1. INTRODUCTION:

Hospitalisation rates serve as a crucial indicator for evaluating the accessibility and effectiveness of the healthcare system, encapsulating both the disease burden and the healthcare-seeking behaviours exhibited by the population. In the context of India, these rates reveal significant variation across diverse regions, socio-economic levels and rural-urban divides, which can be attributed to disparities in healthcare infrastructure, economic viability and awareness levels. Rural females face greater accessibility gaps in healthcare compared to urban females. Males generally have better access to private healthcare facilities while females predominantly rely on government and charitable institutions highlighting significant gender disparities in healthcare access across rural and urban areas.¹

As a fundamental measure of a nation's health system, hospitalisation rates provide profound insights into the population's capacity to access necessary medical care efficiently. They illuminate the intricate relationships that exist among disease prevalence, healthcare accessibility, socio-economic factors and cultural perceptions concerning the pursuit of medical intervention.

Hospitalisation rates throughout India illustrate marked inequities that differ by region, socio-economic status, and rural-urban distinctions, highlighting significant disparities in access to healthcare services. Although hospitalisation represents a crucial aspect of medical intervention for addressing both acute and chronic health issues, a multitude of barriers–including inadequate healthcare infrastructure, financial constraints and low health literacy–hinder equitable service utilization. These inequalities are particularly stark between rural and urban areas and across different socio-economic groups. In rural areas, where the majority of India's population resides, hospitalisation rates remain relatively low not due to better health outcomes but because of limited access to medical facilities and economic challenges. In contrast, urban regions benefit from better infrastructure and healthcare availability, resulting in higher hospitalisation rates, although these are often accompanied by significant financial burdens, particularly in the private sector. These discrepancies are further intensified by socio-economic status, educational attainment and prevailing cultural attitudes, which together influence healthcare-seeking behaviours. A growing concern within this landscape is the significant increase in India’s elderly population, particularly in rural areas, with projections indicating a 279% growth by 2050. This demographic shift brings to light critical healthcare challenges, such as the rising prevalence of chronic diseases, mobility issues and cognitive decline–challenges that are further compounded by poverty, gender inequality and lack of accessible services. The elderly, especially in underserved rural regions, face substantial barriers to accessing timely and quality healthcare, making them particularly vulnerable to health shocks and catastrophic expenditures.²

The changing disease pattern, coupled with an aging population, is associated with increasing hospitalisation and escalating healthcare costs at global, national, and local levels. The economic consequences for households are both direct (medical expenses) and indirect (loss of income, time and productivity of both patients and caregivers) and vary by illness type and severity.^3,4 These findings highlight the urgent need for targeted policy interventions and comprehensive healthcare reforms to reduce disparities, address the unique needs of the elderly, and promote equitable access to medical care for all segments of the population.

India is experiencing the triple burden of diseases, that is, rising non-communicable diseases, increasing injuries and the unfinished agenda of infectious diseases.⁵ The disease pattern is changing rapidly, with non-communicable diseases like cardiovascular diseases, cancer, chronic respiratory diseases, diabetes, etc. becoming the leading cause of mortality. Non-Communicable Diseases (NCDs) in India accounted 50 per cent of total deaths in 2004 and increased to 60 percent by 2014.^6,7 Similarly, hospitalisation due to NCDs accounted for 29 percent of total hospitalisation in 2004 and increased to 38 per cent by 2014.^8,9

This study aims to investigate the determinants that influence hospitalisation rates in India with a particular focus on regional, socio-economic and rural-urban disparities. It seeks to clarify the systemic challenges that hinder equitable access to healthcare and to identify policy interventions that have the potential to enhance healthcare equity and operational efficiency. More specifically, the following research questions need to be addressed. How do hospitalisation rates for various categories of ailments vary across rural and urban areas in India? What is the gender-based difference in hospitalisation rates for different categories of ailments in India? What is the role of household expenditure quintiles in influencing hospitalisation rates in rural and urban India? How do disparities in healthcare infrastructure between rural and urban regions contribute to differences in hospitalisation rates in India? How do different types of hospitals like government/public, private, charitable/trust/NGO-run impact hospitalisation rates in rural and urban areas? The present study attempts to address these questions.

