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Measuring Socio-Economic Inequality in Self-Reported Morbidity in India: Decomposition Analysis

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  • M.D. Azharuddin Akhtar
  • Nadeem Ahmad
  • Indrani Roy Chowdhury

Abstract

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.

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  • M.D. Azharuddin Akhtar & Nadeem Ahmad & Indrani Roy Chowdhury, 2020. "Measuring Socio-Economic Inequality in Self-Reported Morbidity in India: Decomposition Analysis," Review of Development and Change, , vol. 25(1), pages 89-111, June.
  • Handle: RePEc:sae:revdev:v:25:y:2020:i:1:p:89-111
    DOI: 10.1177/0972266120916317
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    as
    1. Powell-Jackson, Timothy & Mazumdar, Sumit & Mills, Anne, 2015. "Financial incentives in health: New evidence from India's Janani Suraksha Yojana," Journal of Health Economics, Elsevier, vol. 43(C), pages 154-169.
    2. Angus Deaton, 2003. "Health, Inequality, and Economic Development," Journal of Economic Literature, American Economic Association, vol. 41(1), pages 113-158, March.
    3. Eddy van Doorslaer & Xander Koolman, 2004. "Explaining the differences in income‐related health inequalities across European countries," Health Economics, John Wiley & Sons, Ltd., vol. 13(7), pages 609-628, July.
    4. Subramanian, S.V. & Subramanyam, Malavika A. & Selvaraj, Sakthivel & Kawachi, Ichiro, 2009. "Are self-reports of health and morbidities in developing countries misleading? Evidence from India," Social Science & Medicine, Elsevier, vol. 68(2), pages 260-265, January.
    5. Wagstaff, Adam, 1991. "QALYs and the equity-efficiency trade-off," Journal of Health Economics, Elsevier, vol. 10(1), pages 21-41, May.
    6. Paul Gertler & Jonathan Gruber, 2002. "Insuring Consumption Against Illness," American Economic Review, American Economic Association, vol. 92(1), pages 51-70, March.
    7. Goli, Srinivas & Arokiasamy, Perianayagam, 2014. "Trends in health and health inequalities among major states of India: assessing progress through convergence models," Health Economics, Policy and Law, Cambridge University Press, vol. 9(2), pages 143-168, April.
    8. Wagstaff, Adam & van Doorslaer, Eddy & Watanabe, Naoko, 2003. "On decomposing the causes of health sector inequalities with an application to malnutrition inequalities in Vietnam," Journal of Econometrics, Elsevier, vol. 112(1), pages 207-223, January.
    9. Wagstaff, Adam & van Doorslaer, Eddy & Paci, Pierella, 1989. "Equity in the Finance and Delivery of Health Care: Some Tentative Cross-country Comparisons," Oxford Review of Economic Policy, Oxford University Press and Oxford Review of Economic Policy Limited, vol. 5(1), pages 89-112, Spring.
    10. Adam Wagstaff & Eddy van Doorslaer, 2003. "Catastrophe and impoverishment in paying for health care: with applications to Vietnam 1993–1998," Health Economics, John Wiley & Sons, Ltd., vol. 12(11), pages 921-933, November.
    11. Teresa Bago d'Uva & Eddy Van Doorslaer & Maarten Lindeboom & Owen O'Donnell, 2008. "Does reporting heterogeneity bias the measurement of health disparities?," Health Economics, John Wiley & Sons, Ltd., vol. 17(3), pages 351-375, March.
    12. Singh-Manoux, A. & Guéguen, A. & Ferrie, J. & Shipley, M. & Martikainen, P. & Bonenfant, S. & Goldberg, M. & Marmot, M., 2008. "Gender differences in the association between morbidity and mortality among middle-aged men and women," American Journal of Public Health, American Public Health Association, vol. 98(12), pages 2251-2257.
    13. Wagstaff, Adam & van Doorslaer, Eddy, 2000. "Chapter 34 Equity in health care finance and delivery," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 34, pages 1803-1862, Elsevier.
    14. van Doorslaer, Eddy & Wagstaff, Adam & Bleichrodt, Han & Calonge, Samuel & Gerdtham, Ulf-G. & Gerfin, Michael & Geurts, Jose & Gross, Lorna & Hakkinen, Unto & Leu, Robert E., 1997. "Income-related inequalities in health: some international comparisons," Journal of Health Economics, Elsevier, vol. 16(1), pages 93-112, February.
    15. Adam Wagstaff, 2005. "The bounds of the concentration index when the variable of interest is binary, with an application to immunization inequality," Health Economics, John Wiley & Sons, Ltd., vol. 14(4), pages 429-432, April.
    16. Isabelle Joumard & Ankit Kumar, 2015. "Improving Health Outcomes and Health Care in India," OECD Economics Department Working Papers 1184, OECD Publishing.
    17. van Doorslaer, Eddy & Wagstaff, Adam & van der Burg, Hattem & Christiansen, Terkel & De Graeve, Diana & Duchesne, Inge & Gerdtham, Ulf-G & Gerfin, Michael & Geurts, Jose & Gross, Lorna, 2000. "Equity in the delivery of health care in Europe and the US," Journal of Health Economics, Elsevier, vol. 19(5), pages 553-583, September.
    18. Sutton, Matthew & Carr-Hill, Roy & Gravelle, Hugh & Rice, Nigel, 1999. "Do measures of self-reported morbidity bias the estimation of the determinants of health care utilisation?," Social Science & Medicine, Elsevier, vol. 49(7), pages 867-878, October.
    19. Planning Commission, India, 2008. "Eleventh Five Year Plan (2007–2012) Volume I Inclusive Growth," Working Papers id:1582, eSocialSciences.
    20. Jason J Madan & Knut Lonnroth & Samia Laokri & Stephen Bertel SB Squire, 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 ," ULB Institutional Repository 2013/223014, ULB -- Universite Libre de Bruxelles.
    21. Kakwani, Nanak & Wagstaff, Adam & van Doorslaer, Eddy, 1997. "Socioeconomic inequalities in health: Measurement, computation, and statistical inference," Journal of Econometrics, Elsevier, vol. 77(1), pages 87-103, March.
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    1. A. Akhtar & Nadeem Ahmad & Indrani Roy Chowdhury, 2020. "Socio-economic inequality in catastrophic health expenditure among households in India: A decomposition analysis," Indian Economic Review, Springer, vol. 55(2), pages 339-369, December.
    2. Shreya Banerjee & Indrani Roy Chowdhury, 2020. "Inequities in curative health-care utilization among the adult population (20–59 years) in India: A comparative analysis of NSS 71st (2014) and 75th (2017–18) rounds," PLOS ONE, Public Library of Science, vol. 15(11), pages 1-23, November.

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