Title : Distributional impact of public health spending on maternal health services in India: Who benefits from health care subsidies?
Abstract:
Equity in health and healthcare utilization is a fundamental objective of public policy globally. Achieving this equity requires that public health expenditure primarily benefits financially disadvantaged and marginalized populations. Ensuring that government spending on health services reaches these vulnerable groups is crucial for improving health outcomes and reducing disparities. As such, understanding how public health financing is distributed among different socio-economic groups is essential. This study focuses on analysing the utilization patterns and benefit incidence of public subsidies on various maternal health services, including pre-natal care, delivery care and post-natal care, across different socio-economic groups in India. The Benefit Incidence Analysis (BIA) method is employed to assess how equitably these public subsidies are distributed. The analysis relies on data from the 75th round of the National Sample Survey (NSS) on household social consumption related to health, providing a comprehensive snapshot of health service utilization in India. The findings reveal that the distribution of public health benefits in maternal health services is skewed in favour of wealthier individuals. Both utilization rates and the benefit distribution for pre-natal, delivery and post-natal care are pro-rich, indicating that economically advantaged groups are more likely to access and benefit from publicly subsidized health services. This inequity is particularly pronounced in higher-level healthcare facilities, where the distribution of subsidies is more heavily skewed toward wealthier groups. However, the distribution of benefits is slightly more even in lower-level healthcare facilities, where access is more accessible to economically disadvantaged populations. A key finding of the study is the disparity between urban and rural areas. The highest public subsidies for maternal health services are enjoyed by the urban population, where both the utilization rates and the distribution of benefits are more equitable. In contrast, rural areas exhibit greater disparities, with poorer women receiving less public health support. This urban-rural divide underscores the challenges of delivering equitable healthcare across different geographic and socio-economic contexts. Additionally, the study examines the distribution of public subsidies by social group, revealing significant inequalities. Women from the General category receive the highest share of benefits from public subsidies, while women from the Scheduled Tribes (ST) receive the least. This social disparity reflects the broader structural inequities within Indian society, where historically marginalized groups continue to face barriers to accessing essential healthcare services.
