Equity in healthcare utilisation and cost of treatment in Western India

Abstract

The paper compares the morbidity and healthcare utilisation scenario prevalent in Gujarat and Maharashtra as well as for all − India over the last 35 years by exploring the National Sample Surveys data for 1980–81, 1986–87, 1995–96, 2004, and 2014. The differentials and trends in morbidity rate, health seeking behaviour, use of public and private providers for inpatient and outpatient care and associated cost, and burden of treatment are analysed by population groups. Changes in people’s demand for health services are correlated with the supply factors i.e. expansion of public and private health infrastructure. Rising cost and burden of treatment on the poor are examined through receipt of free inpatient and outpatient services as well as the extent of financial protection under the health insurance schemes received by them. Overtime, morbidity rates have gone up, with several folds increase in select states; the reliance on public provision has gone down substantially despite being cheaper than the private sector; and cost of treatment at constant prices increased considerably even for the poor. Hospitalisation costs were higher among insured than the non-insured households in several states irrespective of whether resident in rural or urban areas (Haryana, Maharashtra, Himachal Pradesh, and Assam have reported that insured households ended-up paying almost double the hospitalisation expenses in 2014). Leaving aside Kerala (where insured households have paid just a half of the cost of the non-insured), this clearly reflects the widespread prevalence of moral hazard and insurance collusion in India.