Benefit incidence analysis in public health facilities in India: utilization and benefits at the national and state levels

Abstract

BackgroundBenefit Incidence Analysis (BIA) is used to understand the distribution of health care utilization and spending in comparison to income distribution. The results can illustrate how effectively governments allocate limited resources towards meeting the needs of the poor. In analyzing the distribution of public spending on inpatient, outpatient, and deliveries, this paper represents the most recent BIA completed in India.MethodsIn order to conduct the BIA statistical analysis for this project, 2014 utilization data from the most recently completed Indian National Sample Survey (NSS) was used. Unit costs were estimated for primary care, hospital inpatient, hospital outpatient, and deliveries. Concentration curves and concentration indices were estimated both at the national and state levels. Analyses were reported for overall utilization, as well as for the gross and net benefits for inpatient, outpatient, and deliveries.ResultsAccording to the results, utilization of government inpatient and delivery services is pro-poor. When gross and net benefits are included in the analysis, services become more equal and less pro-poor. Gross benefits, which are measured with state-level unit costs, are virtually equal for all services. Although there are some pro-poor gross benefits trends for national outpatient services, the results also show that the equality of national gross benefits trends hides a significant disparity across Indian States. While a number of Indian States have outpatient gross benefits that are pro-poor, few show pro-poor benefits for inpatient and delivery services. Net benefits, which considers both unit costs for each respective service, and out-of-pocket (OOP) expenditures, trend similarly to gross benefits. In addition, those who use public facilities spend considerable OOP to supplement government services.ConclusionsThis BIA reveals that government spending on public health care has not resulted in significantly pro-poor services. While some progress has been made relative to deliveries and outpatient services, inpatient stays are not pro-poor. In addition, national results mask significant disparities across Indian states.Electronic supplementary materialThe online version of this article (10.1186/s12939-019-0921-6) contains supplementary material, which is available to authorized users.

Equity in distribution of public subsidy for noncommunicable diseases among the elderly in India: an application of benefit incidence analysis

“…Their results indicate that for few states the utilization of public healthcare services is pro-poor; however, for many states the distribution is skewed towards the rich. A recent study by Bowser et al, (2019) [31] show that the public outpatient and delivery care is pro-poor in India. The study also documented the state level variations in benefit distribution among the MPCE classes for inpatient and delivery services.…”

“…It is also revealed that in most of the states out-patient services is also pro-poor. However, users of public healthcare facilities are forced to spend considerable amount as out-of-pocket to supplement the government services [31]. Another study by Mahal et al, (2001) showed the inequity in subsidy distribution across income groups in India for various healthcare services using BIA [32].…”

Equity in Distribution of Public Subsidy for Noncommunicable Diseases among the Elderly in India: An Application of Benefit Incidence Analysis

“…Their results indicate that for few states the utilization of public healthcare services is pro-poor; however, for many states the distribution is skewed towards the rich. A recent study by Bowser et al, (2019) [26] show that the public outpatient and delivery care is pro-poor in India. The study also documented the state level variations in benefit distribution among the MPCE classes for inpatient and delivery services.…”

Unregulated Private Health Sector: India’s Challenges in Realizing Universal Health Coverage

“…The poor population prefers to utilize health services from private providers mainly due to inadequate availability of services from public health facilities, and the problem is so severe in the rural and remote areas in the country. The quality of services delivered by the private providers differs as compared to that in the urban areas (Bowser et al, 2019;Chatterjee et al, 2019). Thus the poor are the victims of unregulated spread of private health services, as they require better care at affordable cost.…”