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

ABSTRACT

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.