TY - JOUR
T1 - An Empirical Examination of the Inequality of Forgone Care in India
AU - Patenaude, Bryan
AU - Rao, Krishna D.
AU - Peters, David H.
N1 - Publisher Copyright:
© 2021 World Bank. Published with license by Taylor & Francis Group, LLC.
PY - 2021
Y1 - 2021
N2 - Understanding how well a health system is meeting the needs of the population is critical to achieving the policy aspirations of universal health coverage. This study focuses on assessing the inequity of forgone care for priority maternal and child health services across India. We utilize data from the 4th round of the Indian National Family Health Survey (NFHS-4) to examine inequality of forgone care. Our outcomes include forgone institutional delivery, antenatal care, medical care for a child with fever or cough, and medical care for a child with diarrhea. Wagstaff’s standardized concentration indices (CIs) are computed at the national level, over urban and rural sub-populations, and by state. Regression decomposition is performed to determine the influence of specific drivers on overall inequality. There was significant variation in the national-level prevalence and CIs for forgone antenatal care (17.8%, CI: −0.423), forgone medical care for a child with fever or cough (32.4%, CI: −0.199), forgone medical care for a child with diarrhea (33.8%, CI: −0.172), and forgone institutional delivery (24.5%, CI: −0.436). For all outcomes, forgone care is disproportionately concentrated among the poor, particularly in rural areas. There is also significant heterogeneity in state-level inequalities. Decomposition analyses show that socioeconomic status, maternal education, rural status, and state-level per capita health spending are the leading drivers of observed inequalities in forgone care. Results suggest attending to both the operation and financing of India’s health care system as well as the social determinants that make poor women more likely to forgo maternal health care.
AB - Understanding how well a health system is meeting the needs of the population is critical to achieving the policy aspirations of universal health coverage. This study focuses on assessing the inequity of forgone care for priority maternal and child health services across India. We utilize data from the 4th round of the Indian National Family Health Survey (NFHS-4) to examine inequality of forgone care. Our outcomes include forgone institutional delivery, antenatal care, medical care for a child with fever or cough, and medical care for a child with diarrhea. Wagstaff’s standardized concentration indices (CIs) are computed at the national level, over urban and rural sub-populations, and by state. Regression decomposition is performed to determine the influence of specific drivers on overall inequality. There was significant variation in the national-level prevalence and CIs for forgone antenatal care (17.8%, CI: −0.423), forgone medical care for a child with fever or cough (32.4%, CI: −0.199), forgone medical care for a child with diarrhea (33.8%, CI: −0.172), and forgone institutional delivery (24.5%, CI: −0.436). For all outcomes, forgone care is disproportionately concentrated among the poor, particularly in rural areas. There is also significant heterogeneity in state-level inequalities. Decomposition analyses show that socioeconomic status, maternal education, rural status, and state-level per capita health spending are the leading drivers of observed inequalities in forgone care. Results suggest attending to both the operation and financing of India’s health care system as well as the social determinants that make poor women more likely to forgo maternal health care.
KW - Forgone care
KW - India
KW - access
KW - inequity
KW - maternal child health
UR - http://www.scopus.com/inward/record.url?scp=85114000814&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85114000814&partnerID=8YFLogxK
U2 - 10.1080/23288604.2021.1894761
DO - 10.1080/23288604.2021.1894761
M3 - Article
C2 - 34464230
AN - SCOPUS:85114000814
SN - 2328-8604
VL - 7
JO - Health Systems and Reform
JF - Health Systems and Reform
IS - 2
M1 - e1894761
ER -