Determinants of Healthcare Expenditure in Eastern Uttar Pradesh, India: Through the lens of NSSO Data

  • Manokamana Ram Assistant Professor, Department of Economics, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
  • Ajay Kumar Research Assistant, Department of Economics, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
Keywords: Determinants, Healthcare, Expenditure, Eastern, Uttar Pradesh, NSSO


This study aims to examine the determinants of health-care expenditure in the Eastern region of Uttar Pradesh. Secondary data from the National Sample Survey Office (NSSO) of 75th round on social consumption related to health were utilized. The Heckman two-step selection model was used to analyse household and individual decisions to seek care. Findings of this study reveal that having household head aged between 31 to 60 and above 60 years, household size greater than 5 members, belonging to religion other than Hindu, non-ST category as Schedule caste, Other backward class and others, people residing in urban area, people having higher economic status, private hospitals, upper primary and secondary+ schooling of household head and having household members with chronic illnesses were determinants contributing more health-care spending. However, female household head had less likely to incur healthcare expenditure as compared to male household in the region. An important finding indicates that the majority of people visited private hospitals in the region which increased the health-care spending at large and it burdened financially to the vulnerable section of the society. Based on the discussion, a few policy suggestions have been proposed to counter the above problems.

How to cite this article:
Ram M, Kumar A. Determinants of Healthcare Expenditure in Eastern Uttar Pradesh, India: Through the lens of NSSO Data. J Commun Dis. 2021;53(3):118-126.



Aday LA, Andersen RM. A framework for the study of access to medical care. Health Serv Res. Fall

;9(3):208-20. [PubMed] [Google Scholar]

Jerome A, Tarani C, Micheal M. Socio-economic status and health: causality and pathways. J Econom.

;112(1):57. [Google Scholar]

Kasthuri A. Challenges to healthcare in India - The five A’s. Indian J Community Med 2018;43:141-3. [Google


Azzani M, Roslani AC, Su TT. Determinants of household catastrophic health expenditure: a systematic review.

Malays J Med Sci. 2019 Jan;26(1):15-43. [PubMed] [Google Scholar]

Bel G, Esteve M. Is private production of hospital services cheaper than public production? A metaregression

of public vs. private costs and efficiency for hospitals. Int. Public Manag. J. 2019. [Google Scholar]

Aregbeshola BS, Khan SM. Out-of-pocket health-care spending and its determinants among households in

Nigeria: a national study. J. Public Health. 2021;29:931-42. [Google Scholar]

Verma CS, Usmani G. Relationship between health and economic growth in India. IJHD. 2019.

Census of India. Report on post enumeration survey. Office of the Registrar General and Census, Ministry

of Home Affairs, Government of India. 2011.

Cissé B, Luchini S, Moatti JP. Progressivity and horizontal equity in health care finance and delivery: what about

Africa? Health Policy. 2007 Jan;80(1):51-68. [PubMed][Google Scholar]

Cantarero D, Lago-Penas S. The determinants of health care expenditure in Spain: A reexamination.

XIV Encuentro De Economia Publica, 2007. [Google Scholar]

Bloom DE, Canning D. The health and wealth of nations. Science. 2000;287:1207-9.

Barik D, Desa S. Determinants of private healthcare utilisation and expenditure patterns in India. Munich

Personal RePEc Archive (MPRA). 2017. Available from: MPRA

Paper No. 77220.

Upadhyay VK, Upadhyay SP. Demographic features in districts of Eastern Uttar Pradesh. The Indian Journal

of Research Anvikshi, 2011.

Fan L, Habibov NN. Determinants of maternity health care utilization in Tajikistan: learning from a

national living standards survey. Health Place. 2009 Dec;15(4):952-60. [PubMed] [Google Scholar]

Government of India. Economic Survey 2018-19. Government of India, Ministry of Finance, Department

of Economic Affairs, Economic Division, New Delhi, India. 2019.

Grossman M. On the concept of health capital and the demand for health. J Polit Econ. 1972;8(2):223-55.

