This study aims at analyzing the differentials across rich and poor states and across rich and poorer strata and rural urban segments of 19 major Indian states. The study indicates that besides individual health financing policies of the respective state governments, there are significant disparities even between rural and urban strata and rich and poorer sections of the society. These are indicated by high inequality coefficients and an emerging pattern of life style second generation health problems as well as levels of utilization of both preventive and curative care both in public and private sectors. Our results emphasise that there is a need to increase public expenditure on health, improve efficiency in utilization of existing public facilities, and popularize government run health insurance schemes meant primarily for the poor. These steps may help to mitigate partly the inequitable outcomes. 1. Introduction There has been a general concern for disparity across rural and urban areas particularly pertaining to human development. This is despite the persistent policies of investing more in rural health infrastructure and an orientation of health policies which remain rural focused in India. It is pertinent to explore the issue that why this outcome of adverse indicators of human development for rural areas has emerged as a prominent outcome of planned effort and to suggest remedy for this disparity. The objective of this paper is to analyse this disparity in terms of human development and health outcomes across major Indian states with a view to suggest suitable policy modifications to overcome the disparity between rural and urban areas in regard to these aspects. Unlike other studies our focus is to link the health and human development aspects using information from household level surveys. Instead of analyzing state level differentials alone the study contributes in understanding the causes of this disparity between rural and urban areas both in poorer and richer states of India and suggests policy imperatives to overcome this outcome. 2. Methodology In this paper we compare human development and health outcomes across major Indian states. First we explain here the basic framework for our analysis and data base. Our focus in this paper is more on health and human development perspective1. To develop empirically testable hypotheses, a model of the demand for health defined in terms of different indicators of mortality and diseases is specified. Since life expectancy at birth is an important component of human development and it depends
References
[1]
WHO/UNICEF, Meeting the Millennium Development Goals DrinkingWater and Sanitation Targets: A Mid-Term Assessment of Progress, NewYork, NY, USA, 2004.
[2]
W. Flores, “Governance and health in an urban setting: key factors and challenges for latin American cities,” in Democratic Governance and Urban Sustainability, J. S. Tulchin, D. H. Varat, and B.A. Ruble, Eds., pp. 89–96, Woodrow Wilson International Center for Scholars, Washington, DC, USA, 2000.
[3]
R. Bitrán, U. Giedion, R. Valenzuela, and P. Monkkonen, La Problemática de Salud de las Poblaciones Urbanas Pobres en América Latina, World Bank, Washington, DC, USA, 2003.
[4]
N. Gouveia and T. Fletcher, “Respiratory diseases in children and outdoor air pollution in Sao Paulo, Brazil: a time series analysis,” Occupational and Environmental Medicine, vol. 57, no. 7, pp. 477–483, 2000.
[5]
L. Pritchett and L. H. Summers, “Wealthier is healthier,” Journal of Human Resources, vol. 31, no. 4, pp. 841–868, 1996.
[6]
WHO, “The role of health centres in the development of urban health systems,” Report of the WHO Study Group on Primary Health Care in Urban Areas, Geneva, Switzerland, 1992.
[7]
I. Kawachi and B. P. Kennedy, “Socio-economic determinants of health: why care about income inequality?” British Medical Journal, vol. 314, pp. 917–921, 1997.
[8]
R. Bazzani, Health and Habitat, International Development Research Center, Ottawa, Canada, 1995.
[9]
Brijesh C. Purohit, Health Care System in India, Gayatri, New Delhi, India, 2010.
[10]
A. Tandon and C. Cashin, Assessing Public Expenditure on Health from a Fiscal Space Perspective, Health, Nutrition and Population (HNP) Discussion Paper, World Bank, Washington, DC, USA, 2010.
GoI, High Level Expert Group Report on Universal Health Coverage for India, submitted to the Planning Commission, Government of India, New Delhi, India, 2011, http://planningcommission.nic.in/reports/genrep/rep_uhc0812.pdf.
[13]
GOI, National Commission on Macroeconomics and Health Ministry of Health & Family Welfare, Government of India, New Delhi, India, 2005.
[14]
International Institute for Population Sciences (IIPS) and Macro International, “National Family Health Survey (NFHS-3), India, 2005-06,” State Level Reports, IIPS, Mumbai, India, 2008.
[15]
A. Jan Paul, “Demand for health care among the urban poor, with special emphasis on the role of time,” The Rand Corporation R-1151-0EO/NYC, 1973.
[16]
RBI, State Finances: A Study Of Budgets of 2010-11, Mumbai, India, 2011.
[17]
M. Grossman, “On the concept of health capital and the demand for health,” Journal of Political Economy, vol. 80, pp. 223–255, 1972.
[18]
G. S. Becker, Human Capital, Columbia University Press for the National Bureau of Economic Research, New York, NY, USA, 1964.
[19]
G. S. Becker, Human Capital and the Personal Distribution of Income: An Analytical Approach, University of Michigan, Ann Arbor, Mich, USA, 1967.
[20]
Y. Ben-Porath, “The production of human capital and the life cycle of earnings,” Journal of Political Economy, vol. 75, pp. 353–367, 1967.
[21]
J. Mincer, Schooling, Experience, and Earnings, Columbia University Press for the National Bureau of Economic Research, New York, NY, USA, 1974.
[22]
G. S. Becker, “A theory of the allocation of time,” Economic Journal, vol. 75, pp. 493–517, 1965.
[23]
K. J. Lancaster, “A new approach to consumer theory,” Journal of Political Economy, vol. 74, no. 96, pp. 32–157, 1966.
[24]
R.T. Michael, “Education in non-market production,” Journal of Political Economy, vol. 81, pp. 306–327, 1973.
[25]
D. Filmer, J. Hammer, and L. Pritchett, “Health policy in poor countries: weak links in the chain,” Policy Research Working Paper 1874, World Bank, Washington, DC, USA, 1997.
