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Health care services in India: A few questions on equity

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DOI: 10.4236/health.2013.51008    4,730 Downloads   7,933 Views   Citations
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This paper analyzes equity in health care utilizetion and out-of-pocket expenditure on health care in India using two rounds (52th round 1995-1996 and 60th round 2004-2005) of National Sample Survey data and data from a household survey carried out in 2007. The findings indicate that the average hospitalization rate has increased and the corresponding value of the concentration index has decreased over the last ten years. However, the health care payment structure is seen to be regressive for inpatient care, and more so for outpatient care. The main reason is the very high out-of-pocket payment on medicine and diagnostic tests even in government hospitals. High out-of-pocket payment has resulted in 34 percent poor households losing all their past savings, 30 percent of households borrowing with interest and 2 percent of households selling their assets. These findings indicate the urgent need for putting in place risk pooling mechanisms.

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Mondal, S. (2013) Health care services in India: A few questions on equity. Health, 5, 53-61. doi: 10.4236/health.2013.51008.


[1] Sen, A. and Dreze, J. (2011) Putting growth in its place. Outlook, 14 November 2011.
[2] Smith, E., Brugha, R. and Zwi, A. (2001) Working with private sector providers for better health care: An introductory guide.]
[3] Gumber, A. (2002) Health insurance for informal sector: Problems and prospects. Indian Council for Research on International Economic Relations.
[4] WHO (2003) Tobacco and health in the developing world. A Back-ground Paper for the High Level Round Table on Tobacco Control and Development Policy.
[5] Ahuja R. (2004) Health insurance for the poor in India. WP-123, Indian Council for Research on International Economic Relations, 2004.
[6] Mahal, A., Yazbeck, A., Peters, D.H. and Ramana, G.N.V. (2001) The poor and health service use in India. Health, Nutrition and Population (HNP), Discussion Paper.
[7] MarMeessen, B., VanDamme, W., Tashoby, K.C. and Tibouti, A. (2006). Poverty and user fees for public health care in low-income countries: Lessons from Uganda and Cambodia. Lancet, 368, 2253-2257. doi:10.1016/S0140-6736(06)69899-1
[8] Ahuja, R. (2006) Health insurance for the poor in India. Policy Brief 12, Indian Council for Research on International Economic Relations.
[9] Garg, C. (1998) Equity of health sector financing and delivery in India.
[10] Fun, J. and Zick, C. D. (2005) The economic burden of health care, funeral, and burial expenditures at the end of life. Journal of Consumer Affairs, 38, 35-55. doi:10.1111/j.1745- 06.2004.tb00464.x
[11] Sun, X., Jackson, S., Carmichael, G. and Sleigh, A. C. (2009) Catastrophic medical payment and financial protection in rural China: Evidence from the new cooperative medical scheme in Shandong Province. Health Economics, 18, 103-119. doi:10.1002/hec.1346
[12] Peters, H.D., Yazbeck, A.S., Sharma, R.R., Ramana, G.N.V., Pritchett, L. and Wagstaff, A. (2002) Better health systems for India’s poor: Findings, analysis, and options. The World Bank, New Delhi. doi:10.1596/0-8213-5029-3
[13] Xu K., Evans D.B., Kawabata, K., Zeramdini, R., Klavus, J. and Murray, C.J.L. (2003) Household catastrophic health expenditure: A multi-country analysis. Lancet, 362, 111-117. doi:10.1016/S0140-6736(03)13861-5
[14] O’Donnell, O., Doorslear, E.V., Eliya, R.P., Somanathan A., Garg C., Hanvo-ravongchai P., et al. (2005) Explaining the incidence of cata-strophic expenditures on health care: Comparative evidence from Asia. Working Paper No. 5, EQUITAP Project.
[15] Su, T.T., Kouyate, B. and Flessa, S. (2006) Catastrophic household expenditure for health care in a low-income society: A study from Nouna District, Burkina Faso. Bulletin of World Health Organization, 84, 21-27. doi:10.2471/BLT.05.023739
