Usual preference for public healthcare services in India: a multilevel analysis

During the last few decades, the Government of India has introduced various policies and programmes to achieve the goals of universal health coverage. However, many people do not prefer using public healthcare services. In this context, this study aims to assess the key factors associated with the preference for public healthcare services and to analyse the contributions of different geographical hierarchies to the total variation in preference across the state, district, primary sampling unit (PSU), and household levels. The data were derived from the Indian National Family Health Survey (2019–21). Usual preference for public healthcare services was the dependent variable, and a group of social, economic, demographic, and geographical factors were considered as independent variables. The results of four-level logistic regression models show that the factors are associated with the preference for public healthcare services. The state level accounted for the highest share of the total variation in the usual preference for public healthcare services. This suggests that state-level characteristics may be closely associated with healthcare service choices. This study suggests that state-specific policies and programmes may be effective in expanding the reach of public healthcare services. The household-level factors, such as social groups, religion, place of residence, and other related characteristics, shape the usual preference for public healthcare facilities in India.