Income Inequity in the Utilisation of Inpatient Services

Existing literature on the effect of publicly financed health insurance schemes focuses on out-of-pocket expenditure and utilisation of health services, while the effect of PFHIs on equity in health service use remains unaddressed. The data on equivalised household income and inpatient service utilisation from the National Sample Survey Office are employed to analyse the extent of inequity in the utilisation of inpatient services before (2004) and after (2014) the implementation of the PFHI in 2008. This is done by estimating concentration indices and the horizontal inequity indices.

Publicly financed health insurance (PFHI) schemes are a major healthcare reform that have been adopted across developing countries, including India, to achieve universal health coverage (UHC). PFHIs reduce healthcare access inequity by targeting poor people and ensuring need-based access (Kutzin 2012; Roberts et al 2015; Kieny et al 2017). Equity is defined as the inequality that remains after accounting for legitimate factors driving inequality. Legitimate factors are those sources of variation in health or health-seeking behaviour that are “fair” or “just” (Fleurbaey and Schokkaert 2009), such as age, sex, and presence of illness. On the contrary, illegitimate determinants are “unfair” sources of variation such as socio-economic status (Wagstaff and van Doorslaer 2004; Fleurbaey and Schokkaert 2009).