Unmasking inequility: socio-economic determinants and gender disparities in Maharashtra and India's health outcomes -- Insights from NFHS-5

Abstract

This research examines the persistent challenge of health inequalities in India, departing from the conventional focus on aggregate improvements in mortality rates. While India has achieved progress in overall health indicators since independence, the distribution of health outcomes remains uneven, a fact starkly highlighted by the COVID-19 pandemic. This study investigates the socio-economic determinants of health disparities using the National Family and Health Survey (NFHS)-5 data from 2019-20, focusing on both national and state-level analyses, specifically for Maharashtra. Employing a health economics framework, the analysis delves into individual-level data, population shares, self-reported morbidity prevalence, and treatment patterns across diverse socio-economic groups. Regression analyses, stratified by gender, are conducted to quantify the impact of socio-economic factors on reported morbidity. Furthermore, a Fairlie decomposition, an extension of the Oaxaca decomposition, is utilised to dissect the gender gap in morbidity, assessing the extent to which observed differences are attributable to explanatory variables. The findings reveal a significant burden of self-reported morbidity, with approximately one in nine individuals in India and one in eight in Maharashtra reporting morbidity. Notably, women exhibit nearly double the morbidity rate compared to men. The decomposition analysis identifies key drivers of gender disparities. In India, marital status exacerbates these differences, while insurance coverage, caste, urban residence, and wealth mitigate them. In Maharashtra, urban residence and marital status widen the gap, whereas religion, caste, and insurance coverage narrow it. This research underscores the importance of targeted policy interventions to address the complex interplay of socio-economic factors driving health inequalities in India.