2. REVIEW OF LITERATURE:

A broad understanding of hospitalization trends across Indian states reveals that individuals face significant financial burdens due to out-of-pocket expenditure during hospitalization. These expenditures vary by age, gender, education and income. Elderly individuals spend nearly twice as much as children and men tend to incur more healthcare costs than women.¹⁰ Higher spending is also associated with wealthier and more educated individuals and the overall out-of-pocket expenditure has sharply increased over the past two decades largely due to the rising cost of private healthcare.¹¹ Private hospitals are significantly more expensive than public ones, limiting access for uninsured and economically weaker sections. Disadvantaged groups, especially in rural areas, tend to rely on under-resourced public hospitals due to financial constraints.¹² Government-sponsored health insurance schemes have done little to relieve this burden for low-income populations, while wealthier groups have benefitted more, raising concerns about the equity of such initiatives.¹³

Closely linked to financial strain is the disparity in healthcare access across socioeconomic and geographic lines. Urban and wealthier populations spend more on hospitalization and tend to access higher-quality care¹⁴ while poorer individuals often receive lower-cost treatments such as cataract surgeries reflecting a broader pattern of healthcare underutilization. Rural patients depend on public hospitals, which frequently lack adequate infrastructure¹² When rural and poorer individuals turn to private facilities for better care, they face higher out-of-pocket expenditure and systemic barriers.¹³ Among the elderly, this inequality is even more pronounced. Scheduled Tribe members and those from the poorest quintiles mainly access public hospitals, indicating limited access to private care options.

These challenges are further complicated by an ongoing epidemiological transition. Over time, non-communicable diseases (NCDs) have overtaken infectious diseases as the leading causes of hospitalization. Among the elderly, a shift from illnesses like diarrhoea and tuberculosis to chronic conditions such as heart disease, diabetes and cancer has been observed.¹¹ Cancer and heart disease now account for the highest hospitalization costs, particularly among wealthier and more educated groups.¹⁰ Conditions like gastrointestinal and musculoskeletal disorders continue to impose financial burdens across all income levels. Cardiovascular diseases are among the most common causes of hospitalization and outpatient care for the elderly.¹³ However, infectious diseases still lead to significant hospitalizations especially in rural areas with poor sanitation and limited healthcare access.¹⁵ Seasonal variations such as increased hospitalizations during the monsoon and winter months highlight the dual burden of communicable and non-communicable diseases.

The elderly emerge as a particularly vulnerable group with higher hospitalization rates and greater financial strain. Older individuals tend to incur more healthcare costs, influenced by their income and education levels.¹⁴ While urban and affluent elderly populations report higher hospitalization rates, this may mask the underreporting among rural and poorer populations due to limited access or affordability concerns.¹³ Maternal and child health also reflect critical trends particularly during crisis periods. Hospital visits by pregnant women increased for serious conditions such as delivery complications and hypertensive disorders, while visits for minor ailments like pelvic pain declined.¹⁶ A rise in cases involving contractions and ruptured membranes suggests that women prioritized care for urgent needs despite challenges posed by lockdowns. This pattern highlights the importance of maintaining access to essential reproductive and maternal healthcare during public health emergencies.

Infant health outcomes also present distinct hospitalization patterns. RSV-related hospitalizations vary widely depending on the method of data collection. While active surveillance shows lower rates, administrative claims and modelling studies report significantly higher figures. A pooled estimate for the 2020 U.S. birth cohort indicates nearly 80,000 RSV-related hospitalizations annually, emphasizing the substantial burden of this virus on infant health and the need for harmonized research approaches to better inform prevention and healthcare planning.¹⁷

Social determinants of health further shape hospitalization trends. Factors such as income, housing and community support often reported by patients themselves have a significant influence on hospitalization outcomes, yet these aspects have long been neglected in mainstream healthcare frameworks. Integrating social determinants into health planning is essential for improving outcomes and reducing disparities.¹⁸

Distinct patterns of hospitalization are also evident among specific patient groups. Peritoneal dialysis patients experience high hospitalization rates primarily due to cardiovascular complications and infections such as peritonitis. While the overall hospitalization rates are similar between peritoneal and haemodialysis patients, those undergoing peritoneal dialysis often spend more days in the hospital, pointing to the need for enhanced infection control and monitoring.¹⁹ Similarly, rheumatoid arthritis patients in the U.S. between 2000 and 2014 showed a decline in hospitalizations directly caused by the disease, alongside an increase in admissions due to complications like sepsis, heart failure and urinary tract infections. Joint replacement surgeries also rose and the leading cause of in-hospital death shifted from pneumonia to sepsis—indicating progress in primary disease management, but also the emergence of new risks.²⁰

Taken together, these studies provide a multidimensional perspective on hospitalization in both developed and developing contexts. They reveal a complex interplay of financial, demographic, epidemiological and social factors. The growing burden of NCDs, disparities in healthcare access, increased vulnerability of elderly populations and the financial hardship caused by high out-of-pocket expenditure highlight critical areas for health policy reform. Equally important is the attention to maternal and infant health, social determinants and specific patient groups like those with chronic illnesses or undergoing dialysis. These findings highlight the need for a healthcare system that is both inclusive and resilient, with targeted interventions for high-risk groups and strategic investment in public healthcare infrastructure, insurance coverage and community-based care.

