Relinquishing Healthcare: A Conscious Choice or an Unconscious Legacy of Inequality in India?

Introduction

Just as there are inequalities in resources in every nation on earth, so too are the striking differentials in health status. This disparity among classes is also reflected in healthcare-seeking behaviours, rather, further confounded by failing public healthcare apparatus and missing social security mechanisms. India, characterized by intangible spending on public healthcare has rendered increased reliance on expensive private healthcare providers. Forgoing necessary treatment is often an extreme coping strategy adopted by poor and marginalized households due to inability to finance humongous Out-of-pocket spending on healthcare. On the contrary, it is also conjectured that relinquished healthcare is a conscious choice due to less severity of illness condition which does not register a systematic socio-economic pattern. This paper contributes to the thin literature in this domain by studying alternative strands and dissecting patterns of forgone care across economic and social gradient.

Data & Methods

Results are drawn from nationally-representative unit level records of morbidity surveys provided by National Sample Survey Office (large data sets) for two decades, viz., 1994 to 2014 using cross-tabulations, binary logistic regression model, Concentration indices and Wagstaff & Doorslaer inequality-decomposition technique.

Results

Estimates show higher forgone care among deprived socio-economic classes, clearly highlighting the greater role of non-need factors like income, rural residence and lower social group/ethnic group like Scheduled Tribes and Scheduled Castes, in explaining a substantial proportion of the prevailing inequality in relinquishing healthcare while need-factors, viz., age, sex and chronic nature of the ailment, explains less than one-fourth of the total disparity in health-seeking behaviour.

Conclusion & Policy Implications

Policies aiming to reduce average inferior health can be different from those targeting at lowering socioeconomic inequality in bad health. In the present context, most of the forgone care inequality is socioeconomic and not need-based per se, which implies that an apt public policy may not be confined to better provisioning of public healthcare but also needs to address the underlying economic and demographic inequalities on which healthcare disparities flourish.