Inequalities in access to health care in urban south India

Kerala - in South India - has favourable indicators of human development, a high availability of public health services, and high levels of utilisation of health services. It is often cited as a model of good health at low cost. However, the private sector is increasingly more available than the public sector. This translates into a high recourse to private care. We know little about social inequalities in access to health care - especially in urban areas - in Kerala.; Our analyses suggest that the poor and casual workers have lower access to health care compared to more favourised populations. These two defavourised groups also have a higher propensity to turn to public services for care, despite indications of lower availability and lower quality compared to services offered in the private sector. Poor populations - despite lower access and restriction in their consumption of services - are also subjected to a higher economic burden of care, particularly in the private sector. Restriction in access is associated with deprivation in the urban context and lower density of health care providers. The public sector seems to play a particular role in facilitating access to health care for poor populations. The density of private services - which is higher in more privileged areas and larger cities - stimulates the utilisation of private services.; Despite a high level of human development, socio-economic inequalities in access to health care remain in urban areas in Kerala. These inequalities are linked to personal deprivation and to characteristics of urban environments. In a context characterised by an ageing population and increase in chronic illnesses, the consolidation of public health sector and the development of mechanisms to protect against the costs of care seem warranted to ensure access for the urban poor.; Keywords: Access to health care; Poverty; Developing countries; India; Urban health services; Private sector; Multilevel analysis.