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Did the poor gain from India’s health policy interventions?

The study has been authored by Sakthivel Selvaraj and others.
National Health Mission (NHM) committed to broader expansion of health care services, a singular focus on maternal and child health conditions especially in backward regions of the country.(AFP)
Published on Jul 24, 2021 02:55 PM IST
ByPublic Health Foundation of India

This article examines whether health policy interventions and accelerated health investments in India during 2004-2018 could close the gap in inequity in health care utilisation and access to public subsidy by different population groups. Did the poor and socio-economically vulnerable population gain from such government initiatives, compared to the rich and affluent sections of society? And whether the intended objective of improving equity between different regions of the country been achieved during the policy initiatives? This article attempts to assess and provide robust evidence in the Indian context.

Employing Benefit-Incidence Analysis (BIA) framework, this paper advances earlier evidence by highlighting estimates of health care utilisation, concentration and government subsidy by broader provider categories (public versus private) and across service levels (outpatient, inpatient, maternal, pre-and post-natal services). We used two waves of household surveys conducted by the National Sample Survey Organisation (NSSO) on health and morbidity. The period of analysis was chosen to represent policy interventions spanning 2004 (pre-policy) and 2018 (post-policy era). We present this evidence across three categories of Indian states, namely, high-focus states, high-focus Northeastern states and non-focus states. Such categorisation facilitates quantification of reform impact of policy level interventions across the three groups.

Utilisation of health care services, except outpatient care visits, accelerated significantly in 2018 from 2004. The difference in utilisation rates between poor and rich (between poorest 20% and richest 20%) had declined significantly during the same period. Pre-natal, institutional delivery and post-natal services in government facilities were found to be pro-poor both in 2004 and 2018 in all three groups of states. The distribution of public subsidy underscoring curative services (inpatient and outpatient) remained pro-rich in 2004 but turned less pro-rich in 2018, In respect to post-natal care, similar results were observed, implying the subsidy on pre-natal and post-natal services was overwhelmingly received by poor, although subsidies underlying institutional delivery did not show pro-poor evidence.


Improvement in infrastructure and service provisioning through the National Health Mission (NHM) route in the public facilities appears to have benefited the poor. Yet they received a relatively smaller health subsidy than the rich when utilising inpatient and outpatient health services. Inequality continues to persist across all healthcare services in private health sector. Although the NHM remained committed to broader expansion of health care services, a singular focus on maternal and child health conditions especially in backward regions of the country has yielded desired results.

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(The study has been authored by Sakthivel Selvaraj and others)

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