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Year : 2017  |  Volume : 30  |  Issue : 5  |  Page : 249-254

Inequity in access to inpatient healthcare services for non-communicable diseases in India and the role of out-of-pocket payments

1 Velammal Medical College and Research Institute, Velammal Village, Anuppanadi, Madurai 625009, Tamil Nadu, India
2 School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
3 Indian Statistical Services, Labour Bureau, Chandigarh, India

Correspondence Address:
Shankar Prinja
School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0970-258X.234390

Background. Growing evidence suggests that non-communicable diseases (NCDs) result in considerable economic burden for individuals and households. With the poor facing a greater burden of NCDs than the rich in India, we undertook this study to analyse the horizontal equity in utilization and vertical equity in out-of-pocket expenditure for NCD care. Methods. We used data of 1 4 large Indian states from the National Sample Survey 60th round to compute hospitalization rates for NCDs. Mean per capita consumption expenditure (MPCE) was computed and used as a proxy measure for socioeconomic status. Out-of-pocket payment as a proportion of MPCE was estimated by wealth quintile (Q) to assess the vertical equity in payments. Concentration index (CoI) was computed to measure the extent of equity, and its 95% confidence interval was estimated to assess statistical significance. Results. Overall, NCD hospitalizations in public facilities in India were used more by the poor (Col –0.041 ), while the rich used proportionately more services in the private sector (CoI 0.174). Out-of-pocket expenditure in public facilities was consistently lower than that in private facilities in urban and rural areas. The mean out-of-pocket expenditure for inpatient services for NCDs was found to be more among the rich in both public (Q5 ₹13 016, Q1 ₹4197) and private (Q5 ₹22 974, Q1 ₹8225) facilities. Conclusion. Public facilities are utilized more by poorer individuals. Strengthening the capacity of the public sector to deliver NCD care is required to meet equitable outcomes.

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