[Google Scholar]

Health Care in India. Current state and key Imperative. Review of National Health Policy, 2015. Available


Hjortsberg C. Why do the sick not utilise health care? The case of Zambia. Health Econ. 2003 Sep;12(9):755-

[PubMed] [Google Scholar]

Hotchkiss DR, Rous JJ, Karmacharya K, Sangraula P. Household health expenditures in Nepal: implications

for health care financing reform. Health Policy Plan. 1998 Dec;13(4):371-83. [PubMed] [Google Scholar]

Htet S, Fan V, Alam K, Mahal A. Financial risks from ill health in Myanmar: evidence and policy implications.

Asia Pac J Public Health. 2015 May;27(4):418-28. [PubMed] [Google Scholar]

Key indicators of social consumption in India: Health. Ministry of Statistics and Programme Implementation,

Government of India. November 2019.

Toor IA, Butt MS. Determinants of health care expenditure in Pakistan. Pak. Eco. Soc. Rev.

;43(1):133-50. [Google Scholar]

Smits J. Estimating the Heckman two-step procedure to control for selection bias with SPSS. 2003. Available


Khaing IK, Malik A, Oo M, Hamajima N. Health care expenditure of households in Magway,

Myanmar. Nagoya J Med Sci. 2015 Feb;77(1-2):203-12. [PubMed] [Google Scholar]

Khan HN, Razali RB, Shafie AB. Modelling determinants of health expenditures in Malaysia: evidence from

time series analysis. Front Pharmacol. 2016 Mar;7:69. [PubMed] [Google Scholar]

Kruse FM, Stadhouders NW, Adang EM, Groenewoud S, Jeurissen P. Do private hospitals outperform public

hospitals regarding efficiency, accessibility, and quality of care in the European Union? A literature review.

Int J Health Plann Manage. 2018 Apr;33(2):e434-53. [PubMed] [Google Scholar]

Kutzin J. Health financing policy: a guide for decisionmakers (Health Financing Policy Paper). World Health

Organization, Regional Office for Europe, Division of Country Health Systems, Copenhagen. 2008. Available

from: assets/pdf_file/0004/78871/E91422.pdf. Accessed 5 February

Mills A, Ataguba JE, Akazili J, Borghi J, Garshong B, Makawia S, Mtei G, Harris B, Macha J, Meheus F,

McIntyre D. Equity in financing and use of health care in Ghana, South Africa, and Tanzania: implications

for paths to universal coverage. Lancet. 2012 Jull;380(9837):126-33. [PubMed] [Google Scholar]

Mohsin M. Why people prefer private hospital over government hospital in Pakistan. Int. J. Curr. Res.


National Family Health Survey (NFHS-3). Mumbai, India: International Institute for Population Sciences. 2005-06. Available from:

NSSO. Key Indicators of Social Consumption in India: Health. NSS KI (75/25.0). National Sample Survey Office,

Available from:

Okunade AA, Suraratdecha C, Benson DA. Determinants of Thailand household healthcare expenditure: The

relevance of permanent resources and other correlates. Health Econ. 2010 Mar;19(3):365-76. [PubMed]

[Google Scholar]

Oluwatimilehin I. Determinants of household health care expenditure in an African country. Accessed

December 26, 2014. Available from: [Google Scholar]

Pal R. Measuring incidence of catastrophic out-ofpocket health expenditure: with application to India.

Int J Health Care Finance Econ. 2012 Mar;12(1):63-85. [PubMed] [Google Scholar]

Planning Commission (C. Rangarajan Committee Report). Report of the expert group to review the

methodology for measurement of poverty. Government of India, New Delhi. 2014. Available from: http://www.

Prinja S, Bahuguna P, Pinto AD, Sharma A, Bharaj G, Kumar V, Tripathy JP, Kaur M, Kumar R. The cost of

universal health care in India: a model based estimate. PLoS One. 2012;7(1):e30362. [PubMed] [Google


Rahman MM, Gilmour S, Saito E, Sultana P, Shibuya K. Health-related financial catastrophe, inequality

and chronic illness in Bangladesh. PLoS One. 2013;8(2):e56873. [PubMed] [Google Scholar]

Reddy KS, Patel V, Jha P, Paul VK, Kumar AK, Dandona L; Lancet India Group for Universal Healthcare. Towards achievement of universal health care in India by 2020: a call to action. Lancet. 2011 Feb;377(9767):760-8.