3. METHODOLOGY:

The study used secondary data obtained from the National Sample Survey (NSS) 75^th round, covering the period from July 2017 to June 2018. It collected data from 5, 55, 114 households spread over every district of the country. The rural households belonged to 8,077 randomly selected villages and the urban households to 6,181 randomly selected urban blocks. The dataset provides detailed information on hospitalization cases across rural and urban, sectors like public, private and charitable hospitals and household expenditure categories. It includes hospital admission rates based on 11 broad categories of ailments. The 11 categories used for classification are 1. infections, 2. cardio-vascular, 3. gastrointestinal, 4. respiratory, 5. genito-urinary, 6. musculo-skeletal, 7. psychiatric/neurological, 8. eye, 9. obstetric and neo-natal, 10. injuries, 11others. The data further categorizes hospitalization by gender, region and household expenditure quintiles. Analysis is conducted using descriptive statistics and cross tabulation to calculate hospitalization rates across different categories.

4. RESULTS AND DISCUSSION:

NSS has classified ailments into 11 broad categories to analyse the percentage distribution of hospitalization cases by ailment type. This classification helps in understanding the burden of different diseases, healthcare utilization patterns and disparities in hospitalization rates across various demographics. It also helps in identifying important trends such as the prevalence of certain types of ailments in rural versus urban areas, across different socio-economic groups and among various healthcare sectors such as public, private and specialty hospitals.

4.1 Composition of health care service providers:

Hospitalization patterns provide critical insights into healthcare accessibility, affordability and patient preferences. The choice of hospital type government, private and charitable reflects both systemic healthcare infrastructure and socio-economic disparities. In India, where healthcare services are delivered through a mix of public and private institutions, hospitalization rates vary significantly across these categories. Analysing the distribution of hospitalization cases by hospital type helps in understanding the reliance on different healthcare providers and the challenges faced by individuals in accessing medical care. The NSS 75th round provides valuable data on hospitalization trends, highlighting the proportion of patients seeking care in government, private and trust-run hospitals.

Figure 1: Composition of health care service providers in India

Source: NSS 75th round (July 2017 to June 2018)

The distribution of hospitalization cases across different types of hospitals in India (NSS, 75^th round) reveals significant insights into healthcare utilization patterns. Compared to government hospitals, private hospitals had the highest share in the total hospitalisation rate in India. Hospitals run by charitable organizations, trusts, or NGOs contributed a minimal in total hospitalizations. This pattern reflects the increasing reliance on private healthcare services despite the availability of government hospitals. The higher share of private hospitalizations may be attributed to factors such as perceived better quality of care, shorter waiting times and availability of specialized medical services. However, this also raises concerns regarding affordability and financial burden, especially for low-income groups who may struggle with high out-of-pocket expenditures.

The share of government hospitals highlights the crucial role of public healthcare in providing medical services, particularly for economically disadvantaged populations. Despite various initiatives to strengthen public healthcare infrastructure, issues such as overcrowding, inadequate facilities and a shortage of medical professionals may limit their capacity to serve a larger proportion of the population.

Hospitalization shares in charitable or trust-run hospitals suggest a relatively small but essential segment of healthcare providers catering to specific communities or offering subsidized medical care. These institutions often play a complementary role in the healthcare system, particularly in urban areas and regions with strong philanthropic involvement. Overall, the dominance of private healthcare in hospitalization cases highlights the need for policy measures to improve the accessibility, affordability and quality of public healthcare services to reduce dependency on private hospitals. Strengthening public hospitals and expanding trust-based healthcare initiatives could help address disparities in healthcare access and affordability across socio-economic groups in India.

