This paper assesses socio-economic inequalities in self-reported morbidities (SRMs) among households in India. Particularly, we addressed two questions. Is socio-economic-related inequality in SRMs significantly pro-rich or pro-poor? What are the major socio-economic and regional determinants contributing to inequality? This study is based on National Sample Survey 71st round (2014). We calculated equity ratio and concentration index (CI) to assess socio-economic-related inequality. Further, we applied probit regression and decomposition of CI to identify the major factors contributing to inequality.
The finding suggests that SRMs and hospital admission have significantly pro-rich distribution, and accessibility to healthcare is a constraint against poor households. After adjusting the inequality, the unjust inequality due to socio-economic gradient is still found to be significant. Overall, income and regional differences are observed to be inflating factors, while education and insurance are observed to be deflating factors in socio-economic inequality in SRMs. High out-of-pocket expenditure with high proportion of transportation cost indicates high burden of accessing healthcare, which acts as a deterrent for poor in seeking healthcare. The government targets of investing 2.5 per cent of the Gross Domestic Product in the healthcare sector and running an ambitious programme like Universal Health Coverage are necessary efforts in the presence of income and health inequalities.
AbelsonP. (2003). The value of life and health for public policy. Economic Record, 79(Special Issue), S2–S13.
2.
AgrawalG.KeshriK. (2014). Morbidity patterns and health care seeking behavior among older widows in India. PloS one, 9(4), e94295.
3.
Bago d’UvaT.Van DoorslaerE.LindeboomM.O’donnellO. (2008). Does reporting heterogeneity bias the measurement of health disparities? Health economics, 17(3), 351–375.
4.
BakerJ.van der GaagJ. (1993). Equity in health care and health care financing: Evidence from five developing countries. In van DoorslaerE.WagstaffA.RuttenF. (Eds.), Equity in the finance and delivery of health care: An international perspective. Oxford.
5.
BalarajanY.SelvarajS.SubramanianS. V. (2011). Health care and equity in India. The Lancet, 377(9764), 505–515.
6.
BaruR.AcharyaA.AcharyaS.KumarA. S.NagarajK. (2010). Inequities in access to health services in India: Caste, class and region. Economic & Political Weekly, 45(38), 49–58.
7.
BhanN.RaoK. D.KachwahaS. (2016). Health inequalities research in India: A review of trends and themes in the literature since the 1990s. International Journal for Equity in Health, 15(1), 166.
8.
BoutayebA.BoutayebS. (2005). The burden of non communicable diseases in developing countries. International Journal for Equity in Health, 4(1), 2.
9.
DanaeiG.SinghG. M.PaciorekC. J.LinJ. K.CowanM. J.FinucaneM. M.RaoM. (2013). The global cardiovascular risk transition: Associations of four metabolic risk factors with national income, urbanization, and Western diet in 1980 and 2008. Circulation, 127(14), 1493–1502.
10.
DeatonA. (2002). Policy implications of the gradient of health and wealth. Health Affairs, 21(2), 13–30.
11.
DeatonA. (2003). Health, inequality, and economic development. Journal of Economic Literature, 41(1), 113–158.
12.
DilipT. R. (2002). Understanding levels of morbidity and hospitalization in Kerala, India. Bulletin of the World Health Organization, 80, 746–751.
13.
DrèzeJ.SenA. (2013). An uncertain glory: India and its contradictions. Princeton University Press.
14.
DrorD. M. (2006). Health insurance for the poor: Myths and realities. Economic & Political Weekly, 41(43–44), 4541–4544.
15.
DuraisamyP. (1998). Morbidity in Tamil Nadu. Economic & Political Weekly, 33(17), 982–990.
16.
GertlerP.GruberJ. (2002). Insuring consumption against illness. American Economic Review, 92(1), 51–70.
17.
GhoshS.ArokiasamyP. (2009). Morbidity in India: Trends, patterns and differentials. Journal of Health Studies, 2(1, 2 & 3), 136–148.
18.
Global Burden of Disease Study (GBD). (2017). Cause specific mortality1980–2016. Institute for Health Metrics and Evaluation (IHME).
19.
GoliS.ArokiasamyP. (2014). Trends in health and health inequalities among major states of India: Assessing progress through convergence models. Health Economics, Policy and Law, 9(2), 143–168.
20.
GoliS.SinghL.JainK.PouL. M. A. (2014). Socio economic determinants of health inequalities among the older population in India: A decomposition analysis. Journal of Cross-Cultural Gerontology, 29(4), 353–369.
21.
GundgaardJ.LauridsenJ. (2006). Decomposition of sources of income-related health inequality applied on SF–36 summary scores: A Danish health survey. Health and Quality of Life Outcomes, 4(1), 53.
