Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2011 Feb 5;377(9764):505-15.
doi: 10.1016/S0140-6736(10)61894-6. Epub 2011 Jan 10.

Health care and equity in India

Y Balarajan  1 , S Selvaraj, S V Subramanian
Affiliations

Health care and equity in India

Y Balarajan et al. Lancet. .

Abstract

In India, despite improvements in access to health care, inequalities are related to socioeconomic status, geography, and gender, and are compounded by high out-of-pocket expenditures, with more than three-quarters of the increasing financial burden of health care being met by households. Health-care expenditures exacerbate poverty, with about 39 million additional people falling into poverty every year as a result of such expenditures. We identify key challenges for the achievement of equity in service provision, and equity in financing and financial risk protection in India. These challenges include an imbalance in resource allocation, inadequate physical access to high-quality health services and human resources for health, high out-of-pocket health expenditures, inflation in health spending, and behavioural factors that affect the demand for appropriate health care. Use of equity metrics in monitoring, assessment, and strategic planning; investment in development of a rigorous knowledge base of health-systems research; development of a refined equity-focused process of deliberative decision making in health reform; and redefinition of the specific responsibilities and accountabilities of key actors are needed to try to achieve equity in health care in India. The implementation of these principles with strengthened public health and primary-care services will help to ensure a more equitable health care for India's population.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest: YB, SS, SVS declare no conflict of interest.

Figures

Figure 1
Figure 1
Inequalities in Under-5 Mortality along different dimensions in India
Figure 2
Figure 2
Association between Under-5 Mortality and State domestic product per capita (at factor cost at current prices)
Figure 3
Figure 3
Trends in inequalities in immunization coverage along different dimensions expressed in rate difference (absolute inequalities) and rate ratio (relative inequalities)
Figure 4
Figure 4
Conceptual model for understanding challenges to equity in health care
Figure 5
Figure 5
Trends in out-of-pocket health expenditures in households per episode, as a share of income by income group and residence
Figure 6
Figure 6
Impact of out-of-pocket payments (OOP) on poverty ratios in India
See this image and copyright information in PMC

Comment in

  • Universal health care in India: the time is right.
    Patel V, Kumar AK, Paul VK, Rao KD, Reddy KS. Patel V, et al. Lancet. 2011 Feb 5;377(9764):448-9. doi: 10.1016/S0140-6736(10)62044-2. Epub 2011 Jan 10. Lancet. 2011. PMID: 21227493 Free PMC article. No abstract available.
  • Towards a truly universal Indian health system.
    Sengupta A, Prasad V. Sengupta A, et al. Lancet. 2011 Feb 26;377(9767):702-3. doi: 10.1016/S0140-6736(10)62043-0. Epub 2011 Jan 10. Lancet. 2011. PMID: 21227495 No abstract available.

References

    1. World Health Organization. Information DoMaH, editor. Global burden of disease. 2009
    1. Srinath Reddy K, Shah B, Varghese C, Ramadoss A. Responding to the threat of chronic diseases in India. The Lancet. 2005;366(9498):1744–1749. - PubMed
    1. UNICEF. New York: Oxford University for UNICEF; 2009. The State of the World’s Children 2009: Maternal and Newborn Health Oxford.
    1. UNICEF. New York: United Nations Children's Fund; 2008. The State of the World’s Children 2008: Child Survival.
    1. World Health Organization. Geneva: World Health Organization; 2010. World health statistics.

Publication types

MeSH terms