A study published in MoSPI publication Sarvekshana (April 2026), based on National Sample Survey (NSS) data, tracks the evolution of inpatient care access in India between 1995–96 and 2017–18, revealing both expanded access and a significant decline in inequality.
National hospitalization rates increased from 16 to 28 per 1,000 persons, with gains observed in both rural (14 to 26)and urban (21 to 34) areas. Over the same period, disparities across gender and education levels narrowed, indicating a more inclusive health system.
The most notable shift is the reduction in wealth-based inequality. The concentration index fell sharply, from 0.38 to 0.19 in rural areas and from 0.19 to 0.05 in urban areas, suggesting that access to inpatient care is no longer as strongly tied to income as it was in the mid-1990s.
Decomposition analysis shows that 63.6% of the improvement is driven by systemic factors, including policy interventions, insurance expansion, and infrastructure growth, rather than changes in population characteristics. This points to the role of sustained public policy in expanding access.
However, the study also highlights persistent gaps, particularly in infrastructure-constrained states, where inequality remains higher. Additionally, uninsured individuals continue to face lower access to care, indicating that financial protection remains uneven.
Key Statistical and Inequality Benchmarks
National Hospitalization Rate: Rose from 16 per 1000 (1995) to 28 per 1000 (2018).
Rural Concentration Index: Dropped from 0.38 to 0.19 (indicating halved inequality).
Urban Concentration Index: Dropped from 0.19 to 0.05 (nearing near-equitable access).
Policy Impact: 63.6% of the increase in access is attributed to systemic and policy-driven factors.
Vulnerable Groups: Hospitalization is highest among the 60+ age group, reflecting India's demographic transition.
Insurance Factor: Uninsured individuals in 2017-18 had significantly lower odds of accessing care compared to the insured.
What is a "Concentration Index" in Health Economics?
A concentration index is a statistical tool used to measure the degree of inequality in a health variable (like hospitalization) relative to a socioeconomic variable (like wealth). It ranges from -1 to 1.
A value of 0 means the health service is distributed equally across all income groups. A positive value (like India’s 0.38 in 1995) means the service is "pro-rich," occurring more frequently among the wealthy. The drop toward zero in this study signifies that India's healthcare system has successfully moved from being an exclusive service for the affluent to a more inclusive public good.
Policy Relevance
Validates Long-Term Health Policy Gains: Confirms impact of schemes like NRHM and insurance expansionin improving access.
Shifts Focus from Income to Systems: Inequality now driven less by wealth, more by infrastructure and service availability.
Highlights Regional Disparities: EAG and low-capacity states require targeted health system strengthening.
Reinforces Need for Universal Coverage: Persistent gaps for the uninsured underscore need to expand PM-JAY and cover the “missing middle.”
Signals Transition to Demand-Led Care: Rising hospitalization reflects improved health-seeking behaviour and awareness.
Points to Next-Generation Reforms: Future gains depend on quality, proximity, and service delivery, not just access expansion.
Follow the Full Paper Here (Page 1 to 21): MoSPI - Sarvekshana Journal Issue 120