Utilization of healthcare services by informal workers: Evidence from Assam

The informal sector is a crucial part of the economy, yet its workers face significant healthcare access barriers, including financial constraints, long working hours, and limited social security. While research on healthcare utilization in India exists, studies focusing on informal workers, especially at the state level, remain limited. Assam, with its high dependence on the informal economy, presents unique healthcare challenges for this workforce. This study examines inpatient and outpatient healthcare utilization among informal workers in Assam, analysing barriers and sources of care. Using both primary, a cross-sectional household survey was conducted across three districts, Dhubri, Sonitpur, and Dhemaji. Healthcare utilization patterns were analysed using probit and logistic regression models, with model selection based on comparative pseudo values. Key socioeconomic, demographic, and health-related factors were examined to assess their influence on healthcare utilization. The findings reveal significant district-wise disparities, with outpatient care rates higher than inpatient care. Urban residents, insured individuals, and non-migrants utilized both services more frequently. Gender disparities persist, with males accessing more inpatient care except in Dhemaji. SC/ST groups and lower-income populations faced greater barriers, while non-communicable diseases primarily drove inpatient care demand. Key barriers included poor service quality and long distances to healthcare facilities. To improve healthcare utilization among informal workers, policies should focus on strengthening public healthcare infrastructure, expanding financial assistance programs, and improving service quality. Awareness campaigns, socioeconomic equity measures, and effective implementation of universal health coverage initiatives are essential for ensuring equitable healthcare access in Assam.