BackgroundIn the past decade, India has seen the introduction of many ‘publicly funded health insurance’ schemes (PFHIs) that claim to cover approximately 300 million people and are essentially forms of purchasing care from both public and private providers to reduce out-of-pocket expenditure (OOPE) for hospitalization.MethodsData from a recent government-organized nationwide household survey, The National Sample Survey 71st Round, were used to analyse the effectiveness and equity of tax-funded public health services and PFHIs as distinct but overlapping approaches to financial protection for hospitalization across different socio-economic categories. Cross-tabulation analysis, multivariate logistic regression and propensity score matching were the main analytical methods used.ResultsGovernment hospitals provide access to 45.6% of all hospitalization needs. Although poorer quintiles use public hospitals more often, even in the poorest quintile, as many as 37.2% are utilizing private hospitals. The average OOPE that a household experiences for hospitalization in public hospitals is approximately only one-fifth of the OOPE for hospitalization in the private sector. PFHI schemes cover 12.8% of the population, and coverage is higher in upper quintiles and in urban areas. Hospitalization rates increase with PFHI coverage, and this occurs with both public and private providers. Propensity score matching shows that PFHI contributes to a marginal reduction (1%) in ‘catastrophic health expenditure incidence at the 25% threshold’ (CHE-25) for the bottom three quintiles. The reported coverage of PFHIs was greater in the upper income quintiles. Utilization of public services was greater in the poorer income quintiles and more marginalized social groups.ConclusionsPeriodic surveys are essential to guide policy choices regarding the appropriate mix of strategies for financial protection in pluralistic systems. There is a need for caution regarding any shift in the role of governments from providing services to purchasing care, given the contexts and limitations of currently available PFHIs. Even with tax-funded public services, although the average OOPE is lower than the care purchased through PFHIs, there is still a modest level of CHE and impoverishment due to health care costs that persist. Both strategies need to be synergized for more effective financial protection.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-5431-8) contains supplementary material, which is available to authorized users.

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Background Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) outbreak, called coronavirus disease - 2019 (COVID-19), has affected more than 200 countries across the globe with a higher fatality rate among the elderly population. Aim of the study is to highlight the vulnerability of the aged amidst the current COVID-19 pandemic, and in the light of the recent international evidence, suggests what government could do to mitigate their vulnerability. Methods Data from the recently released (November 2019) 75th Round National Sample Survey (NSS), which was conducted from July 2017 to June 2018, across 8077 rural villages and 6181 urban wards was used for this study. Data collected from 555,115 individuals (rural: 325,232; urban: 229,232) included 42,762 elderly individuals (60 years or above). Bivariate and multivariate analyses were used for the calculation. Results Of the total sample of elderly individuals, 27.7% reported suffering from an ailment in the last 15 days, whereas 8.5% had been hospitalized during the last 365 days. Among the elderly, hospitalization rate was higher in the urban areas (OR: 1.23), general social category (OR: 1.18), richest economic quintile (OR: 1.69), and among those living alone (OR: 2.40). Also, among the elderly, 64% of those in the scheduled tribe (social group) and 51% in the poorest economic quintile utilized public facilities for hospitalization. Cardiovascular ailments were the major cause for hospitalization (18.1%) and outpatient visit (32%) among the elderly. Ailments related to diabetes and hypertension constituted 55% of outpatient visit for the elderly. Only 18.9% of the elderly had health insurance though chances of facing catastrophic health expenditures were high among the elderly. 6.6% of elderly female and 1.6% male live alone, and 27.5% of age 80 years and above are immobile. 50% of male and 90% of female are financially dependent on others and more so in poorer economic quintiles. Conclusions The vulnerability of India’s elderly increases across economic levels, and other dimensions such as the place of residence, gender, social group (caste), marital status, living arrangements, surviving children, and economic dependence. The current COVID-19 pandemic poses a greater risk of social isolation among the elderly, which may cause detrimental health impact. Trial registration Not applicable since the study is based on secondary data.

Introduction Understanding the cost of care associated with different kinds of healthcare providers is necessary for informing the policy debates in mixed health-systems like India’s. Existing studies reporting Out of Pocket Expenditure (OOPE) per episode of outpatient care in public and private providers in India do not provide a fair comparison because they have not taken into account the government subsidies received by public facilities. Public and private health insurance in India do not cover outpatient care and for-profit providers have to meet all their costs out of the payments they take from patients. Methods The average direct cost per acute episode of outpatient care was compared for public providers, for-profit formal providers and informal private providers in Chhattisgarh state of India. For public facilities, government subsidies for various inputs were taken into account. Resources used were apportioned using Activity Based Costing. Land provided free to public facilities was counted at market prices. The study used two datasets: a) household survey on outpatient utilisation and OOPE b) facility survey of public providers to find the input costs borne by government per outpatient-episode. Results The average cost per episode of outpatient care was Indian Rupees (INR) 400 for public providers, INR 586 for informal private providers and INR 2643 for formal for-profit providers and they managed 39.3, 37.9 and 22.9% of episodes respectively. The average cost for government and households put together was greater for using formal for-profit providers than the public providers. The disease profile of care handled by different types of providers was similar. Volume of patients and human-resources were key cost drivers in public facilities. Close to community providers involved less cost than others. Conclusions and recommendations The findings have implications for the desired mix of public and private providers in India’s health-system. Poor regulation of for-profit providers was an important structural cost driver. Purchasing outpatient care from private providers may not reduce average cost. Policies to strengthen public provisioning of curative primary care close to communities can help in reducing cost.

Abstractobjectives We conducted a case study of an urban immunization outreach strategy to determine the feasibility of the intervention and to measure administrative immunization coverage outcomes.methods A multipronged strategy for improving immunization coverage in Urban Patna, India, was implemented for 1 year (2009 ⁄ 2010). The strategy was designed to increase immunization sites, shift human resources, plan logistics, improve community mobilization, provide supervision, strengthen data flow and implement special vaccination drives.results Over 1 year, the coverage of all primary vaccines of the Universal Immunization Program improved by over 100%.conclusion Coverage can be rapidly improved through outreach immunization in low socioeconomic areas if existing opportunities are carefully utilized.