Studies from a number of low-income countries have found that the wealthy often use publicly financed health services at a higher rate than the poor. To examine the situation in India, the use of public and private sector hospital services by economic class was analysed and the relationship between utilisation and public spending on health services and the reported out-of-pocket payments were assessed. Not surprisingly, hospital services in the private sector were found to be significantly pro-rich. In contrast to previous studies, it was found that India's poor report using hospital services in the public sector at a higher rate than the wealthy, particularly in urban areas. However, this varied across states. High OOP expenditure correlated with higher degrees of inequity, and was a likely barrier to accessing care for the poor. Further work is required to explore the significant variation seen between states and to understand the history of its development. A number of policy options are discussed to reduce inequities in access to public health services in India.
