Rising Private Sector and Falling ‘Good Health at Low Cost’: Health Challenges in China, Sri Lanka, and Indian State of Kerala

Thresia, C. U.

doi:10.2190/hs.43.1.c

Cited by 26 publications

(13 citation statements)

References 46 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…12 The causes of Kerala's unexpectedly high CVD prevalence are widely debated, but the urgent need for improved CVD prevention and control is undisputed. 7 13–17 …”

Section: Introductionmentioning

confidence: 99%

Potential for the use of mHealth in the management of cardiovascular disease in Kerala: a qualitative study

et al. 2015

View full text Add to dashboard Cite

ObjectivesTo assess the potential for using mHealth in cardiovascular disease (CVD) management in Kerala by exploring: (1) experiences and challenges of current CVD management; (2) current mobile phone use; (3) expectations of and barriers to mobile phone use in CVD management.DesignQualitative, semistructured, individual interviews.Setting5 primary health centres in Ernakulam district, Kerala, India.Participants15 participants in total from 3 stakeholder groups: 5 patients with CVD and/or its risk factors, 5 physicians treating CVD and 5 Accredited Social Health Activists (ASHAs). Patients were sampled for maximum variation on the basis of age, sex, CVD diagnoses and risk factors. All participants had access to a mobile phone.ResultsThe main themes identified relating to the current challenges of CVD were poor patient disease knowledge, difficulties in implementing primary prevention and poor patient lifestyles. Participants noted phone calls as the main function of current mobile phone use. The expectations of mHealth use are to: improve accessibility to healthcare knowledge; provide reminders of appointments, medication and lifestyle changes; save time, money and travel; and improve ASHA job efficacy. All perceived barriers to mHealth were noted within physician interviews. These included fears of mobile phones negatively affecting physicians’ roles, the usability of mobile phones, radiation and the need for physical consultations.ConclusionsThere are three main potential uses of mHealth in this population: (1) as an educational tool, to improve health education and lifestyle behaviours; (2) to optimise the use of limited resources, by overcoming geographical barriers and financial constraints; (3) to improve use of healthcare, by providing appointment and treatment reminders in order to improve disease prevention and management. Successful mHealth design, which takes barriers into account, may complement current practice and optimise use of limited resources.

show abstract

“…12 The causes of Kerala's unexpectedly high CVD prevalence are widely debated, but the urgent need for improved CVD prevention and control is undisputed. 7 13–17 …”

Section: Introductionmentioning

confidence: 99%

Potential for the use of mHealth in the management of cardiovascular disease in Kerala: a qualitative study

et al. 2015

View full text Add to dashboard Cite

show abstract

“…Many have acknowledged the likelihood of market failure in healthcare but have advocated for greater involvement of private-sector by nding methods to mitigate the market-failure [87][88][89][90]. Others have warned that health systems relying predominantly on private-sector are unlikely to achieve meaningful progress towards equity and UHC [91][92][93][94][95][96][97][98]. Proponents of greater role of private-sector feel that its capacity needs to be used to expand access and improve quality [99].…”

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

View full text Add to dashboard Cite

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.

show abstract

“…The data show an increasing trend of private health care usage and of out‐of‐pocket health care expenditures . Kumara and Samaratunga find that on average, more than 60% of households incur out‐of‐pocket health care expenditures.…”

Section: Introductionmentioning

confidence: 95%

Have out‐of‐pocket health care payments risen under free health care policy? The case ofSriLanka

Pallegedara

Grimm

2018

Health Planning & Management

View full text Add to dashboard Cite

SummaryCompared to its neighbors, Sri Lanka performs well in terms of health. Health care is provided for free in the public sector, yet households' out‐of‐pocket health expenditures are steadily increasing. We explore whether this increase can be explained by supply shortages and insufficient public health care financing or whether it is rather the result of an income‐induced demand for supplementary and higher quality services from the private sector. We focus on total health care expenditures and health care expenditures for specific services such as expenses on private outpatient treatments and expenses on laboratory and other diagnostic services. Overall, we find little indication that limited supply of public health care per se pushes patients into the private sector. Yet income is identified as one key driver of rising health care expenditures, ie, as households get richer, they spend an increasing amount on private services suggesting a dissatisfaction with the quality offered by the public sector. Hence, quality improvements in the public sector seem to be necessary to ensure sustainability of the public health care sector. If the rich and the middle class increasingly opt out of public health care, the willingness to pay taxes to finance the free health care policy will certainly shrink.

show abstract

Rising Private Sector and Falling ‘Good Health at Low Cost’: Health Challenges in China, Sri Lanka, and Indian State of Kerala

Cited by 26 publications

References 46 publications

Potential for the use of mHealth in the management of cardiovascular disease in Kerala: a qualitative study

Potential for the use of mHealth in the management of cardiovascular disease in Kerala: a qualitative study

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

Have out‐of‐pocket health care payments risen under free health care policy? The case ofSriLanka

Contact Info

Product

Resources

About