Health care services in India: A few questions on equity

Mondal, Swadhin

doi:10.4236/health.2013.51008

Cited by 9 publications

(7 citation statements)

References 27 publications

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“…The finding that spending was highly regressive is in line with findings from national studies describing the regressive nature of total health care financing/payments in these two countries [ 30 , 31 ]. India and Kenya have different health systems structures in that India has a decentralised public health system, while Kenya’s system is highly centralized [ 30 , 31 ]. However, both settings are pluralistic, with a significant proportion of services offered either by private providers or by public providers charging users fees at the point of use.…”

Section: Discussionsupporting

confidence: 86%

Inequity in costs of seeking sexual and reproductive health services in India and Kenya

Haghparast‐Bidgoli

Pulkki-Brännström

Lafort

et al. 2015

Int J Equity Health

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ObjectiveThis study aims to assess inequity in expenditure on sexual and reproductive health (SRH) services in India and Kenya. In addition, this analysis aims to measure the extent to which payments are catastrophic and to explore coping mechanisms used to finance health spending.MethodsData for this study were collected as a part of the situational analysis for the “Diagonal Interventions to Fast Forward Enhanced Reproductive Health” (DIFFER) project, a multi-country project with fieldwork sites in three African sites; Mombasa (Kenya), Durban (South Africa) and Tete (Mozambique), and Mysore in India. Information on access to SRH services, the direct costs of seeking care and a range of socio-economic variables were obtained through structured exit interviews with female SRH service users in Mysore (India) and Mombasa (Kenya) (n = 250). The costs of seeking care were analysed by household income quintile (as a measure of socio-economic status). The Kakwani index and quintile ratios are used as measures of inequitable spending. Catastrophic spending on SRH services was calculated using the threshold of 10 % of total household income.ResultsThe results showed that spending on SRH services was highly regressive in both sites, with lower income households spending a higher percentage of their income on seeking care, compared to households with a higher income. Spending on SRH as a percentage of household income ranged from 0.02 to 6.2 % and 0.03–7.5 % in India and Kenya, respectively. There was a statistically significant difference in the proportion of spending on SRH services across income quintiles in both settings. In India, the poorest households spent two times, and in Kenya ten times, more on seeking care than the least poor households. The most common coping mechanisms in India and Kenya were “receiving [money] from partner or household members” (69 %) and “using own savings or regular income” (44 %), respectively.ConclusionHighly regressive spending on SRH services highlights the heavier burden borne by the poorest when seeking care in resource-constrained settings such as India and Kenya. The large proportion of service users, particularly in India, relying on money received from family members to finance care seeking suggests that access would be more difficult for those with weak social ties, small social networks or weak bargaining positions within the family - although this requires further study.

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Section: Discussionsupporting

confidence: 86%

Inequity in costs of seeking sexual and reproductive health services in India and Kenya

Haghparast‐Bidgoli

Pulkki-Brännström

Lafort

et al. 2015

Int J Equity Health

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“…We provide some plausible explanations. Public health centers continues to be the mainstay of health services for the poor while rich people preferring to use private health services [63, 64]. This is due to the higher ability to pay for health services among the non-poor, health system of the state and access to health insurance / reimbursement mechanism.…”

Section: Discussionmentioning

confidence: 99%

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

Dash

Mohanty

2019

BMC Public Health

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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.

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“…The regressive system of OOPP for hospitalisation in 2014 is an important finding from a policy perspective. A previous study in India showed that the OOPP for hospitalisation was regressive in 2004 ( Mondal, 2013 ). OOPP in most countries is an especially regressive means of raising healthcare revenues indicating the inability and weakness of the healthcare system in financing and protecting its poor population from negative health shocks ( Pannarunothai and Mills, 1997 , Cisse et al, 2007 , Akazili et al, 2011 , Baji et al, 2012 , Munge and Briggs, 2014 , Bock et al, 2014 , Rezapour et al, 2015 ).…”

Section: Discussionmentioning

confidence: 99%

Inequity in out-of-pocket payments for hospitalisation in India: Evidence from the National Sample Surveys, 1995–2014

Pandey

Clarke

Dandona

et al. 2018

Social Science & Medicine

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ObjectiveWe report inequity in out-of-pocket payments (OOPP) for hospitalisation in India between 1995 and 2014 contrasting older population (60 years or more) with a population under 60 years (younger population).MethodsWe used data from nationwide healthcare surveys conducted in India by the National Sample Survey Organisation in 1995–96, 2004 and 2014 with the sample sizes ranging from 333,104 to 629,888. We used generalised linear and fractional response models to study the determinants of OOPP and their burden (share of OOPP in household consumption expenditure) at a constant price. The relationship between predicted OOPP and its burden with monthly per capita consumption expenditure (MPCE) quintiles and selected socioeconomic characteristics were used to examine vertical and horizontal inequities in OOPP.ResultsThe older population had higher OOPP for hospitalisation at all time points (range: 1.15–1.48 times) and a greater increase between 1995–96 and 2014 than the younger population (2.43 vs 1.88 times). Between 1995–96 and 2014, the increase in predicted mean OOPP for hospitalisation was higher for the poorest than the richest (3.38 vs 1.85 times) older population. The increase in predicted mean OOPP was higher for the poorest (2.32 vs 1.46 times) and poor (2.87 vs 1.05 times) older population between 1995–96 and 2004 than in the latter decade. In 2014, across all MPCE quintiles, the burden of OOPP was higher for the less developed states, females, private hospitals, and non-communicable disease and injuries, more so for the older than the younger population. In 2014, the predicted absolute OOPP for hospitalisation was positively associated with MPCE quintiles; however, the burden of OOPP was negatively associated with MPCE quintiles indicating a regressive system of healthcare financing.ConclusionHigh OOPP for hospitalisation and greater inequity among older population calls for better risk pooling and prepayment mechanisms in India.

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Health care services in India: A few questions on equity

Cited by 9 publications

References 27 publications

Inequity in costs of seeking sexual and reproductive health services in India and Kenya

Inequity in costs of seeking sexual and reproductive health services in India and Kenya

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

Inequity in out-of-pocket payments for hospitalisation in India: Evidence from the National Sample Surveys, 1995–2014

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