4.2 Health care service providers across region:

The distribution of hospitalization cases across region reflecting differences in healthcare access and affordability. Public hospitals provide low-cost treatment and serve a large portion of economically weaker populations, while private hospitals offer specialized care but at higher costs. Many people prefer private hospitals due to better facilities and shorter waiting times, despite the financial burden. The choice of hospital is influenced by factors like income, insurance coverage and availability of services in different regions. Understanding this distribution helps policymakers improve healthcare accessibility and ensure better service delivery across both public and private sectors.

Figure 2: Share of health care service providers across region

Source: NSS 75th round (July 2017 to June 2018)

In both rural and urban areas, private hospitals have the major share of hospitalisations. While private hospitals have a major share of hospitalizations in both rural and urban areas, the urban setting features a significantly higher number of these facilities compared to rural regions. In cities, a higher population density, more robust economic activities and greater access to resources have contributed to the proliferation of private healthcare institutions. This concentration not only caters to the large urban population but also reflects the demand for quick, high-quality healthcare services that private hospitals are perceived to offer. In contrast, rural areas typically have fewer private hospitals, which may result in patients having to travel further distances to access such services or rely more on public healthcare options. This disparity highlights the broader differences in healthcare infrastructure and resource allocation between urban and rural areas. Furthermore, factors such as increased health insurance coverage, economic growth and a rising middle class have made private healthcare more accessible and appealing, further reinforcing the sector's dominant role in providing hospital services nationwide.

4.3 Rate of hospitalisation across ailment:

Hospitalization patterns provide valuable insights into the burden of diseases and the healthcare needs of a population. The distribution of hospitalisation cases across different ailment categories reflects the prevalence of various health conditions and their impact on healthcare utilisation.

Table 1: Percentage of hospitalisation cases across ailment

Category of Ailment	Hospitalisation Rate (per cent)
Infections	31.4
Injuries	11.2
Gastro-intestinal	9.9
Cardio-vascular	9.1
Genito-urinary	5.9
Psychiatric/neurological	5.7
Musculo-skeletal	4.4
Eye	3.6
Obstetric and neo-natal	3.5
Other	11.1

Source: NSS 75th round (July 2017 to June 2018)

Infection has the highest hospitalisation rate indicates infections are the major cause of hospitalisation. Children, elderly individuals, pregnant women are more susceptible to infections, often requiring hospitalisation. Gastrointestinal Infections, Vector-Borne Diseases like Dengue Fever, Malaria, Urinary Tract Infections, Meningitis, Hepatitis, Influenza (Flu) etc are the infectious diseases which contribute significantly to hospitalisation. The impact of inadequate household amenities on the spread of infectious diseases in India has been highlighted, particularly the lack of access to toilets and garbage disposal, which heightens health risks. Socio-demographic factors such as rural residency, gender, socio-economic status and age influence disease prevalence, with infections being more common in rural areas, among males and particularly in children and adults.²¹ Jaundice, malaria, tuberculosis, typhoid, dengue fever and chikungunya as the most prevalent infectious diseases, emphasizing the need for targeted health interventions.

Accidental injuries such as road traffic accidents, falls, burning and workplace injuries are a leading cause of hospitalisation. Injuries in India are influenced by a multitude of factors, ranging from occupational hazards to transport-related issues. The burden of transport injuries in India has remained unchanged from 1990 to 2019.²² The incidence rate and Disability-Adjusted Life Years (DALYs) associated with transport injuries have significantly increased among individuals above 50 years. Transport injuries contribute to a substantial number of new cases and deaths, leading to increased medical costs and financial strain on families. Moreover, workplace injuries are a major concern, with 28 per cent of workers reporting accidents in the past year among which the most common injuries were cuts, fractures and dislocations and burns.²³

4.4 Rate of hospitalisation across region:

Hospitalization patterns vary significantly across regions due to differences in disease prevalence, healthcare infrastructure, socioeconomic conditions and accessibility of medical services. Analysing hospitalization rates by ailment category across regions provides valuable insights into regional health disparities and helps identify areas requiring targeted healthcare interventions. By examining hospitalization trends across different regions, policymakers and healthcare providers can better allocate resources, strengthen public health infrastructure and implement region-specific health programs to improve overall healthcare access and outcomes.

