London School of Economics & Political Science, London, UK.
Indian J Med Res. 2012 Sep;136(3):421-31.
BACKGROUND & OBJECTIVES: Income inequality is associated with poor health. Inequities exist in service utilization and financing for health care. Health care costs push high number of households into poverty in India. We undertook this study to ascertain inequities in health status, service utilization and out-of-pocket (OOP) health expenditures in two States in north India namely, Haryana and Punjab, and Union Territory of Chandigarh.
Data from National Sample Survey 60 th Round on Morbidity and Health Care were analyzed by mean consumption expenditure quintiles. Indicators were devised to document inequities in the dimensions of horizontal and vertical inequity; and redistribution of public subsidy. Concentration index (CI), and equity ratio in conjunction with concentration curve were computed to measure inequity.
Reporting of morbidity and hospitalization rate had a pro-rich distribution in all three States indicating poor utilization of health services by low income households. Nearly 57 and 60 per cent households from poorest income quintile in Haryana and Punjab, respectively faced catastrophic OOP hospitalization expenditure at 10 per cent threshold. Lower prevalence of catastrophic expenditure was recorded in higher income groups. Public sector also incurred high costs for hospitalization in selected three States. Medicines constituted 19 to 47 per cent of hospitalization expenditure and 59 to 86 per cent OPD expenditure borne OOP by households in public sector. Public sector hospitalizations had a pro-poor distribution in Haryana, Punjab and Chandigarh.
INTERPRETATION & CONCLUSIONS: Our analysis indicates that public sector health service utilization needs to be improved. OOP health care expenditures at public sector institutions should to be curtailed to improve utilization of poorer segments of population. Greater availability of medicines in public sector and regulation of their prices provide a unique opportunity to reduce public sector OOP expenditure.
收入不平等与健康状况不佳有关。在医疗保健服务的利用和融资方面存在不平等现象。医疗保健费用使印度大量家庭陷入贫困。我们进行这项研究是为了确定印度北部的哈里亚纳邦、旁遮普邦和昌迪加尔联邦属地这两个邦和联邦属地的健康状况、服务利用和自付（OOP）医疗支出方面的不平等情况。
利用国家抽样调查第 60 轮的发病率和医疗保健数据，按平均消费支出五分位数进行分析。设计了指标来记录水平和垂直不公平以及公共补贴再分配方面的不公平。使用集中指数（CI）和公平比率以及集中曲线来衡量不公平。
在所有三个邦，发病率和住院率的报告都呈现出向富人倾斜的分布，表明低收入家庭对卫生服务的利用不足。在哈里亚纳邦和旁遮普邦，分别有近 57%和 60%的最贫困收入组家庭在达到 10%的门槛时面临灾难性的 OOP 住院支出。较高收入组的灾难性支出发生率较低。在选定的三个邦，公共部门的住院费用也很高。在公共部门，药品占住院支出的 19%至 47%，占门诊支出的 59%至 86%，由家庭自费支付。在哈里亚纳邦、旁遮普邦和昌迪加尔，公共部门的住院治疗呈有利于穷人的分布。
我们的分析表明，需要改善公共部门的卫生服务利用情况。应减少公共部门医疗机构的自付医疗费用，以提高较贫困人群的利用率。在公共部门增加药品供应并规范其价格，为降低公共部门的自付支出提供了独特的机会。
