Do poor people in the poorer states pay more for healthcare in India?

Abstract

Background Rising health spending is associated with high out-of-pocket expenditure (OOPE), catastrophic health spending (CHS), increasing poverty, and impoverishment. Though studies have examined poverty and impoverishment effect of health spending in India, there is limited research on the regional patterns of health spending by type of health centers. This paper tests the hypothesis that the poor people from the poorer states of India pay significantly more for hospitalization in public health centers than those in the richer states of India. Methods Data from the Social Consumption of Health Survey (71st round, 2014), carried out by the National Sample Survey (NSS) is used in the analyses. Descriptive statistics, log-linear regression model and tobit model were used to examine the determinants and variations in health spending. Results Inter-state variations in the utilization of public health services and the OOPE on hospitalization are high in India. States with high levels of poverty make higher use of the public health centers and yet incur high OOPE. In 2014, the mean OOPE per episode of hospitalization in public health centers in India was ₹5688 and ₹4264 for the economically poor households. It was lowest in the economically developed state of Tamil Nadu and highest in the economically poorer state of Bihar. The OOPE per episode of hospitalization in public health centers among the poor in the poorer states was at least twice that in Tamil Nadu. Among the poor using public health centers, the share of direct cost account 24% in Tamil Nadu compared to over 80% in Bihar, Odisha and other poorer states. Adjusting for socio-economic correlates, the cost of hospitalization per episode (CHPE) among the poor using public health centers was 51% lower than for the non-poor using private health centers in India. Conclusion The poor people in the poorer states in India pay significantly more to avail hospitalization in public health centers than those in the developed states. Provision of free medicines, surgery and free diagnostic tests in public health centers may reduce the high OOPE and medical poverty in India. Electronic supplementary material The online version of this article (10.1186/s12889-019-7342-8) contains supplementary material, which is available to authorized users.

Performance of India’s national publicly funded health insurance scheme, Pradhan Mantri Jan Arogaya Yojana (PMJAY), in improving access and financial protection for hospital care: findings from household surveys in Chhattisgarh state

“…Their sample is population based and nationally representative [41]. Researchers have observed that the above rounds provide comprehensive information on morbidity patterns, health care, type of providers (public or private), out of pocket expenditure for hospitalization [41,42]. NSS has reported adequate respondentcooperation rates in its 60th and 71st rounds.…”

Understanding equity of institutional delivery in public health centre by level of care in India: An assessment using Benefit Incidence Analysis

“…NFHS-4 did not include any information on the actual cost of delivery care at the public health centre. Hence in line with previous literature, we have used the OOP payment for delivery care in private health centres as the proxy for the actual cost of delivery care in public health centres [22,49].…”

“…To examine the economic inequality in the utilization of delivery care services in public/private health centre, we used CC and CI. CC and CI are commonly used by researchers to measure health inequality [49][50]. CC plots the cumulative proportion of the population (ranked by wealth) against the cumulative proportions of the population utilizing delivery care services in public/private health centres.…”

“…About 71% of health spending was met by households in 2004 and 69.1% in 2014 was met by household themselves [47][48]. OOP is larger in poorer states and among poorer people of poorer states [49]. The catastrophic health spending has shown an increasing pattern, increased from 11.1% in 1995-96 to 24.9% by 2014 [8].…”

Social factors associated with practice of self-monitoring of blood glucose among type-2 diabetic patients

“…The lack of awareness about disease management, inequitable distribution of health care facilities in rural areas coupled with high cost of SMBG test strips, financial constraints have led to comparatively decreased utilization of SMBG in rural areas. 14,15 The specialized health-care centres which are located in urban areas, generally provide more comprehensive medical care with greater focus on patient satisfaction with their medical care and patient-provider relationship. 1,14,15 This is also reflected in the present study wherein a significantly lesser percentage of diabetics from rural areas practised SMBG when compared to the diabetics who were residents of urban areas (Table 2).…”