Ottawa Hospital Research Institute, Box 511, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.
Department of Agricultural & Resource Economics, College of Agriculture and Life Sciences, University of Arizona, Tucson, AZ, 85721-0078, USA.
J Racial Ethn Health Disparities. 2023 Aug;10(4):1918-1932. doi: 10.1007/s40615-022-01374-8. Epub 2022 Aug 22.
Caste plays a significant role in individual healthcare access and health outcomes in India. Discrimination against low-caste communities contributes to their poverty and poor health outcomes. The Rashtriya Swasthya Bima Yojana (RSBY), a national health insurance program, was created to improve healthcare access for the poor. This study accounts for caste-based disparities in RSBY enrollment in India by decomposing the contributions of relevant factors.
Using the data from the 2015-2016 round of the National Family Health Survey, we compare RSBY enrollment rates of low-caste and high-caste households. We use a non-linear extension of Oaxaca-Blinder decomposition and estimate two models by pooling coefficients across the comparison groups and all caste groups. Enrollment differentials are decomposed into individual- and household-level characteristics, media access, and state-level fixed effects, allowing 2000 replications and random ordering of variables.
The analysis of 480,766 households show that scheduled tribe households have the highest enrollment (18.85%), followed by 14.13% for scheduled caste, 10.67% for other backward caste, and 9.33% for high caste. Household factors, family head's characteristics, media access, and state-level fixed effects account for a 32% to 52% gap in enrollment. More specifically, the enrollment gaps are attributable to differences in wealth status, educational attainment, residence, family size, dependency ratio, media access, and occupational activities of the households.
Weaker socio-economic status of low-caste households explains their high RSBY enrollments.
在印度，种姓制度对个人获得医疗保健的机会和健康结果有着重要的影响。针对低种姓社区的歧视导致了他们的贫困和较差的健康结果。Rashtriya Swasthya Bima Yojana（RSBY），一个国家健康保险计划，旨在改善贫困人口的医疗保健获取途径。本研究通过分解相关因素的贡献，考虑了印度 RSBY 参保中的种姓差异。
利用 2015-2016 年全国家庭健康调查的数据，我们比较了低种姓和高种姓家庭的 RSBY 参保率。我们使用了 Oaxaca-Blinder 分解的非线性扩展，并通过在比较组和所有种姓组中汇总系数来估计两个模型。入学差异被分解为个人和家庭层面的特征、媒体获取和州级固定效应，允许进行 2000 次复制和变量的随机排序。
对 480766 户家庭的分析表明，在册部落家庭的参保率最高（18.85%），其次是在册种姓家庭（14.13%）、其他落后种姓家庭（10.67%）和高种姓家庭（9.33%）。家庭因素、家庭户主的特征、媒体获取和州级固定效应占入学率差距的 32%至 52%。更具体地说，入学差距归因于家庭的财富状况、教育程度、居住地点、家庭规模、抚养比、媒体获取和职业活动的差异。
低种姓家庭较弱的社会经济地位解释了他们较高的 RSBY 参保率。