Table 2: Rate of hospitalisation across region

Category of Ailment	Hospitalisation Rate (percent)
Category of Ailment	Rural	Urban
Infections	31.3	31.6
Injuries	12.1	9.6
Gastro-intestinal	10.4	9.0
Cardio-vascular	8.1	11.1
Genito-urinary	5.7	6.3
Psychiatric/neurological	5.7	5.7
Musculo-skeletal	4.5	4.3
Eye	3.6	3.5
Obstetric and neo-natal	4.0	2.4
Other	10.5	12.0

Source: NSS 75th round (July 2017 to June 2018)

The hospitalisation rates for infections are same in both rural and urban areas. In rural areas children, elderly people and those with limited access to healthcare may experience more severe infections, leading to hospitalisation. In urban areas overcrowding, pollution and a higher prevalence of lifestyle-related diseases may also make individuals more susceptible to infections that require hospitalisation. Injuries account more hospitalisations in rural areas compared to urban areas. Rural populations are more engaged in agriculture, construction and manual labour, increasing the risk of workplace injuries. Limited access to primary healthcare facilities and emergency services in rural areas can lead to minor injuries worsening, requiring hospitalisation. Moreover, the tendency to depend on traditional medicine or delay seeking medical care due to financial constraints in rural areas often leads to complications that necessitate hospitalisation. Rural populations experience 1.5 times higher injury-related mortality and morbidity than metropolitan areas, highlighting the need for targeted prevention. Important risk factors include demographic like age, sex, socio-economic status, behavioural factors like alcohol use and environmental factors like road conditions and medical access. There is an increased burden of rural injury in terms of severity and healthcare costs, indicating that rural injuries are often more severe and require more resources for treatment compared to urban injuries.²⁴

4.5. Hospitalization case by gender in different age groups:

Understanding hospitalization patterns across different age groups and genders is essential for evaluating healthcare needs and identifying disparities in access to medical services. Hospitalization rate is defined as the number of individuals treated as inpatients per 1,000 population vary significantly by gender in different age groups. These variations can be attributed to differences in disease prevalence, health-seeking behaviour and access to healthcare facilities between men and women.

Figure 3: Hospitalization cases by ailment category: A gender-based analysis

Source: NSS 75th round -2017 to 2018

Figure 3 on hospitalization rates per 1000 persons across different age groups shows a clear trend of increasing hospitalizations with age for both males and females. In the younger age groups, particularly from 0 to 14 years, males exhibit higher hospitalization rates than females. From the age of 15 to 44, females surpass males in hospitalization rates. This pattern is likely influenced by reproductive and maternal health-related hospitalizations. Among women, increased hospital utilization is influenced not only by healthcare needs but also by psychosocial factors such as low levels of well-being and socio demographic characteristics including marital status, low income and unemployment which highlight the role of broader societal determinants in shaping disparities in access to and use of health services among women.²⁵

From the 45–59 age group onwards, the trend begins to shift with males gradually recording higher hospitalization rates than females. This pattern becomes more pronounced in the older age groups, with a noticeable gap emerging in the 60–69 group and continuing to widen in the 70–74, 75–79 and 80+ age groups.

Males aged 50 and above are at higher hospitalization risk due to factors such as skin ulcers, psychiatric conditions, dyspnoea, cardiovascular issues, diabetes, functional deficits, multiple comorbidities and increased medication usage.²⁶ These figures suggest that while females may utilize hospital services more during their reproductive years, males face a greater burden of hospitalization as they age, potentially due to a higher incidence of chronic illnesses or age-related health deterioration.

4.6 Hospitalization cases by ailment on gender:

Understanding hospitalization patterns across different ailments and genders is crucial for assessing healthcare needs and disparities in medical access. Variations in hospitalization rates by ailment type can reflect differences in disease prevalence, health-seeking behaviour and accessibility to medical facilities among men and women. Gender-based disparities in healthcare utilization may be influenced by biological, socio-economic and cultural factors. Analysing hospitalization data by ailment category provides valuable insights into the burden of diseases across genders and helps in designing targeted healthcare policies to improve equitable access to medical care.

Figure 4: Hospitalization cases by ailment on gender

Source: NSS 75th round -2017 to 2018

The hospitalisation rates for infections are same for both male and female with nearly identical rates. Infections tend to be prevalent across all demographic groups and the nature of infections such as respiratory, gastrointestinal or urinary tract infections doesn't significantly differ by gender. Both males and females have similar exposure to environmental factors that can lead to infections such as poor sanitation, overcrowding or seasonal changes. Also, both genders may experience similar access to healthcare services for treating infections, leading to comparable hospitalisation rates.

