Centre for the Study of Regional Development, School of Social Sciences, Jawaharlal Nehru University, New Delhi, India.
PLoS One. 2020 Nov 25;15(11):e0241994. doi: 10.1371/journal.pone.0241994. eCollection 2020.
The study attempts (a) to compute the degree of socio-economic inequity in health care utilization and (b) to decompose and analyze the drivers of socio-economic inequity in health care utilization among adults (20-59 years) in India during the periods 2014 and 2017-18.
The analysis has been done by using the unit level data of Social Consumption: Health (Schedule number 25.0), of National sample Survey (NSS), corresponding to the 71st and 75th rounds.
Odds ratios were computed through logistic regression analysis to examine the effect of the socio-economic status on the health seeking behaviour of the ailing adult population in India. Concentration Indices (CIs) were calculated to quantify the magnitude of socio-economic inequity in health care utilization. Further, the CIs were decomposed to find out the share of the major contributory factors in the overall inequity.
The regression results revealed that socio-economic status continues to show a strong association with treatment seeking behavior among the adults in India. The positive estimates of CIs across both the rounds of NSS suggested that health care utilization among the adults continues to be concentrated within the higher socio-economic status, although the magnitude of inequity in health care utilization has shrunk from 0.0336 in 2014 to 0.0230 in 2017-18. However, the relative contribution of poor economic status to the overall explained inequities in health care utilisation observed a rise in its share from 31% in 2014 to 45% in 2017-18.
To reduce inequities in health care utilization, policies should address issues related to both supply and demand sides. Revamping the public health infrastructure is the foremost necessary condition from the supply side to ensure equitable health care access to the poor. Therefore, it is warranted that India ramps up investments and raises the budgetary allocation in the health care infrastructure and human resources, much beyond the current spending of 1.28% of its GDP as public expenditure on health. Further, to reduce the existing socio-economic inequities from the demand side, there is an urgent need to strengthen the redistributive mechanisms by tightening the various social security networks through efficient targeting and broadening the outreach capacity to the vulnerable and marginalized sections of the population.
本研究旨在（a）计算卫生保健利用方面社会经济不平等的程度，以及（b）分解和分析 2014 年和 2017-18 年期间印度 20-59 岁成年人卫生保健利用方面社会经济不平等的驱动因素。
本分析使用了国家抽样调查（NSS）第 25.0 号附表中关于社会消费：卫生的单位水平数据，涉及第 71 轮和第 75 轮调查。
通过逻辑回归分析计算了优势比，以检验社会经济地位对印度患病成年人口寻求卫生保健行为的影响。计算了集中指数（CI）以量化卫生保健利用方面社会经济不平等的程度。此外，还对 CI 进行了分解，以找出导致整体不平等的主要因素的份额。
回归结果表明，社会经济地位继续与印度成年人的治疗寻求行为密切相关。NSS 两轮调查的 CI 均为正值，这表明成年人的卫生保健利用继续集中在较高的社会经济地位，尽管卫生保健利用方面的不平等程度从 2014 年的 0.0336 缩小到 2017-18 年的 0.0230。然而，贫困经济状况对卫生保健利用方面总体可解释不平等的相对贡献，其份额从 2014 年的 31%上升到 2017-18 年的 45%。
为了减少卫生保健利用方面的不平等，政策应解决供需双方的问题。从供给方面改革公共卫生基础设施是确保向穷人公平获得卫生保健的首要必要条件。因此，印度有必要增加投资，将卫生保健基础设施和人力资源方面的预算拨款提高到目前占国内生产总值 1.28%的公共卫生支出以上。此外，为了从需求方面减少现有的社会经济不平等，迫切需要通过有效瞄准加强各种社会保障网络，扩大对人口中脆弱和边缘化群体的服务范围，来加强再分配机制。
