Health and Morbidity in India (2004-2014)

Abstract

In this study, we use National Sample Survey (NSS) data from surveys conducted by the Government of India. These are recall-based household surveys on multiple topics, including healthcare and consumer expenditure. More specifically, we use the 60th and 71st rounds of the NSS which included a questionnaire focused on healthcare, with questions on morbidity and the consumption of healthcare for all individuals within the surveyed households. Over the 10 years, the similarity of information collected in the two rounds of the surveys, gives us an opportunity to make scientific comparisons to understand the big changes in health and morbidity outcomes for Indian households. Our main results for health-seeking behaviour show that households still overwhelmingly depend on private providers for healthcare services. While as much as 75 per cent of out-patient care is exclusively private, 55 per cent of in-patient care is from private hospitals in India. This dependence, however, is declining and more significantly so for in-patient care. Indian households’ dependence on public care has risen by 6 per cent for out-patient care and by 7 per cent for in-patient care. Most of these increases are driven by rural women seeking more public healthcare, over last 10 years. More precisely, our analysis of the data shows that the Janani Suraksha Yojana incentives led to a significant increase of 15 per cent in institutional childbirth in India with a commensurate decline in deliveries at home. The disaggregated data also shows that there was a large increase of 22 per cent in deliveries in government hospitals, which was mirrored by an 8 per cent decline in childbirth at private hospitals and a 16 per cent decline in childbirth at home. Given that the fundamental objective of the JSY was to raise institutional deliveries, the NSSO data shows that the scheme performed well over the 10 years. At the same time, it is important to note that our analysis points to the increase in public hospitalisation being incentive driven, which does not allow us to draw an inference about either the quality of services provided or the sustainability of the increase.