Use of hospital services and socio-economic status in urban India: Does health insurance ensure equitable outcomes?

In recent years universal health coverage has become an important issue in developing countries. Successful introduction of such a social security system requires knowledge of the relationship between socio-economic status and usage of health care services. This paper examines this relationship, and analyzes the impact of introducing health insurance into the model, using data for India, a major developing country with poor health outcomes. In contrast to similar works undertaken for developed countries, results of the instrumental variable model estimated reveals that the positive relation between usage of in-patient services and socio-economic status persists even in the presence of health insurance. This implies that insurance is unable to eliminate the inequities in accessing health care services stemming from disparities in socio-economic status. In fact, the presence of a double moral hazard and adverse selection leads to further attenuation of inequity in the health care market. The study is based on unit level data from the “Morbidity and Health Care Survey” undertaken by the National Sample Survey Organization (2005-06).