ORIGINAL ARTICLE Poor and non-poor differentials in household health spending in India Neha Seth 1 & Sanjay K. Mohanty 2 Received: 29 April 2016 /Accepted: 19 August 2016 /Published online: 8 September 2016 # Springer-Verlag Berlin Heidelberg 2016 Abstract Purpose The rich-poor differentials in health outcomes such as life expectancy at birth, infant mortality rate and disability in India have remained large over time. Though health care is a basic input in the production of health and governed by the economic well-being of households, no study has examined the extent of poor and non-poor differentials in household health spending in India. The aim of this article is to examine the poor and non-poor differentials in household health spending in India. Methods The unit data from the 68th round of the consump- tion expenditure schedule of the National Sample Survey (NSS), which covered 101,662 households, is used in the analyses. Descriptive statistics, regression analyses and the Blinder-Oaxaca decomposition methods are used. Results Household health spending is a significant determi- nant of longevity and infant survival in India. The monthly per capita household health spending (MPHHS) among the non- poor was 4.7 times higher than that of the poor. The ratio of poor and non-poor health spending varies from 2.7 each in the states of Assam and Bihar to 5.7 in the state of West Bengal. The MPHHS was 4.33 % of the monthly per capita consump- tion expenditure among the poor compared to 7.33 % among the non-poor linking health spending to ability to pay. Decomposition analyses reveal that the 86 % variation in poor and non-poor differentials is due to endowment. Economic well-being of the household explains the larger variation in health spending among the poor and the non-poor in India. Conclusion Affordable health services should be made avail- able to the poor and needy to reduce the health inequalities of the population. Keywords Poor . Non-poor . Health spending . Decomposition . Ability to pay . India Introduction Health inequality research in developing countries is gaining increasing attention among public health professionals, econ- omists, demographers, planners and policy makers. Many na- tional and local governments, international organisations and donors are making concerted efforts to reduce the health in- equality by improving the health and health care utilisation of the poor. The Millennium Declaration with the overall objec- tive of eradicating poverty in all form integrated two health- related goals in its global development agenda. These goals were modified with additional health dimensions in the Sustainable Development Goals (SDGs) (UN 2016). The in- troduction of conditional cash transfer schemes, universal health coverage schemes and promotion of health insurance in many developing countries aimed at improving the health care utilisation among the poor and disadvantaged and reduc- tion of health inequality in the population. Despite these ef- forts, the poor are disadvantaged in health outcomes; they share the disease burden disproportionately and the health costs of poverty are high (Kaplan 2009; Wagstaff 2002; World Bank 2001). The extent of disability is higher among income poor and multidimensional poor (Mitra et al. 2013; Yeo and Moore 2003). Besides, the rich-poor gap in health care utilisation including maternal care has remained large * Sanjay K. Mohanty sanjayiips@yahoo.co.in Neha Seth sethneha051@gmail.com 1 Banaras Hindu University, Varanasi, India 2 Department of Fertility Studies, International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai 400088, India J Public Health (2017) 25:75–86 DOI 10.1007/s10389-016-0765-0