Three Essays on Health Economics

Dinkar Kuchibhotla

This dissertation consists of three papers analyzing inequality and inequity in health and hospital care along with identification of drivers of inequality and inequity among the elderly in India. The first paper analyzes inequality in health among a growing yet under-researched segment of the population, the elderly. Our interest in this group is underscored by fast paced economic change that has accompanied the break up of traditional family structures, which have provided care for the elderly. Using data gathered from a nationally representative household survey we measure inequality using two measures of health—self-assessed health (current) and self-assessed health (relative to last year). However, data on self-assessed health are prone to various biases. After statistically controlling for bias arising from several sources we find no significant evidence of inequality in health among this cohort. The second paper extends the work done in the first paper to the domain of hospital care to look not just at inequality but also inequity in inpatient hospital usage. Inequality in any distribution of health care is likely to exist but not all of it can be justified or deemed illegitimate. We find evidence of pro-rich horizontal inequity in hospital care usage after accounting for need for such care with the help of an extensive set of health indicators. In addition to measuring inequity we also identify factors driving inequity. We find that inequity is mostly driven by socioeconomic status as measured by monthly per capita household expenditure. The third paper further extends the second paper to examine vertical equity in hospital usage. Research on equity issues in health care has largely been confined to the horizontal dimension on the assumption that vertical equity norm is met on average; however making such an assumption implies the risk of underestimating overall inequity especially under a tight resource constraint. We explore vertical equity assuming that the use-need relationship is appropriate in the richest half and among the non-tribal group of the population. Overall, we find evidence of vertical equity.

Three Essays on Health Economics

Files and links (1)

Abstract

Metrics

Details