J Korean Med Sci.  2015 Nov;30(Suppl 2):S155-S166. 10.3346/jkms.2015.30.S2.S155.

Horizontal Inequity in Elderly Health Care Utilization: Evidence from India

• Joe W
• Rudra S
• Subramanian SV

• KMID: 2351154
• DOI: http://doi.org/10.3346/jkms.2015.30.S2.S155

Abstract

Against the backdrop of population aging, this paper presents the analysis of need-standardised health care utilization among elderly in India. Based on nationally representative morbidity and health care survey 2004, we demonstrate that the need for health care utilization is indeed pro-poor in nature. However, the actual health care utilization is concentrated among richer sections of the population. Further, the decomposition analysis reveals that income has a very strong role in shifting the distribution of health care away from the poor elderly. The impact of income on utilization is well-demonstrated even at the ecological-level as states with higher per capita incomes have higher elderly health care utilization even as the levels of need-predicted distribution across these states are similar. We also find that the distribution of elderly across social groups and their educational achievements favours the rich and significantly contributes to overall inequality. Nevertheless, contribution of need-related self-assessed health clearly favours pro-poor inequality. In concluding, we argue that to reduce such inequities in health care utilization it is necessary to increase public investments in health care infrastructure including geriatric care particularly in rural areas and underdeveloped regions to enhance access and quality of health care for the elderly.

Keyword

Aged; Health Care; Surveys; Delivery of Health Care; Socioeconomic Factors

MeSH Terms

Aged
Aged, 80 and over
*Cultural Characteristics
Evidence-Based Medicine
Female
Health Care Rationing/*statistics & numerical data
Health Equity/*statistics & numerical data
Health Services for the Aged/*utilization
Humans
Income/*statistics & numerical data
India/epidemiology
Male
Middle Aged
Socioeconomic Factors
*Utilization Review

Figure

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  Fig. 1 Distribution (in %) of actual (unstandardized), need-predicted and need-standardized health care utilization in previous 15 days by MPCE quintiles, India 2004.

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  Fig. 2 Distribution (in %) of actual (unstandardized) and need-standardized health care utilization in previous 15 days, Major Indian states 2004.

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  Fig. 3 Distribution of actual (unstandardized), need-predicted and need-standardized health care utilization in previous 15 days by MPCE quintiles, India 2004.

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  Fig. 4 Contributions (in %) to concentration index for health care utilization in last-15 days, India 2004.

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  Fig. 5 Association of actual utilization and need-predicted utilization with state per capita NSDP, Indian states 2004.

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