Healthcare inequity arising from unequal response to need in the older (45+ years) population of India: Analysis of nationally representative data

Simple item page
dc.contributor.authorMohanty, Sanjay K.en
dc.contributor.authorKhan, Junaiden
dc.contributor.authorMaiti, Surajen
dc.contributor.authorKämpfen, Fabriceen
dc.contributor.authorMaurer, Jürgenen
dc.contributor.authorO'Donnell, Owenen
dc.date.accessioned2025-02-20T20:22:54Zen
dc.date.available2025-02-20T20:22:54Zen
dc.date.issued2024-11-20en
dc.description.abstractGiven the large and growing number of older (45+ years) people in India, inequitable access to healthcare in this population would slow global progress toward universal health coverage. We used a 2017-18 nationally representative sample of this population (n = 53,687) to estimate healthcare inequality and inequity by economic status. We used an extensive battery of indicators in nine health domains, plus age and sex, to adjust for need. We measured economic status by monthly per capita consumption expenditure and used a concentration index to measure inequalities in probabilities of any doctor visit and any hospitalisation within 12 months. We decomposed inequality with a regression method that allowed for economic and urban/rural heterogeneity in partial associations between healthcare and both need and non-need covariates. We used the associations achieved by the richest fifth of urban dwellers to predict a need-justified distribution of healthcare and compared the actual distribution with that benchmark to identify inequity. We found pro-rich inequalities in doctor visits and hospitalisations, which were driven by use of private healthcare. Adjustment for the greater need of poorer individuals revealed pro-rich inequity that exceeded inequality by about 65% and 39% for doctor visits and hospitalisations, respectively. These adjustments would have been substantially smaller, and inequity underestimated, without allowing for use-need heterogeneity, which accounted for 11% of the inequity in doctor visits and was 373% of inequity in hospitalisations. Targeting service coverage on poorer and rural groups, and increasing their access to private providers, would both reduce inequity and raise average coverage in the older population of India.en
dc.description.versionPublished versionen
dc.format.mimetypeapplication/pdfen
dc.identifier117535 (Article number)en
dc.identifier.doihttps://doi.org/10.1016/j.socscimed.2024.117535en
dc.identifier.eissn1873-5347en
dc.identifier.issn0277-9536en
dc.identifier.orcidMaiti, Suraj [0000-0001-5441-1399]en
dc.identifier.otherS0277-9536(24)00989-4 (PII)en
dc.identifier.pmid39615099en
dc.identifier.urihttps://hdl.handle.net/10919/124671en
dc.identifier.volume364en
dc.language.isoenen
dc.publisherElsevieren
dc.relation.urihttps://www.ncbi.nlm.nih.gov/pubmed/39615099en
dc.rightsCreative Commons Attribution 4.0 Internationalen
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en
dc.subjectAgeingen
dc.subjectDecompositionen
dc.subjectHealthcare utilisationen
dc.subjectInequalityen
dc.subjectUniversal health coverageen
dc.subject.meshHumansen
dc.subject.meshHospitalizationen
dc.subject.meshSocioeconomic Factorsen
dc.subject.meshAgeden
dc.subject.meshAged, 80 and overen
dc.subject.meshMiddle Ageden
dc.subject.meshRural Populationen
dc.subject.meshHealth Services Needs and Demanden
dc.subject.meshHealth Services Accessibilityen
dc.subject.meshIndiaen
dc.subject.meshFemaleen
dc.subject.meshMaleen
dc.subject.meshHealthcare Disparitiesen
dc.titleHealthcare inequity arising from unequal response to need in the older (45+ years) population of India: Analysis of nationally representative dataen
dc.title.serialSocial Science and Medicineen
dc.typeArticle - Refereeden
dc.type.dcmitypeTexten
dc.type.otherJournal Articleen
dcterms.dateAccepted2024-11-19en
pubs.organisational-groupVirginia Techen
pubs.organisational-groupVirginia Tech/Scienceen
pubs.organisational-groupVirginia Tech/Science/Economicsen
pubs.organisational-groupVirginia Tech/Graduate studentsen
pubs.organisational-groupVirginia Tech/Graduate students/Doctoral studentsen

Files

Original bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
1-s2.0-S0277953624009894-main.pdf
Size:
514.89 KB
Format:
Adobe Portable Document Format
Description:
Published version
Download
License bundle
Now showing 1 - 1 of 1
Name:
license.txt
Size:
1.5 KB
Format:
Plain Text
Description:
Download

Collections

Graduate Student Papers