Benefit Incidence of Public Health Expenditure in India: Urban–Rural Equity Matters for Universal Health Coverage

Abstract

Background

Benefit incidence analysis (BIA) is a tool to estimate the equity of healthcare benefits accrued to individuals across socio-economic groups. The results help to illustrate the extent of the effectiveness of public health resource allocation on public health by the government in meeting the needs of vulnerable populations. This article represents the most recent BIA completed in India and presents an analysis of the distribution of public spending in outpatient and inpatient care.

Purpose

This paper presents a benefit incidence analysis of the distribution of public spending in outpatient and inpatient care in India.

Methods

Benefit Incidence Analysis estimates healthcare benefit equity across socioeconomic groups. Data from the 75th National Sample Survey Organisation round was used for analysis. Disease burden, out-of-pocket expenses, and non-utilisation of public health services for outpatient and inpatient care were analysed. Concentration curves and indices were calculated for rural and urban areas.

Results

In rural areas, the utilisation of public health facilities for outpatient and inpatient care is concentrated among non-poor individuals but is more pro-poor for outpatient care. When both outpatient and inpatient care are considered together, public health spending approaches a more equitable distribution. However, for inpatient care, public health spending is more pro-poor, whereas for outpatient care, it is more pro-rich. In rural areas, public health spending on outpatient and inpatient care is more pro-poor compared to urban areas, where it tends to be more pro-rich.

Conclusion

Our analysis of equity between urban and rural health services using BIA reveals that public spending has not resulted in significantly pro-poor services in India.