Main Factors Leading to Supplier-Induced Demand in Iran: A Comprehensive Review

Seyedin, Hesam; Afshari, Mahnaz; Isfahani, Parvaneh; Rakhshan, Amir; Hasanzadeh, Ebrahim; Taherimirghaed, Masood

doi:10.5812/jhealthscope.96366

Cited by 5 publications

(6 citation statements)

References 31 publications

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“…Why were the private hospitals more expensive? Many studies have reported that over-charging from patients remains a common practice in the Indian private sector [ 33 – 37 ]. Another factor could be the tendency of private providers to push unnecessary and costly procedures, drugs and tests [ 38 – 45 ].…”

Section: Discussionmentioning

confidence: 99%

“…The current study covered the early days of the PMJAY policy but it seems that the key limitations of earlier PFHI schemes have persisted in its implementation. A qualitative study has highlighted the failure of contracts in regulating provider behavior and the normative and cultural context in which over-charging persists under PFHI in India [ 37 ]. Considering the above findings, demand-side spending through PFHI does not seem to be an effective strategy for reducing OOPE in the Indian context.…”

Section: Discussionmentioning

confidence: 99%

“…Quality of care is poorly regulated in private hospitals in India [ 46 ]. There has been little conclusive evidence in India whether private hospitals provided a better quality of care than public hospitals [ 10 , 32 , 37 – 40 , 63 ]. It has been suggested that greater competition among providers can influence cost but the current study did not examine this aspect [ 62 ].…”

Section: Discussionmentioning

confidence: 99%

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How much do government and households spend on an episode of hospitalisation in India? A comparison for public and private hospitals in Chhattisgarh state

et al. 2022

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Background Improvements in the financing of healthcare services are important for developing countries like India to make progress towards universal health coverage. Inpatient-care contributes to a big share of total health expenditure in India. India has a mixed health-system with a sizeable presence of private hospitals. Existing studies show that out-of-pocket expenditure (OOPE) incurred per hospitalisation in private hospitals was greater than public facilities. But, such comparisons have not taken into account the healthcare spending by government. Methods For a valid comparison between public and for-profit private providers, this study in Indian state of Chhattisgarh assessed the combined spending by government and households per episode of hospitalisation. The supply-side and demand-side spending from public and private sources was taken into account. The study used two datasets: a) household survey for data on hospital utilisation, OOPE, cash incentives received by patients and claims raised under publicly funded health insurance (PFHI) schemes (n = 903 hospitalisation episodes) b) survey of public facilities to find supply-side government spending per hospitalisation (n = 64 facilities). Results Taking into account all relevant demand and supply side expenditures, the average total spending per day of hospitalisation was INR 2833 for public hospitals and INR 6788 for private hospitals. Adjusted model for logarithmic transformation of OOPE while controlling for variables including case-mix showed that a hospitalisation in private hospitals was significantly more expensive than public hospitals (coefficient = 2.9, p < 0.001). Hospitalisations in private hospitals were more likely to result in a PFHI claim (adjusted-odds-ratio = 1.45, p = 0.02) and involve a greater amount than public hospitals (coefficient = 0.27, p < 0.001). Propensity-score matching models confirmed the above results. Overall, supply-side public spending contributed to 16% of total spending, demand-side spending through PFHI to 16%, cash incentives to 1% and OOPE to 67%. OOPE constituted 31% of total spending per episode in public and 86% in private hospitals. Conclusions Government and households put together spent substantially more per hospitalisation in private hospitals than public hospitals in Chhattisgarh. This has important implications for the allocative efficiency and the desired public-private provider-mix. Using public resources for purchasing inpatient care services from private providers may not be a suitable strategy for such contexts.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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How much do government and households spend on an episode of hospitalisation in India? A comparison for public and private hospitals in Chhattisgarh state

et al. 2022

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“…Different methods of payment and compensation have a significant effect on the professional behavior of physicians and could encourage them to induce demand for profit and self-interest. [ 25 26 27 28 29 ] Studies have shown that the FFS system is directly associated with an increase in the quantity of services provided. [ 30 31 32 ] Giuffrida and Gravelle studied the market for night visits in primary care and found that an increase in fees for night visits by general practitioners (GPs) led to large increases in the number of visits.…”

