Health equity in a thriving city and dying villages: A study of multidimensional healthcare access in urban-villages of Delhi, India

Healthcare as a significant component of human development, is of particular interest in the process of urbanization. Generally, urban populations are found to have better average health than their rural counterparts. But... [ view full abstract ]

Healthcare as a significant component of human development, is of particular interest in the process of urbanization. Generally, urban populations are found to have better average health than their rural counterparts. But whether such advantages are equally distributed to all in a city, is a question worth asking. Equity of health is most commonly defined in terms of equal access. Available literatures suggest three major dimensions of healthcare access i.e., availability (physical access), affordability (financial access), and acceptability (Socio-cultural Access). This study conceptualized healthcare access as a multidimensional concept (structured on availability, affordability and acceptability) and attempted to measure households’ healthcare access in Urban-villages and in planned residential urban neighborhoods (PRUN) of Delhi, India. It also analyzed factors of accessibility of healthcare in study area. This study was based on primary data, collected through household survey. A total 512 households were selected in 8 urban-villages and 3 PRUNs. To provide a brief statement of various dimensions of healthcare access, a composite index of accessibility (based on non-linear/ Categorical PCA) was designed. This composite index itself was the product of aggregation of the three of accessibility indices:1) Index of Geographical Access; 2) Index of Economic Access; 3) Index of Socio-cultural Access. Measurements obtained on different dimensions as level of healthcare access (High, medium, low etc.) were further linked to the households’ characteristics through Partial Proportional Odds regression model. It was found that a significantly high percentage of sample household located in PRUN had high level of access of health care over all the three parameters (Geographical Dimensions; Economic Dimensions; and Socio-cultural Dimensions). On the other hand households belonging to the urban villages fared poorly over different parameters including composite index. In analyses of determinants of healthcare accessibility nothing were found as significant as location of households’ and standard of living.