This study explored reasons for the shift toward outpatient care in India between 2014 and 2017-18. The study used the most recent unit-level data from health surveys conducted by the National Sample Survey for the years 2017-18 and 2014. It is based on the uniform 15-day recall period for utilization of inpatient and outpatient care. Multivariate decomposition analysis was used to identify the contribution of covariates that explain this shift in utilization from inpatient to outpatient care in India. Decomposition analysis suggests that most of this shift is attributable to the change in the coefficient of explanatory variables (98%). The age and nature of diseases accounted for more than 40% of this shift. The age of the patient and non-communicable diseases are the two most significant drivers of the shift toward outpatient care between 2014 and 2017-18.
ElekPMolnárTVáradiB.The closer the better: does better access to outpatient care prevent hospitalization?Eur J Health Econ. 2019;20(6):801-817. doi:10.1007/s10198-019-01043-4
2.
AbramsKBalan-CohenABurbhaP. Growth in outpatient care: the role of quality and value incentives a report by the Deloitte Center for Health Solutions. Published 2018. Accessed July 12, 2025. www.deloitte.com/us/ValueBasedCare
3.
AdhikariSR.An assessment of a substitute or complement for inpatient and outpatient care of visceral leishmaniasis in Nepal. J Vector Borne Dis. 2012;49:242-248.
4.
BaumannAWyssK.The shift from inpatient care to outpatient care in Switzerland since 2017: policy processes and the role of evidence. Health Policy. 2021;125(4):512-519. doi:10.1016/j.healthpol.2021.01.012
SchneebergerARWerthmuellerSBarcoSHeussSC.Patients’ preference regarding inpatient versus outpatient setting: a systematic review. Int J Health Plann Manage. 2023;38(5):1409-1419. doi:10.1002/hpm.3669
7.
FreibergLJr.Substitution of outpatient care for inpatient care: problems and experience. J Health Polit Policy Law. 1979;3(4):479-496. doi:10.1215/03616878-3-4-479
GhoshPKMaalAKaneS. et al. Health Seeking Pathways in Four Indian States (4IS), India. Report, National Council of Applied Economic Research, New Delhi, and Nossal Institute for Global Health, Melbourne, The University of Melbourne, 2023. https://ncaer.org/wp-content/uploads/2023/09/HSPSReportSept2023-1.pdf
10.
Ministry of Statistics and Programme Implementation, Government of India. India-social consumption: health, NSS 71st round: Jan-June 2014. Accessed July 1, 2024. https://microdata.gov.in/nada43/index.php/catalog/135
GuptaIDasguptaP; National Council of Applied Economic Research. Demand for curative health care in rural India: choosing between private, public and no care. Accessed July 13, 2025. www.ncaer.org
13.
GhoshS.Health sector reforms and changes in prevalence of untreated morbidity, choice of healthcare providers among the poor and rural population in India. Int J Health Policy Manag. 2014;2(3):125-130. doi:10.15171/ijhpm.2014.32
14.
LevesqueJFHaddadSNarayanaDFournierP.Insular pathways to health care in the city: a multilevel analysis of access to hospital care in urban Kerala, India. Trop Med Int Health. 2007;12(7):802-814. doi:10.1111/j.1365-3156.2007.01870.x
15.
RoutSKSahuKSMahapatraS.Utilization of health care services in public and private healthcare in India: causes and determinants. Int J Healthc Manag. 2021;14(2):509-516. doi:10.1080/20479700.2019.1665882
16.
KastorAMohantySK.Disease-specific out-of-pocket and catastrophic health expenditure on hospitalization in India: do Indian households face distress health financing. PLoS ONE. 2018;13(5):e0196106. doi:10.1371/journal.pone.0196106
17.
PaiMMuhammadT.Examining factors contributing to the socioeconomic inequalities in handgrip strength among older adults in India: a decomposition analysis. Sci Rep. 2024;14(1):1-16. doi:10.1038/s41598-023-50613-3
18.
GoliSSinghLJainKPouLMA. Socioeconomic determinants of health inequalities among the older population in India: a decomposition analysis. J Cross Cult Gerontol. 2014;29(4):353-369. doi:10.1007/S10823-014-9251-8/METRICS
19.
MondalBDubeyJD.Gender discrimination in health-care expenditure: an analysis across the age-groups with special focus on the elderly. Soc Sci Med. 2020;258:113089. doi:10.1016/J.SOCSCIMED.2020.113089
20.
O’DonnellOvan DoorslaerEWagstaffALindelowM.Analyzing Health Equity Using Household Survey Data: A Guide to Techniques and Their Implementation. World Bank; 2008. doi:10.1596/978-0-8213-6933-3
21.
PowersDAYoshiokaHYunMS.Mvdcmp: multivariate decomposition for nonlinear response models. Stata J. 2012;11:556-576.
KaoYHLinWTChenWHWuSCTsengTS.Continuity of outpatient care and avoidable hospitalization: a systematic review. Am J Manag Care. 2019;25(4):e126-e134. Accessed July 13, 2025. www.ajmc.com
ZhangTLiuJWangXLiuC.County hospital responses to funding reforms in Zhejiang, China: an interrupted time-series analysis. Health Syst Reform. 2023;9(1):2258770. doi:10.1080/23288604.2023.2258770
26.
KellySLJaoudeGJAPalmerT, et al. Public health benefits of shifting from hospital-focused to ambulatory TB care in Eastern Europe: optimising TB investments in Belarus, the Republic of Moldova, and Romania. PLOS Glob Public Health. 2023;3(6):e0001025. doi:10.1371/journal.pgph.0001025
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