Section: Discussionmentioning

confidence: 99%

The main factors of supplier-induced demand in health care

Seyedin

Afshari

Isfahani

et al. 2021

Journal of Education and Health Promotion

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BACKGROUND: Induced demand is a major challenge for financing health promotion, whereby providers exploit patients' information gap to manipulate their demand for health care. The purpose of this study was to identify the factors associated with induced demand for health-care services in hospitals affiliated with Iran University of Medical Sciences (IUMS) in 2018. MATERIALS AND METHODS: In this qualitative study, semi-structured interviews were conducted with 20 participants from IUMS hospitals, including faculty members, physicians, public hospital managers, patients, and researchers with academic and practical experience. Inductive content analysis was used to analyze the data. RESULTS: Overall, 24 subthemes or factors were identified and classified into the health system, the insurer, health-care provider, and health-care recipient themes. Poor monitoring and control, the fee-for-service payment system, limited role of insurance companies, insufficient monitoring of insurance companies, the educational nature of our health centers, health-care providers' interests, and patients' information gap were some important factors in induced demand for health-care services. CONCLUSION: Our results showed that there are many factors that contribute to induced demand for health care. Given the four levels of factors identified in this study, health policymakers and managers must develop strategies at each level to reduce induced demand for health care.

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“…Many of the problems private sector in India have been echoed for many other LMICs [59]. Possibility of provider induced demand has been pointed out as a key problem with for-pro t providers and an important cause of high OOPE [76][77][78][79]. Some have indicated that public funded and privately provided care suffers from provider capture [80].…”

Section: Discussionmentioning

confidence: 99%

Assessing the Pattern of Utilisation and Out of Pocket Expenditure in Public and Private Hospitals in India – Lessons for Universal Health Coverage from the Healthcare Rounds of National Sample Survey 1996 to 2017

Garg

Bebarta

Tripathi

2020

Preprint

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Introduction: Out of Pocket Expenditure (OOPE) contributes to impoverishment and Catastrophic Health Expenditure (CHE) and restricts equitable access to healthcare in many Low and Medium Income Countries (LMICs), including India. Indian government has implemented different strategies to expand access and to reduce OOPE in public and private hospitals in its mixed healthcare system. The study aims to assess the long-term pattern of utilization, OOPE and CHE in public and private hospitals and to draw policy lessons for Universal Health Coverage in India. Methods: Indian government conducts periodic household surveys called National Sample Survey (NSS). Unit data from the last four rounds of NSS (1996 to 2017) on healthcare utilization were analysed. Multivariate analysis was used to find out determinants of utilization, choice of provider, OOPE and CHE. Propensity Score Matching was applied to find effect of specific variables on OOPE and CHE. Results: The share of public-sector in hospital-utilisation fell from 1996 to 2004 but grew consistently after 2004, reaching 51% of utilization in 2017. Socio-economically vulnerable sections were more likely to utilize public-sector. Mean OOPE per hospitalization in public-sector registered a decline from 2004 to 2017, while it increased substantially in private-sector. OOPE in private sector was around six times greater than public sector in 2017 and incidence of CHE was nine times. Utilising private-sector was an important determinant of incurring CHE. Coverage under publicly funded insurance was ineffective in reducing OOPE or CHE. Discussion: Public sector provided effective protection to the poor from financial risk. While, the structural-adjustment policies of 1990s had resulted in reduction in public-sector utilisation, the supply-side strengthening of public sector after 2005 was more effective in improving access and financial-protection. For achieving UHC, Indian health-system needs increased public funding for strengthening public-sector, especially to provide services for NCDs and injuries. Persistently high OOPE in private-sector raises doubts whether public-funding or contracting can align provider incentives with goals of UHC. The debate on public-private provider mix and financing policies continues to hold relevance for health-systems performance across LMICs.

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Main Factors Leading to Supplier-Induced Demand in Iran: A Comprehensive Review

Cited by 5 publications

References 31 publications

How much do government and households spend on an episode of hospitalisation in India? A comparison for public and private hospitals in Chhattisgarh state

How much do government and households spend on an episode of hospitalisation in India? A comparison for public and private hospitals in Chhattisgarh state

The main factors of supplier-induced demand in health care

Assessing the Pattern of Utilisation and Out of Pocket Expenditure in Public and Private Hospitals in India – Lessons for Universal Health Coverage from the Healthcare Rounds of National Sample Survey 1996 to 2017

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