22.
GumberA. (1997). Burden of disease and cost of ill health in India: Setting priorities for health interventions during the Ninth Plan. Margin-New Delhi, 29, 133–172.
23.
GwatkinD. R. (2000). Health inequalities and the health of the poor: What do we know? What can we do? Bulletin of the World Health Organization, 78(1), 3–18.
24.
HalabiS.ZuraykH.AwaidaR.DarwishM.SaabB. (1992). Reliability and validity of self and proxy reporting of morbidity data: A case study from Beirut, Lebanon. International Journal of Epidemiology, 21(3), 607–612.
25.
HosseinpoorA. R.Van DoorslaerE.SpeybroeckN.NaghaviM.MohammadK.MajdzadehR.VegaJ. (2006). Decomposing socio-economic inequality in infant mortality in Iran. International Journal of Epidemiology, 35(5), 1211–1219.
26.
IdlerE. L.BenyaminiY. (1997). Self-rated health and mortality: A review of twenty-seven community studies. Journal of Health and Social Behavior, 38(1), 21–37.
27.
Indian Council of Medical Research, Public Health Foundation of India and Institute for Health Metrics and Evaluation, India (2017). Health of the nation’s states-the India state-level disease burden initiative. Author.
28.
International Institute for Population Sciences (IIPS) and Macro International. (2007). National family health survey (NFHS-3), 2005–06: India(volume 1). IIPS.
29.
JacksonP. T.MazumdarS.MillsA. (2015). Financial incentives in health: New evidence from India’s Janani Suraksha Yojana. Journal of Health Economics, 43, 154–169.
30.
JoeW.MishraU. S.NavaneethamK. (2008). Health inequality in India: Evidence from NFHS 3. Economic & Political Weekly, 43(31), 41–47.
31.
JoshiP.IslamS.PaisP.ReddyS.DorairajP.KazmiK.YusufS. (2007). Risk factors for early myocardial infarction in South Asians compared with individuals in other countries. Jama, 297(3), 286–294.
32.
JoumardI.KumarA. (2015). Improving health outcomes and health care in India(Working Paper No. 1184). Economics Department, OECD.
33.
KakwaniN. C. (1980). Income inequality and poverty. World Bank.
34.
KakwaniN.WagstaffA.Van DoorslaerE. (1997). Socio-economic inequalities in health: Measurement, computation, and statistical inference. Journal of Econometrics, 77(1), 87–103.
35.
KrishnajiN. (1980). Poverty and family size. Social Scientist, 9(4), 22–35.
36.
KrishnaswamiP. (2004). Morbidity study: Incidence, prevalence, consequences, and associates. Kerala Research Programme on Local Level Development, Centre for Development Studies.
37.
MahalA.RajaramanI. (2010). Decentralisation, preference diversity and public spending: Health and education in India. Economic & Political Weekly, 45(43), 57–63.
38.
MadanJ.LönnrothK.LaokriS.SquireS. B. (2015). What can dissaving tell us about catastrophic costs? Linear and logistic regression analysis of the relationship between patient costs and financial coping strategies adopted by tuberculosis patients in Bangladesh, Tanzania and Bangalore, India. BMC Health Services Research, 15(1), 476.
39.
MidthjellK.HolmenJ.BjørndalA.Lund-LarsenG. (1992). Is questionnaire information valid in the study of a chronic disease such as diabetes? The Nord-Trøndelag diabetes study. Journal of Epidemiology & Community Health, 46(5), 537–542.
40.
ModiglianiF.BrumbergR. (1954). Utility analysis and the consumption function: An interpretation of cross-section data. Franco Modigliani, 1, 388–436.
41.
MorasaeE. K.ForouzanA. S.MajdzadehR.Asadi-LariM.NoorbalaA. A.HosseinpoorA. R. (2012). Understanding determinants of socio-economic inequality in mental health in Iran’s capital, Tehran: A concentration index decomposition approach. International journal for equity in health, 11(1), 18.
42.
MurrayC. J.ChenL. C. (1992). Understanding morbidity change. The Population and Development Review, 481–503
43.
National Sample Survey Organization (NSSO). (2014). Social consumption: Health NSS 71st round. Government of India.
44.
NedjatS.HosseinpoorA. R.ForouzanfarM. H.GolestanB.MajdzadehR. (2012). Decomposing socio-economic inequality in self-rated health in Tehran. Journal of Epidemiology and Community Health, 66(6), 495–500.
45.
NicholsonA.BobakM.MurphyM.RoseR.MarmotM. (2005). Socio-economic influences on self-rated health in Russian men and women—A life course approach. Social Science & Medicine, 61(11), 2345–2354.
