Mahapatro Sandhya R, James K S, Mishra Udaya S
A.N. Sinha Institute of Social Studies, India.
International Institute for Population Sciences, India.
Health Policy Open. 2021 Apr 2;2:100040. doi: 10.1016/j.hpopen.2021.100040. eCollection 2021 Dec.
Despite renewed policy priorities to universalise health coverage, unmet need for healthcare is long-standing concern in India. The recent data suggests the unmet healthcare need amounts to a notable share of twelve per cent. While studies have examined inequalities in healthcare utilisation in single axes of social power, there was no consensus on the role of the intersectionality between class, caste and gender in shaping the unmet health need. Utilising data from National Sample survey 75th round (2017-18), this paper identifies the factors contributing to such unmet need and investigate the intersectionality of class with caste and gender in determining unmet need. The contribution of socioeconomic factors was assessed by the decomposition method & multivariate logistic regression was used to measure inter and intra-class differentials in unmet need. The analysis informs that class inequality is fundamental to having unmet need with limited role of gender and caste. Economic class however, interacting with caste and gender unfolds wider gaps in access to healthcare. While inter-class differences in unmet need are observed across caste as well as gender, intra-class differences intensify more by caste inequalities. The findings indicate the significance of the intersectional approach in identifying the sources of health inequity and special recognition to the income-poor and socially marginalised in policy agenda. Eliminating the barriers to health care access therefore needs a multidimensional construct of identifying combination of attributes to be focused towards realization of universal health coverage. These observations should aid in formulation and restructuring of the existing healthcare interventions to achieve equity in healthcare provision.
尽管重新将普及健康覆盖作为政策重点，但印度长期以来一直关注医疗保健需求未得到满足的问题。最近的数据表明，未得到满足的医疗保健需求占比高达12%。虽然已有研究考察了社会权力单一维度下医疗保健利用方面的不平等现象，但对于阶级、种姓和性别之间的交叉性在塑造未得到满足的健康需求方面所起的作用，尚未达成共识。本文利用第75轮全国抽样调查（2017 - 2018年）的数据，确定了导致这种未得到满足的需求的因素，并研究了阶级与种姓和性别的交叉性在决定未得到满足的需求方面的情况。通过分解方法评估社会经济因素的贡献，并使用多元逻辑回归来衡量未得到满足的需求在阶级间和阶级内的差异。分析表明，阶级不平等是导致未得到满足的需求的根本因素，而性别和种姓的作用有限。然而，经济阶级与种姓和性别相互作用，在获得医疗保健方面造成了更大的差距。虽然在种姓和性别方面都观察到了阶级间在未得到满足的需求上的差异，但阶级内差异因种姓不平等而加剧。研究结果表明，交叉性方法在确定健康不平等根源方面具有重要意义，并且在政策议程中应特别关注收入贫困和社会边缘化群体。因此，消除获得医疗保健的障碍需要一种多维结构，即确定为实现全民健康覆盖而应关注的属性组合。这些观察结果应有助于制定和调整现有的医疗保健干预措施，以实现医疗保健提供的公平性。
