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

et al. 2020

Preprint

Background: The National Health Mission (NHM), the largest ever publicly funded health programme worldwide, used over half of the national health budget in India and primarily aimed to improve maternal and child health in the country. Though large scale public health investment in India has improved the health care utilization and health outcomes across states and socio-economic groups, little is known on the equity concern of NHM. In this context, this paper examines the utilization pattern and net benefit of public subsidy for institutional delivery by the level of care in India. Methods: Data from the most recent round of the National Family Health Survey (NFHS 4), conducted during 2015-16, was used in the study. A total of 148,645 last birth delivered in a health centre during the five years preceding the survey were used for the analyses. Out-of-pocket (OOP) payment on delivery care was taken as the dependent variable and was analysed by primary care and secondary level of care. Benefits Incidence Analysis (BIA), descriptive statistics, concentration index (CI), and concentration curve (CC) were used to do the analysis. Results: Institutional delivery from the public health centres in India is pro-poor and has a strong economic gradient. About 28% mothers from richest wealth quintile did not pay for delivery in public health centres compared to 16% among the poorest wealth quintile. Benefit incidence analyses suggests a pro-poor distribution of institutional delivery both at primary and secondary level of care. In 2015-16, at the primary level, about 32.29% of subsidies were used by the poorest, 27.22% by poorer, 20.39% by middle, 13.36% by richer and 6.73% by the richest wealth quintile. The pattern at the secondary level was similar, though the magnitude was lower. The concentration index of institutional delivery in public health centres was -0.161 [95% CI: -0.158, -0.165] compared to 0.296 [95% CI: 0.289, 0.303] from private health centres.Conclusion: Provision and use of public subsidy for institutional delivery in public health centres is pro-poor in India. Improving the quality of service in primary health centres is recommended to increase utilisation and reduce OOP payment for health care in India.

Section: Bene T Incidence Analysismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Understanding equity of institutional delivery in public health centre by level of care in India: An assessment using Benefit Incidence Analysis

et al. 2020

Preprint

“…In Northeast India, the benefits of inpatient care were pro-poor in urban and pro rich in rural areas [52]. A recent study found a prorich distribution of public subsidy for inpatient care of non-communicable diseases (NCDs) among the elderly [53]. In West Bengal, the benefit of public subsidy was highest for the lower-middle income group in rural areas and for the upper-middle income group in urban areas [23].…”

Section: Introductionmentioning

confidence: 99%

Understanding equity of institutional delivery in public health centre by level of care in India: an assessment using benefit incidence analysis

et al. 2020

Int J Equity Health

Background The National Health Mission (NHM), the largest ever publicly funded health programme worldwide, used over half of the national health budget in India and primarily aimed to improve maternal and child health in the country. Though large scale public health investment has improved the health care utilization and health outcomes across states and socio-economic groups in India, little is known on the equity concern of NHM. In this context, this paper examines the utilization pattern and net benefit of public subsidy for institutional delivery by the level of care in India. Methods Data from the most recent round of the National Family Health Survey (NFHS 4), conducted during 2015–16, was used in the study. A total of 148,645 last birth delivered in a health centre during the 5 years preceding the survey were used for the analyses. Out-of-pocket (OOP) payment on delivery care was taken as the dependent variable and was analysed by primary care and secondary level of care. Benefits Incidence Analysis (BIA), descriptive statistics, concentration index (CI), and concentration curve (CC) were used to do the analysis. Results Institutional delivery from the public health centres in India is pro-poor and has a strong economic gradient. However, about 28% mothers from richest wealth quintile did not pay for delivery in public health centres compared to 16% among the poorest wealth quintile. Benefit incidence analyses suggests a pro-poor distribution of institutional delivery both at primary and secondary level of care. In 2015–16, at the primary level, about 32.29% of subsidies were used by the poorest, 27.22% by poorer, 20.39% by middle, 13.36% by richer and 6.73% by the richest wealth quintile. The pattern at the secondary level was similar, though the magnitude was lower. The concentration index of institutional delivery in public health centres was − 0.161 [95% CI, − 0.158, − 0.165] compared to 0.296 [95% CI, 0.289, 0.303] from private health centres. Conclusion Provision and use of public subsidy for institutional delivery in public health centres is pro-poor in India. Improving the quality of service in primary health centres is recommended to increase utilisation and reduce OOP payment for health care in India.

“…One of the di culties in bene t incidence analyses is obtaining the cost of services. In the absence of cost of services, the modal value of OOP payment for delivery has been used in literature [43]. However, we have used the median value in our study since a signi cant proportion of women reported zero OOP (varying from 7-10% across the wealth quintile) of delivery at the accredited private health centres (JSY under NHM programme has such provision) and so the modal value for OOP payments became zero.…”

Section: Bene T Incidence Analysismentioning

confidence: 99%

“…In Northeast India, the bene ts for inpatient care in urban area were pro-poor whereas for rural areas, the bene ts were pro-rich in nature [42]. A recent study found a pro-rich distribution of public subsidy for inpatient care of non-communicable diseases (NCDs) among elderly [43]. In West Bengal, the bene t of public subsidy was highest for individuals belonging to lower-middle group in rural areas and upper-middle income group in urban areas [44].…”

Section: Introductionmentioning

confidence: 99%

Understanding equity of institutional delivery in public health centre in India: An assessment using Benefit Incidence Analysis

et al. 2020

Preprint

Background: The National Health Mission (NHM), the largest ever publicly funded health programme worldwide used over half of the national health budget in India and primarily targeted to improve maternal and child health in the country. Though increased public health investment in India has improved the health care utilization and health outcomes across geographies and socio-economic groups, little is known on equity aspect of such large scale investment. In this context, this paper examines the utilisation pattern of delivery care and equity aspect of public investment in India.Methods: Data from the recent round of National Family Health Survey (NFHS 4) conducted during 2015-16 used in the analyses. A total of 148,645 last birth delivered in an institution in a reference period of five years has been used in the analyses. The out-of-pocket (OOP) payment on delivery care is the dependent variable. Benefits Incidence Analysis (BIA), descriptive statistics, concentration index (CI), and concentration curve (CC) used in the analysis.Results: Utilization of natal care from public health centres in India is pro-poor and have a strong economic gradient. However, about 28% mothers in richest wealth quintile did not pay for delivery in public health centres compared to 16% among the poorest wealth quintile. The median OOP payments for institutional delivery from public health centre was ₹1200 for mothers belonging to the poorest wealth quintile compared to ₹2000 for mothers belonging to richest wealth quintile. Benefit incidence analyses suggests that about 17.4 % of subsidies were used among poorest, 19.3% among richest quintile and 21.9% in the middle quintile. The concentration index of institutional delivery from public health centres was -0.161 [95% Confidence Interval: -0.158, -0.165] compared to 0.296 [95% Confidence Interval: 0.289, 0.303] from private health centres.Conclusion: Utilisation of natal care services from public health centres in India is pro-poor. However, benefit-incidence analyses suggest that the use of subsidy is relatively higher among wealthier and better off mothers in India.