46.
O’donnellO.Van DoorslaerE.WagstaffA.LindelowM. (2007). Analyzing health equity using household survey data: A guide to techniques and their implementation. The World Bank.
47.
Planning Commission (Government of India). (2008). Eleventh five-year plan 2007–2012. Vol I: Inclusive growth. Oxford University Press.
48.
PrinjaS.JeyashreeK.RanaS.SharmaA.KumarR. (2015). Wealth related inequalities in self reported morbidity: Positional objectivity or epidemiological transition? The Indian Journal of Medical Research, 141(4), 438.
49.
PrinjaS.KanavosP.KumarR. (2012). Health care inequities in north India: Role of public sector in universalizing health care. The Indian journal of Medical Research, 136(3), 421.
50.
ReddyK. S.ShahB.VargheseC.RamadossA. (2005). Responding to the threat of chronic diseases in India. The Lancet, 366(9498), 1744–1749.
51.
SelvarajS.FarooquiH. H.KaranA. (2018). Quantifying the financial burden of households’ out-of-pocket payments on medicines in India: A repeated cross-sectional analysis of National Sample Survey Data, 1994–2014. BMJ Open, 8(5), e018020.
52.
SenA. (1993). Positional objectivity. Philosophy & Public Affairs, 22(2), 126–145.
53.
SinghM. A.GuéguenA.FerrieJ.ShipleyM.MartikainenP.MartikainenP.BonenfantS.GoldbergM.MarmotM. (2008). Gender differences in the association between morbidity and mortality among middle-aged men and women. American Journal of Public Health, 98(12), 2251–2257.
54.
ShariffA. (1995). Health transition in India(No. 57). National Council of Applied Economic Research.
55.
SubramanianS. V.AckersonL. K.SubramanyamM. A.SivaramakrishnanK. (2008). Health inequalities in India: The axes of stratification. The Brown Journal of World Affairs, 14(2), 127–138.
56.
SubramanianS. V.SubramanyamM. A.SelvarajS.KawachiI. (2009). Are self-reports of health and morbidities in developing countries misleading? Evidence from India. Social Science & Medicine, 68(2), 260–265.
57.
SundararamanT.MuraleedharanV. R. (2015). Falling sick, paying the price. Economic & Political Weekly, 33, 17–20.
58.
SundmacherL.Scheller-KreinsenD.BusseR. (2011). The wider determinants of inequalities in health: A decomposition analysis. International Journal for Equity in Health, 10(1), 30.
59.
SuttonM.Carr-HillR.GravelleH.RiceN. (1999). Do measures of self-reported morbidity bias the estimation of the determinants of health care utilisation? Social Science & Medicine, 49(7), 867–878.
60.
Van DoorslaerE.WagstaffA.BleichrodtH.CalongeS.GerdthamU. G.GerfinM.O’DonellO. (1997). Income-related inequalities in health: Some international comparisons. Journal of Health Economics, 16(1), 93–112.
61.
Van DoorslaerE.KoolmanX. (2004). Explaining the differences in income-related health inequalities across European countries. Health Economics, 13(7), 609–628.
62.
Van DoorslaerE.WagstaffA.Van der BurgH.ChristiansenT.De GraeveD.DuchesneI.HäkkinenU. (2000). Equity in the delivery of health care in Europe and the US. Journal of Health Economics, 19(5), 553–583.
63.
WagstaffA. (1991). QALYs and the equity-efficiency trade-off. Journal of Health Economics, 10(1), 21–41.
64.
WagstaffA. (2002). Poverty and health sector inequalities. Bulletin of the World Health Organization, 80(2), 97–105.
65.
WagstaffA. (2005). The bounds of the concentration index when the variable of interest is binary, with an application to immunization inequality. Health Economics, 14(4), 429–432.
66.
WagstaffA.DoorslaerE. V. (2003). Catastrophe and impoverishment in paying for health care: With applications to Vietnam 1993–1998. Health Economics, 12(11), 921–933.
67.
WagstaffA.Van DoorslaerE.PaciP. (1989). Equity in the finance and delivery of health care: Some tentative cross-country comparisons. Oxford Review of Economic Policy, 5(1), 89–112.
68.
WagstaffA.Van DoorslaerE.WantanbeN. (2003). On decomposing the causes of Health sector inequalities, with an application to malnutrition inequalities in Vietnam. Journal of Econometrics, 112(1), 219–227.
69.
YiengprugsawanV.LimL. L.CarmichaelG. A.SidorenkoA.SleighA. C. (2007). Measuring and decomposing inequity in self-reported morbidity and self-assessed health in Thailand. International Journal for Equity in Health, 6(1), 23.
