Department of Fertility Studies, International Institute for Population Sciences, Mumbai, India.
Research Scholar, International Institute for Population Sciences, Mumbai, India.
Int J Equity Health. 2020 Dec 9;19(1):217. doi: 10.1186/s12939-020-01331-z.
The National Health Mission (NHM), the largest ever publicly funded health programme worldwide, used over half of the national health budget in India and primarily aimed to improve maternal and child health in the country. Though large scale public health investment has improved the health care utilization and health outcomes across states and socio-economic groups in India, little is known on the equity concern of NHM. In this context, this paper examines the utilization pattern and net benefit of public subsidy for institutional delivery by the level of care in India.
Data from the most recent round of the National Family Health Survey (NFHS 4), conducted during 2015-16, was used in the study. A total of 148,645 last birth delivered in a health centre during the 5 years preceding the survey were used for the analyses. Out-of-pocket (OOP) payment on delivery care was taken as the dependent variable and was analysed by primary care and secondary level of care. Benefits Incidence Analysis (BIA), descriptive statistics, concentration index (CI), and concentration curve (CC) were used to do the analysis.
Institutional delivery from the public health centres in India is pro-poor and has a strong economic gradient. However, about 28% mothers from richest wealth quintile did not pay for delivery in public health centres compared to 16% among the poorest wealth quintile. Benefit incidence analyses suggests a pro-poor distribution of institutional delivery both at primary and secondary level of care. In 2015-16, at the primary level, about 32.29% of subsidies were used by the poorest, 27.22% by poorer, 20.39% by middle, 13.36% by richer and 6.73% by the richest wealth quintile. The pattern at the secondary level was similar, though the magnitude was lower. The concentration index of institutional delivery in public health centres was - 0.161 [95% CI, - 0.158, - 0.165] compared to 0.296 [95% CI, 0.289, 0.303] from private health centres.
Provision and use of public subsidy for institutional delivery in public health centres is pro-poor in India. Improving the quality of service in primary health centres is recommended to increase utilisation and reduce OOP payment for health care in India.
国家健康使命（NHM）是全球有史以来规模最大的公共资助卫生项目，占印度国家卫生预算的一半以上，主要目标是改善该国的母婴健康。尽管大规模的公共卫生投资改善了印度各州和社会经济群体的医疗保健利用和健康结果，但对于 NHM 的公平性问题知之甚少。在这种情况下，本文研究了印度公共补贴对机构分娩的利用模式和净效益，以及按护理水平的差异。
本研究使用了最近一轮国家家庭健康调查（NFHS4）的数据，该调查于 2015-16 年进行。共分析了调查前 5 年在卫生中心分娩的 148645 例最近一次分娩。以分娩时的自费（OOP）支付为因变量，并按初级保健和二级保健水平进行分析。采用受益发生率分析（BIA）、描述性统计、集中指数（CI）和集中曲线（CC）进行分析。
印度公共卫生中心的机构分娩有利于贫困人口，且具有强烈的经济梯度。然而，与最贫穷的五分之一财富组的 16%相比，约 28%的最富有五分之一财富组的母亲在公共卫生中心分娩时没有支付费用。受益发生率分析表明，在初级和二级保健水平上，机构分娩的分配都有利于贫困人口。2015-16 年，在初级保健水平上，最贫穷的五分之一财富组约有 32.29%的补贴被使用，较贫穷的五分之一财富组有 27.22%，中等的五分之一财富组有 20.39%，较富裕的五分之一财富组有 13.36%，最富有的五分之一财富组有 6.73%。二级保健水平的模式类似，只是规模较小。与私立卫生中心的 0.296 [95%置信区间，0.289，0.303]相比，公共卫生中心机构分娩的集中指数为-0.161 [95%置信区间，-0.158，-0.165]。
印度公共卫生中心为机构分娩提供和使用公共补贴有利于贫困人口。建议提高初级保健中心的服务质量，以增加利用，并减少印度医疗保健的自费支付。
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