Equity in the utilization of healthcare services in India: evidence from National Sample Survey.

BACKGROUND The pursuit of equity in health and healthcare has been the key feature of health policy in India. However, despite the policy significance, the volume of literature available on this issue is scarce. Therefore, this paper is an attempt to examine the horizontal inequities in healthcare utilization, consisting of outpatient and inpatient care in 15 major states and north-eastern region of India. METHODS Cross-sectional data were taken from the National Sample Survey Organization (NSSO) 60th round (2004), the survey on 'morbidity and healthcare'. While outpatient care was assessed using the probability of outpatient visit 15 days prior to the survey date, the indicators of inpatient care utilization were based on the following variables: the probability of hospital admission and length of stay in hospital over a 12-month period. All these measures of healthcare utilization were standardized for need differences and controlled for socio-economic factors. Need standardized concentration indices were used to measure interstate and intrastate income-related inequities in healthcare utilization. RESULTS Absolute inequalities were found between states in the proportion of the population reporting a visit to an outpatient provider, in the range of 4.42% to 21.72%. Similarly, inpatient care varied from 1% to 10%. The magnitude of inequity for both outpatient and inpatient care was pro-rich across rural and urban areas of India and in majority of the states. In fact, in majority of the states, the horizontal inequity across types of curative care was noticeably higher within the rural population than in the urban population. The analysis demonstrated that high per capita government health spending was significantly associated with low inequity in utilization of inpatient care. CONCLUSION The study concludes that it would be necessary to address the prevailing inequities in healthcare by substantially scaling up the public spending on health, and achieving effective universal coverage of healthcare in India.