Intersection of class, caste, gender and unmet healthcare needs in India: Implications for health policy

IF 1.7 Q3 HEALTH CARE SCIENCES & SERVICES
Sandhya R. Mahapatro , K.S. James , Udaya S. Mishra
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引用次数: 6

Abstract

Despite renewed policy priorities to universalise health coverage, unmet need for healthcare is long-standing concern in India. The recent data suggests the unmet healthcare need amounts to a notable share of twelve per cent. While studies have examined inequalities in healthcare utilisation in single axes of social power, there was no consensus on the role of the intersectionality between class, caste and gender in shaping the unmet health need. Utilising data from National Sample survey 75th round (2017–18), this paper identifies the factors contributing to such unmet need and investigate the intersectionality of class with caste and gender in determining unmet need. The contribution of socioeconomic factors was assessed by the decomposition method & multivariate logistic regression was used to measure inter and intra-class differentials in unmet need.

The analysis informs that class inequality is fundamental to having unmet need with limited role of gender and caste. Economic class however, interacting with caste and gender unfolds wider gaps in access to healthcare. While inter-class differences in unmet need are observed across caste as well as gender, intra-class differences intensify more by caste inequalities. The findings indicate the significance of the intersectional approach in identifying the sources of health inequity and special recognition to the income-poor and socially marginalised in policy agenda. Eliminating the barriers to health care access therefore needs a multidimensional construct of identifying combination of attributes to be focused towards realization of universal health coverage. These observations should aid in formulation and restructuring of the existing healthcare interventions to achieve equity in healthcare provision.

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印度阶级、种姓、性别和未满足的医疗保健需求的交集:对卫生政策的影响
尽管重新确定了全民健康覆盖的政策重点,但未满足的医疗保健需求是印度长期存在的问题。最近的数据表明,未满足的医疗保健需求占12%的显著份额。虽然研究调查了社会权力单一轴的医疗保健利用不平等现象,但对于阶级、种姓和性别之间的相互交织在形成未满足的医疗保健需求方面的作用,没有达成共识。本文利用全国抽样调查第75轮(2017-18)的数据,确定了导致这种未满足需求的因素,并调查了阶级、种姓和性别在确定未满足需求方面的交叉性。采用分解法评价社会经济因素的贡献;多元逻辑回归用于测量未满足需求的阶级间和阶级内差异。分析表明,阶级不平等是性别和种姓作用有限的需求未得到满足的根本原因。然而,经济阶层与种姓和性别的相互作用揭示了在获得医疗保健方面更大的差距。虽然在未满足需求方面存在不同种姓和性别的阶级间差异,但种姓不平等加剧了阶级内部差异。调查结果表明,交叉方法在查明卫生不平等的根源和在政策议程中特别承认收入贫穷和社会边缘化方面具有重要意义。因此,消除获得卫生保健的障碍需要一个多维结构,确定将重点放在实现全民健康覆盖的各种属性的组合。这些观察结果应有助于制定和调整现有的卫生保健干预措施,以实现卫生保健提供的公平性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Health Policy Open
Health Policy Open Medicine-Health Policy
CiteScore
3.80
自引率
0.00%
发文量
21
审稿时长
40 weeks
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