The socioeconomic inequity in healthcare utilization among individuals with cardiovascular diseases in India

We assess the effects of socioeconomic inequity on healthcare utilization among individuals with cardiovascular diseases (CVDs) in India using the indirect standardization method with Erreygers' corrected concentration index. We analyze both horizontal and vertical inequities and linearly decompose the respective inequities to identify the major factors driving both kinds of inequities. Our findings show that actual healthcare utilization is highly concentrated among rich CVD individuals. After controlling for the confounding effects of health needs, horizontal inequity is found to be significantly pro-rich, and income and urban concentration are found to be the major factors driving this inequity. However, the direction and magnitude of vertical inequity vary, depending on the selection of the target group. When we use healthcare utilization of the richest 20 percent as the target, we find no significant vertical inequity among CVD individuals. However, when we take the richest 10 percent as the target, we observe a significant pro-rich differential effect of health needs on healthcare utilization between all individuals and the target group. Decomposition reveals an inappropriate differential effect of health needs and age in driving vertical inequity. Hence, the presence of vertical inequity may trigger further pro-rich socioeconomic inequity in healthcare utilization if not supported by any targeted healthcare coverage.