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

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.