Injuries contribute in hospitalisation rate much higher for males than females. Males are more likely to engage in high-risk occupations such as construction, agriculture and manufacturing which expose them to greater chances of workplace injuries. Males tend to participate more in high-risk behaviours, including reckless driving, adventure sports and heavy machinery operation, leading to a higher incidence of accidents. Notable gender differences can be seen in injuries related to athletes and sports, where 46 per cent of male injuries are linked to sports or exercise compared to 14 per cent among females, highlighting these disparities.²⁷ The results suggest that while infectious diseases and injuries are major causes of hospitalization, gender-based differences are visible in injury-related hospitalizations and obstetric conditions. These trends indicate differences in health risks, biological factors and possibly healthcare-seeking behaviour between men and women.

4.7 Hospitalisation across household expenditure:

Household expenditure plays a crucial role in determining access to healthcare services, influencing hospitalization rates across different economic groups. Analysing the share of hospitalization cases by expenditure quintiles helps in understanding healthcare utilization patterns among various income groups in rural and urban India. Here household expenditure is classified into five quintiles from one to five where one shows low expenditure group and five is the highest expenditure group.

Table 3: Hospitalisation across household expenditure

Household Expenditure (in Quintile)	Hospitalisation Cases(percent)
Household Expenditure (in Quintile)	Rural	Urban
1	12.9	16.2
2	14.0	18.9
3	18.8	21.4
4	22.5	21.1
5	31.9	22.4

Source: NSS 75^th round (July 2017 to June 2018)

Table 3 presents a positive relationship between the quintile class of household expenditure and hospitalisation cases, meaning that as household expenditure increases, the share of hospitalisation cases also rises. This suggests that higher-income households are either more likely to seek hospitalisation due to better financial capacity and awareness or have greater access to healthcare services compared to lower-income groups.

The proportion of hospitalization cases increases consistently with household expenditure, from 12.9 percent in the lowest quintile to 31.9 percent in the highest quintile. This trend suggests that wealthier rural households are more likely to access hospitalization, likely due to better financial resources, awareness and healthcare accessibility. Lower hospitalization rates in the poorest quintiles may indicate financial barriers, reliance on alternative treatments or inadequate healthcare infrastructure. However, unlike rural areas, hospitalization rates remain relatively stable in the fourth and fifth quintiles of urban area. This suggests that access to hospitalization in urban settings is less dependent on income beyond a certain threshold, possibly due to better availability of healthcare facilities across different income groups.

Economic disparities play a crucial role in hospitalization access, especially in rural areas where lower-income households have significantly lower hospitalization rates. The gap between the lowest and highest quintiles is more pronounced in rural areas, whereas in urban areas, the disparity is narrower. In urban India, hospitalization rates stabilize at higher expenditure quintiles, possibly due to the greater availability of healthcare facilities across income groups.

5. CONCLUSION:

The analysis reveals that infections are the leading cause of hospitalisation in India. This is particularly prominent among vulnerable groups such as children, elderly and pregnant women, who are more susceptible to diseases like respiratory infections, gastrointestinal issues and vector-borne diseases. Injuries, another significant contributor to hospitalisations, represent with rural areas experiencing a higher rate compared to urban areas. This is attributed to the nature of work in rural areas, where individuals are more likely to engage in manual labour or agriculture, increasing their exposure to accidents. The limited access to primary healthcare and emergency services in rural areas often causes the severity of injuries, leading to hospitalisation.

The breakdown of hospitalisation cases by type of hospital indicates that private hospitals account for the majority of hospitalisations followed by public hospitals. This suggests that private hospitals, with their perceived better service quality, shorter waiting times and better facilities, are the preferred choice, especially in urban areas. However, public hospitals still play a crucial role in providing affordable healthcare to lower-income groups, despite challenges such as overcrowding and resource constraints. The relationship between household expenditure and hospitalisation rates shows that wealthier households are more likely to seek hospitalisation, as they have better access to healthcare services and the financial means to afford private care. This is particularly evident in the higher quintiles of expenditure, where the share of hospitalisation cases increases significantly. These findings emphasize the need for improving healthcare access, particularly in rural areas and addressing the affordability and quality of public healthcare services. The results of the study will be used to derive policy recommendations aimed at improving healthcare access and equity and to address disparities in hospitalization rates across rural and urban areas, genders and economic groups and guide the allocation of resources to regions and sectors where healthcare needs are most critical.

6. CERTIFICATE OF CONFLICT OF INTEREST:

We hereby declare that we have no conflict of interest or personal relationship that could have appear to influence the work reported in this paper.

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