[PubMed] [Google Scholar]

Little RJA. A note about models for selectivity bias. Econometrica. 1985;53(6):1469-74. [Google Scholar]

Sengupta A, Nundy S. The private health sector in India. BMJ. 2005 Nov;331(7526):1157-8. [PubMed]

[Google Scholar]

Hooda SK. Determinants of public expenditure on health in India: The panel data estimates. Institute for

Studies in Industrial Development (ISID), New Delhi. [Google Scholar]

Bushway S, Johnson BD, Slocum LA. Is the magic still there? The use of the Heckman two-step correction

for selection bias in criminology. J Quant Criminol. 2007;23:151-78. [Google Scholar]

Shi W, Chongsuvivatwong V, Geater A, Zhang J, Zhang H, Brombal D. The influence of the rural health

security schemes on health utilization and household impoverishment in rural China: data from a household

survey of western and central China. Int J Equity Health. 2010 Feb;9:7. [PubMed] [Google Scholar]

Roy S. Determinants of healthcare expenditure on human capital and economic growth in Bangladesh:

a longitudinal data analysis from 1995-2010. Asian J. Pharm. Res. Health Care 2014;6(1):6-10. [Google


Nghiem SH, Connelly LB. Convergence and determinants of health expenditures in OECD countries. Health Econ Rev. 2017 Aug;7(1):29. [PubMed] [Google Scholar]

SRS Statistical Report. Office of the Registrar General & Census Commissioner, India. Ministry of Home Affairs, Government of India. 2018.

Su TT, Pokhrel S, Gbangou A, Flessa S. Determinants of household health expenditure on western institutional health care. Eur J Health Econ. 2006;7(3):199-207. [PubMed] [Google Scholar]

Rahman T. Determinants of public health expenditure: some evidence from Indian states. Appl. Econ. Lett.

;15(11):853-7. [Google Scholar]

Verma CS, Singh S, Ranjan A, Sundararaman T. Social and systemic determinants of utilisation of public

healthcare services in Uttar Pradesh. Economic & Political Weekly 2018;45. [Google Scholar]

Bajpai V. The challenges confronting public hospitals in India, their origins, and possible solutions. Adv. Pub.

Hea. 2014, 27 pages. [Google Scholar]

Jack W, Lewis M. Health investments and economic growth: an overview. Macroeconomic evidence and

microeconomic foundations (The World Bank). [Google Scholar]

World Bank. World development indicators 2019. The World Bank, Washington, DC. 2019.

World Health Organization. Sustainable health financing, universal coverage and social health

insurance. World Health Organization, Geneva. 2005. Available from:

handle/10665/20383/WHA58_33-en.pdf? sequence=1.Accessed 5 February 2020.

Kea X, Saksenaa P, Holly A. The determinants of health expenditure: A country-level panel

data analysis. World Health Organisation, 2011. Available from:

u p l o a d s / Tra n s i s i t i o n s I n H e a l t h F i n a n c i n g _DeterminantsofExpenditures.pdf. [Google Scholar]

Heckman J. Sample selection bias as a specification error. Econometrica. 1979;47(1):153-61. [Google


Rezaei S, Fallah R, Karyani AK, Daroudi R, Zandiyan H, Hajizdeh M. Determinants of healthcare expenditures in

Iran: evidence from a time series analysis. Med J Islam Repub Iran. 2016;30:313. [PubMed] [Google Scholar]

Dwivedi R, Pradhan J. Does equity in healthcare spending exist among Indian states? Explaining regional

variations from national sample survey data. Int J Equity Health. 2017;16:15. [PubMed] [Google Scholar]

Halliday TJ, Park M. Household size, home health care, and medical expenditures. Working Papers 2009

, University of Hawaii at Manoa, Department of Economics. [Google Scholar]