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Health care and equity in India

Open access
Balarajan, Y, Selvaraj, S, Subramanian, SV·2011·The Lancet
DOI 10.1016/s0140-6736(10)61894-6
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Abstract

India’s health system faces the ongoing challenge of responding to the needs of the most disadvantaged members of Indian society. Despite progress in improving access to health care, inequalities by socioeconomic status, geography and gender continue to persist. This is compounded by high out-of-pocket expenditures, with the rising financial burden of health care falling overwhelming on private households, which account for more than three-quarter of health spending in India. Health expenditures are responsible for more than half of Indian households falling into poverty; the impact of this has been increasing pushing around 39 million Indians into poverty each year. In this paper, we identify key challenges to equity in service delivery, and equity in financing and financial risk protection in India. These include imbalanced resource allocation, limited physical access to quality health services and inadequate human resources for health; high out-of-pocket health expenditures, health spending inflation, and behavioral factors that affect the demand for appropriate health care. Complementing other paper in this Series, we argue for the application of certain principles in the pursuit of equity in health care in India. These are the adoption of equity metrics in monitoring, evaluation and strategic planning, investment in developing a rigorous knowledge-base of health systems research; development of more equity-focused process of deliberative decision-making in health reform, and redefinition of the specific responsibilities and accountabilities of key actors. The implementation of these principles, together with strengthening of public health and primary care services, provide an approach for ensuring more equitable health care for India’s population.

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Metadata

Authors
Balarajan, Y., Selvaraj, S., & Subramanian, S.
Venue
The Lancet
Publisher
Elsevier BV
Published
2011-02
Volume
377
Issue
9764
Pages
505-515
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
DOI
10.1016/s0140-6736(10)61894-6
OpenAlex
W2152846959
Cited by
1,026
References
3
FWCI
87.81
Type
journal article
Language
en
Open access
green
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)

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Balarajan, Y., Selvaraj, S., & Subramanian, S. (2011). Health care and equity in India. The Lancet. https://doi.org/10.1016/s0140-6736(10)61894-6

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