title: Inequality and inequity in healthcare utilization in urban Nepal: a cross-sectional observational study.
abstract: Inequality in access to quality healthcare is a major health policy challenge in many low- and middle-income countries. This study aimed to identify the major sources of inequity in healthcare utilization using a population-based household survey from urban Nepal. A cross-sectional survey was conducted covering 9177 individuals residing in 1997 households in five municipalities of Kathmandu valley between 2011 and 2012. The concentration index was calculated and a decomposition method was used to measure inequality in healthcare utilization, along with a horizontal inequity index (HI) to estimate socioeconomic inequalities in healthcare utilization. Results showed a significant pro-rich distribution of general healthcare utilization in all service providers (Concentration Index: 0.062, P < 0.001; HI: 0.029, P < 0.05) and private service providers (Concentration Index: 0.070, P < 0.001; HI: 0.030, P < 0.05). The pro-rich distribution of probability in general healthcare utilization was attributable to inequalities in the level of household economic status (percentage contribution: 67.8%) and in the self-reported prevalence of non-communicable diseases such as hypertension (36.7%) and diabetes (14.4%). Despite the provision of free services by public healthcare providers, our analysis found no evidence of the poor making more use of public health services (Concentration Index: 0.041, P = 0.094). Interventions to reduce the household economic burden of major illnesses, coupled with improvement in the management of public health facilities, warrant further attention by policy-makers.
authors: Graduate School of Medicine, The University of Tokyo, Tokyo, Japan, saito.eiko@gmail.com.
authors: Eiko
authors: E
authors: Saito
authors: Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors: Stuart
authors: S
authors: Gilmour
authors: Department of Statistical Science, School of Advanced Sciences, The Graduate University for Advanced Studies, Tokyo, Japan.
authors: Daisuke
authors: D
authors: Yoneoka
authors: Deutsche Gesellschaft fuer Internationale Zusammenarbeit (GIZ) GmbH, Kathmandu, Nepal and.
authors: Ghan Shyam
authors: GS
authors: Gautam
authors: Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors: Md Mizanur
authors: MM
authors: Rahman
authors: Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
authors: Pradeep Krishna
authors: PK
authors: Shrestha
authors: Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors: Kenji
authors: K
authors: Shibuya
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009390:Nepal; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011203:Poverty / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors
keywords: : Health economics; health care utilization; health inequalities