[16] Flores, G., Krishnakumar, J., O’Donnell, O. and Doorslaer, E.V. (2008) Coping with health-care costs: Implications for the measurement of catastrophic expenditures and poverty. Health Economics, 17, 1393-1412. doi:10.1002/hec.1338
[17] Vaishnavi, S.D. and Dash, U. (2009) Catastrophic payments for health care among households in urban Tamil Nadu, India. Journal of International Development, 21, 169-184. doi:10.1002/jid.1554
[18] Culyer, A.J. and Wagstaff, A. (1993) Equity and equality in health and health care. Journal of Health Economics, 12, 431-457. doi:10.1016/0167-6296(93)90004-X
[19] Waters, H.R. (2000) Measuring equity in access to health care. Social Science and Medicine, 51, 599-612. doi:10.1016/S0277-9536(00)00003-4
[20] Arrow, K.J. (1963) Uncertainty and the welfare economics for medical care. American Economic Review, 53, 921-969
[21] Sen, A.K. (2006) The possibility of social choice. In: Agarwal, B., Humphries, J. and Robeyns, I., Eds., Capabilities, Freedom and Equality: Amartya Sen’s Work from a Gender Perspective. Oxford University Press, New Delhi, 369-419.
[22] Sen, A.K. (1985) Commodities and capabilities. Oxford University Press, New Delhi.
[23] Sen, A.K. (1993) Positional objectivity. Philosophy and Public Affairs, 22, 126-145.
[24] Lall, R.B. and Seal, S.C. (1949) General Rural Health Survey: Singur Health Centre 1944. All India Institute of Hygiene and Public Health, Kolkata.
[25] Smith, J. (1994) Measuring Health and economic status of older adults in developing countries. Gerontologist, 34, 491-496. doi:10.1093/geront/34.4.491
[26] Soldo, B.J. and Hill, M. (1995) Family structure and transfer measures in the health and retirement study: Background and overview. Journal of Human Resources, Supplement, 30, S108-S137.
[27] Wallace R.B. and Herzog A.R. (1995) Overview of the health measures in health and retirement study. Journal of Human Resources, Supplement, 30, S84-S107.
[28] Manton, K.G., Stallard, E. and Cordel, R. (1997) Changes in age dependence of mortality and disability: Cohort and other determinants. Demography, 34, 135-157. doi:10.2307/2061664
[29] Idler, E.L. and Benyamini, Y. (1997) Self-rated health and mortality: A review of twenty-seven community studies. Journal of Health and Social Behavior, 38, 21-37. doi:10.2307/2955359
[30] Idler, E.L. and Kasl, S. (1995) Self-ratings of health: Do they also predict change in functional ability? Journal of Gerontology, 50B, S344-S353.
[31] Schechter, S., Beatty, P. and Willis, G.B. (1998) Asking survey respondents about health status: Judgment and response issues. In: Schwarz., N., Park, D., Knauper, B. and Sudman, S., Eds., Cognition, Aging, and Self-Reports, Taylor & Francis, Ann Arbor, 229-247.
[32] Beckett, M., Weinstein, M., Goldman, N. and Yu-Hsuan, L. (2000) Do health interview surveys yield reliable data on chronic illness among older respondents? American Journal of Epidemiology, 151, 315-323. doi:10.1093/oxfordjournals.aje.a010208
[33] Rahman, M.O. and Barsky, A.J. (2003) Self-reported health among older Ban-gladeshis: How good a health indicator is it? The Gerontologist, 43, 856-863. doi:10.1093/geront/43.6.856PMid:14704385
[34] Wagstaff, A. and Doorslear, E.D. (1991) On the measurement of inequalities in health. Social Science and Medicine, 33, 545-557. doi:10.1016/0277-9536(91)90212-U
[35] Lambert, P. (1993) The distribution and redistribution of income: A mathematical analysis. Manchester University Press, Manchester.
[36] Kakwani, N.C. (1977) Measurement of tax progres-sivity: An international computation and statistical inference. Journal of Econometrics, 77, 87-104. doi:10.1016/S0304-4076(96)01807-6
[37] Kakwani, N.C. (1977) Measurement of tax prograssivity: An international comparison. Economic Journal, 87, 71- 80. doi:10.2307/2231833
[38] Wagstaff, A. (1989) Econometric studies in health economics: A survey of the British literature. Journal of Health Economics, 8, 1-51. doi:10.1016/0167-6296(89)90008-8
[39] National Sample Survey Organization [NSSO] (2004) Morbidity, health care and the condition of the aged. Report on NSS 60th Round, New Delhi.

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