Health Expenditure Benefit Incidence: WHO International Classification of Diseases-wise Analysis of India

Chakraborty, Lekha S and Bhadra, Kaushik and Arora, Rashmi (2025): Health Expenditure Benefit Incidence: WHO International Classification of Diseases-wise Analysis of India.

Abstract

‘Fiscal policies and inequality’ is an elusive area of research. This study examines disease-wise utilisation of publicly subsidised healthcare in India using benefit incidence analysis. Quite contrary to the earlier studies on benefit incidence analysis based on aggregate public health spending, our study attempts the benefit capture by mapping the classification of diseases extracted from the unit record data of the latest 75th National Sample Survey health rounds with the latest International Classification of Diseases (ICD)-11 of version 2024 produced by World Health Organisation (WHO). Our broad findings based on the WHO_ICD disease- specific benefit incidence analysis revealed that the public health subsidy appears to be pro- poor or progressive in distribution for WHO_ICD categories, however with evident gender differentials. The disaggregated benefit incidence analysis based on ICD also showed that there is no “elite capture” in the public health financing in India. This inference has policy implications for strengthening the role of fiscal policy in further ensuing equality and social justice in access and utilisation of health care in India.

• Item Type: MPRA Paper
• Language: English
• Keywords: concentration curve; public healthcare; health inequality; benefit incidence analysis; gender
• Subjects: H - Public Economics > H7 - State and Local Government ; Intergovernmental Relations > H75 - State and Local Government: Health ; Education ; Welfare ; Public Pensions; I - Health, Education, and Welfare > I1 - Health > I14 - Health and Inequality; I - Health, Education, and Welfare > I1 - Health > I15 - Health and Economic Development

References

Arrow, K.J. (1963). 'Uncertainty and the Welfare Economics of Medical Care', The American Economic Review, 53(5): 941-973.

Banerjee, A., A. Deaton, & E. Duflo (2004). ‘Health Care Delivery in Rural Rajasthan’,Economic and Political Weekly, 39(9): 944-949.

Barik D., & A. Thorat (2015). 'Issues of unequal access to public health in India', Front. Public Health, 3:245.

Bhadra, K. K. (2016). Inequality Effects of Fiscal Policy: Analysing the Benefit Incidence on Health Sector in India. W(orking Papers. id:8433, eSocialSciences.

Bose, M., & S. Banerjee (2019). ‘Equity in distribution of public subsidy for noncommunicable diseases among the elderly in India: an application of benefit incidence analysis’, BMC Public Health, 19(1): 1-12.

Bowser, D., B. Patenaude, M. Bhawalkar, D. Duran, & P. Berman (2019). 'Benefit incidence analysis in public health facilities in India: utilization and benefits at the national and state levels', International Journal for Equity in Health, 18:13.

Castro-Leal, F., J. Dayton, L. Demery, & K. Mehra (1999). ‘Public Social Spending in Africa: Do the Poor Benefit?’, The World Bank Research Observer, 14(1): 49-72.

Chakraborty, L.S., Y. Singh, & J.F. Jacob (2013). ‘Analyzing Public Expenditure Benefit Incidence in Health Care: Evidence from India’, Levy Economics Institute of Bard College Working Paper no. 748.

Chauhan, A.S., L. Guinness, P. Bahuguna, M.P. Singh, V. Aggarwal, K. Rajsekhar, S. Tripathi, and S. Prinja (2022). 'Cost of hospital services in India: a multi-site study to inform provider payment rates and Health Technology Assessment', BMC Health Services Research, 22(1):1343.

Costa-Font, J., & D. Parmar (2017). 'Political Agency and Public Health Care: Evidence from India', CESifo Working Paper 6640: August.

Davoodi, H. R., Tiongson, E. R., & Asawanuchit, S. S. (2010). Benefit Incidence of Public Education and Health Spending Worldwide: Evidence From A New Database. Poverty &Public Policy, 2(2), 5–52.

Davoodi, H.R., E.R. Tiongson, & S.S. Asawanuchit (2003). ‘How Useful Are Benefit Incidence Analysis of Public Education and Health Spending?’, IMF Working Paper 03/22733.

Demery, L. (2000). Benefit incidence: a practitioner’s guide. Poverty and Social Development.Group,. The World Bank (mimeo), Washington, DC: World Bank.

Essama-Nssah, B. (2008). 'Assessing the Redistributive Effect of Fiscal Policy', Policy Research Working Paper 4592: The World Bank.

Filmer, & Lant, H. P. (1998). Estimating Wealth Effects without Expenditure Data-or Tears: An Application to Educational Enrolments in States of India Deon. Demography, 38(1), Published By: Duke University Press, 115-132.

Filmer, D., J. Hammer, & L. Pritchett (1998). ‘Health Policy in Poor Countries: Weak Links in the Chain’, Policy Research Working Paper no. 1874, The World Bank.

