in practice, are not subject to national labour legislation, income taxation, social protection or entitlement to employment benefits (International Labour Organization (ILO), 2012).
 
3
Inpatient expenditure comprises of health care services delivered to patients who are formally admitted to hospitals, ambulatory premises or self-standing centers.
 
4
Outpatient expenditure includes expenses on physician’s private office, hospital outpatient center or ambulatory-care center. Patient does not stay overnight.
 
5
The Scheduled Castes (SCs), Scheduled Tribes (STs) and Other Backward Class (OBC) indicate constitutional classification of various groups of historically disadvantaged indigenous people in India. Various provisions are made by the Constitution of India, to provide reservation, protection and safeguards, in public employment in respect of the persons belonging to the SCs/STs and OBCs.
 
6
The Scheduled Castes are sometimes referred to as lower caste or Dalits, and are officially regarded as the socially disadvantaged group of population.
 
7
Scheduled Tribes is used as an official term for Adivasi or indigenous people, mainly residing in the hilly, forest or other inaccessible areas. In the Indian context, these people are mainly the indigenous people who are officially regarded as socially disadvantaged.
 
8
Other Backward Class (OBC) is a collective term used by the Constitution of India to categorize castes which are socially and educationally disadvantaged.
 
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Metadata
Title
Does equity in healthcare spending exist among Indian states? Explaining regional variations from national sample survey data
Authors
Rinshu Dwivedi
Jalandhar Pradhan
Publication date
01-12-2017
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2017
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-017-0517-y

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