This paper analyzes equity in health care utilize- tion and out-of-pocket expenditure on health care in India using two rounds (52th round 1995-1996 and 60th round 2004-2005) of National Sample Survey data and data from a household survey carried out in 2007. The findings indicate that the average hospitalization rate has increased and the corresponding value of the concentration index has decreased over the last ten years. However, the health care payment structure is seen to be regressive for inpatient care, and more so for outpatient care. The main reason is the very high out-of-pocket payment on medicine and diagnostic tests even in government hospitals. High out-of-pocket payment has resulted in 34 percent poor households losing all their past savings, 30 percent of households borrowing with interest and 2 percent of households selling their assets. These findings indicate the urgent need for putting in place risk pooling mechanisms.