Professor of Health Economics, Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Research Scientist, Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Indian J Public Health. 2024 Jan 1;68(1):44-49. doi: 10.4103/ijph.ijph_991_22. Epub 2024 Apr 4.
There is mixed evidence on the extent of association between the allocation of public revenue for healthcare and its indicators of need.
In this study, we examined the relationship between allocations through state health financing (SHF) and the Central Government with infant mortality.
District-wise infant mortality rate (IMR) was computed using National Family Health Survey-4 data. State-wise data for health budgets through SHF and National Health Mission (NHM, a Centrally Sponsored Scheme), were obtained for the year 2015-16. We used a multivariable analysis through generalized linear model method using identity-link function.
We found per capita SHF (₹3169) to be more than 12 times that of public health spending per capita through NHM (₹261). IMR was lower in districts with higher SHF allocation, although statistically insignificant. The allocation through NHM was higher in districts with higher IMR, which is statistically significant. Every unit percentage increase in per capita net state domestic product and female literacy led to 0.31% and 0.54% decline, while a 1% increase in under-five diarrhoea prevalence led to 0.17% increase in IMR.
The NHM has contributed to enhancing vertical equity in health-care financing. The States' need to be more responsive to the differences in districts while allocating health-care resources. There needs to be a focus on spending on social determinants, which should be the cornerstone for any universal health coverage strategy.
公共医疗保健支出与需求指标之间的关联程度存在混合证据。
本研究旨在检验州级卫生筹资（SHF）和中央政府拨款与婴儿死亡率之间的关系。
利用全国家庭健康调查-4 数据计算各区的婴儿死亡率（IMR）。获取了 2015-16 年通过 SHF 和国家健康使命（NHM，中央资助计划）的州级卫生预算数据。我们使用广义线性模型方法通过身份链接函数进行多变量分析。
我们发现人均 SHF（₹3169）是通过 NHM 进行的人均公共卫生支出（₹261）的 12 倍以上。尽管统计学上不显著，但 SHF 拨款较高的地区的 IMR 较低。NHM 的拨款在 IMR 较高的地区更高，这具有统计学意义。人均净州内生产总值和女性识字率每增加一个百分点，IMR 就会分别下降 0.31%和 0.54%，而五岁以下腹泻流行率每增加 1%，IMR 就会增加 0.17%。
NHM 有助于增强医疗保健融资的垂直公平性。各州在分配医疗保健资源时需要更加关注地区之间的差异。需要关注社会决定因素的支出，这应该是任何全民健康覆盖战略的基石。
