Equity in the utilisation of health care services in India: Implications for paths to UHC

Pursuit of equity in health and health care has been the key feature of health policy in India. Despite the policy significance, the volume of literature on this important topic is very inadequate in the Indian context. This paper, for the first time seeks to provide evidence on horizontal inequity in health care utilization in 16 major states and north-eastern region of India. The number of outpatient care visits in the past 15 days, number of hospitalizations and length of stay in hospital over 12 months period were extracted from 60th round (2004) data of National Sample Survey. All these measures of health care utilization were standardized for need differences using demographic characteristics and morbidity indicators and controlling for other socioeconomic factors. Need standardized concentration indices were used to measure income related inequities in health care utilization. Absolute inequalities are found between states in the proportion of the population reporting a visit to an outpatient provider, from as low as 4 percent in Bihar to as high as 22 percent in Kerala. Notwithstanding, after standardization, no violation of principle of horizontal equity is found in outpatient care in many states. Significant inequity is observed with respect to the utilization of inpatient care, favouring the rich in all states except