Gillespie, W. I. (1965). Effect of Public Expenditures on the Distribution of Income. In R. (Ed.), Essays in Fiscal Federalism. Washington, DC: The Brookings Institution.

Lanjouw, P., & Ravallion, M. (1994). Poverty and Household Size. (Policy Research . Working Paper Series 1332). Washington, DC: The World Bank.

Lanjouw, P., and M. Ravallion (1999). ‘Benefit Incidence, Public Spending Reforms, and the Timing of Program Capture’, World Bank Economic Review, 13(2): 257-273.

Li, G., Steele, D., & Glewe, P. (1999). Distribution of Government Education Expenditures in Developing Countries. Preliminary Estimates. Washington, DC: The World Bank.

Lustig, N. (2015). ‘The Redistributive Impact of Government Spending on Education and Health: Evidence from Thirteen Developing Countries in the Commitment to Equity Project’, CEQ Working Paper No. 30.

Mahal, A., J. Singh, F. Afridi, V. Lamba, A. Gumber, & V. Selvaraju (2000). ‘Who “Benefits” From Public Sector Health Spending In India? Results of a Benefit Incidence Analysis for India’, National Council of Applied Economic Research (NCAER), mimeo.

Manasan, R. G., Cuenca, J. S., & Villanueva, C. (2007). Benefit Incidence of Public Spending on Education in the Philippines. . (Discussion Paper series no. 2007-09). Philippine Institute for Development Studies.

McIntyre, D., & J.E. Ataguba. (2011). 'How to do (or not to do) . . . a benefit incidence analysis', Health Policy and Planning, 26:174-182.

Mohanty, S.K., R.S. Mishra, S. Mishra, & S. Sen (2020). 'Understanding equity of institutional delivery in public health centre in India: An assessment using Benefit Incidence Analysis', Research Square (Research Square).

Mohapatra, A. (2019). 'Faith or Rationality - what dominates the health scenario? - Reflections from a non-governmental organization based health center in a tribal area of rural Maharashtra', Journal of Education and Health Promotion, 8: 100.

O’Donnell, O., E. van Doorslaer, A. Wagstaff, & M. Lindelow (2008). ‘Analyzing Health Equity Using Household Survey Data: A Guide to Techniques and Their Implementation’, WBI Learning Resources Series, The World Bank.

Sahn, D. E., & Younger, S. (2000). Expenditure Incidence in Africa: Microeconomic Evidence. Fiscal Studies,. Institute for Fiscal Studies, 21(3), 329-47.

Sahn, D.E., & S.D. Younger (2000). 'Dominance Testing of Social Sector Expenditures and Taxes in Africa', IMF Working Paper 99/172. Washington DC.

Samba, M., I. Thiam, & E. Paul (2024). 'Which socio-economic groups benefit most from public health expenditure in Senegal? A dynamic benefit incidence analysis', SSM - Population Health, 28:101714.

Sambodo, N.P., E.V. Doorslaer, M. Pradhan, & R. Sparrow (2021). 'Does geographic spending variation exacerbate healthcare benefit inequality? A benefit incidence analysis for Indonesia', Health Policy and Planning, 36: 1129-1139.

Selden, T., & Wasylenko, M. (1992, June 17-19). Measuring the Distributional Effects of Public Education in Peru. (Paper prepared for the World Bank Conference on Public Expenditure and the Poor: Incidence and Targeting) Washington, DC.

Sen, G. (2010). ‘Equity and Health-Care in the Era of Reforms’, The Fourth Krishna Raj Memorial Lecture, Mumbai, April 9.

Sheikh, N., M. Sultana, A.R. Sarker, & A. Morton (2023). 'Equity assessment of maternal and child healthcare benefits utilization and distribution in public healthcare facilities in Bangladesh: a benefit incidence analysis', Population Health Metrics, 21:12.

Tiebout, C.M. (1956). 'A Pure Theory of Local Expenditures', The Journal of Political Economy, 64(5): 416-424.

Yan, C., X. Fu, X. Liu, Y. Zhang, Y. Gao, J. Wu, & Q. Li (2022). 'A survey of automated International Classification of Diseases coding: development, challenges, and applications', Intelligent Medicine, 2(3): 161-173.

Younger, S. (2002). Public Social Sector Expenditures and Poverty in Peru. In C. Morrisson (Ed.), Education and Health Expenditure, and Development: The Cases of Indonesia and Peru. Paris, France: Organization for Economic Co-operation and Development.

Younger, S. D. (2003). ‘Benefits on the Margin: Observations on Marginal Benefit Incidence Analysis’, World Bank Economic Review, 17(1): 89-106.

Yu, Z., L. Wang, & T. Ariyo (2021). ‘Supply and Demand-Related Decisive Factors in the Utilization of Non-Medical Community Healthcare Services among Elderly Chinese’, International Journal of Environmental Research and Public Health, 18(1): 228.