National Sample Surveys (NSS) on population health: data analytics over 70 Years: reflections on concepts, definitions, measurement and analysis of data

National Sample Survey Organisation (Government of India) has made rigorous attempts in developing and measuring morbidity and capturing health seeking behaviour of people since the inception of NSSO in 1950. Since the 1980s the NSSO launched the nationwide population health surveys representing every state & union territory to portray the scenario for All-India separately for Rural and Urban areas on morbidity and healthcare utilisation. This paper firstly discusses the concepts and measurement of morbidity and health care utilisation used in the 13 rounds of the survey done so far since 1950s. Further, it compares the morbidity and healthcare utilisation scenario prevalent in Gujarat and Maharashtra as well as for all-India of over the last 40 years by exploring the National Sample Surveys data for 1980-81, 1986-87, 1995-96, 2004, 2014, and 2017-18. The differentials and trends in morbidity rate, health-seeking behaviour, use of public and private providers especially for hospitalization and associated cost and burden of treatment are analysed by population groups. The rising cost and burden of treatment on the poor are examined through receipt of free inpatient services as well as the extent of financial protection under the health insurance schemes. Over time, morbidity rates have gone up, with several folds increase in select states; the reliance on public provision has gone down substantially despite being cheaper than the private sector; and the cost of treatment at constant prices has grown exponentially even for the poor. Hospitalisation costs were higher for insured than the non-insured households in several states irrespective of whether residents in rural or urban areas (Haryana, Maharashtra, Himachal Pradesh, and Assam have reported that insured households ended up paying almost double the hospitalisation expenses in 2014). Leaving aside Kerala (where insured households have paid just a half of the cost of the non-insured), this clearly reflects the widespread prevalence of moral hazard and insurance collusion in India.