Socio-Cultural Sustainability of Private Healthcare Providers in an Indian Slum Setting: A Bottom-of-the-Pyramid Perspective

Abstract

Delivery of affordable healthcare services to communities is a necessary precondition to poverty alleviation. Co-creation approaches to the development of business models in the healthcare industry proved particularly suitable for improving the health-seeking behavior of BOP patients. However, scant research was conducted to understand BOP consumers’ decision-making process leading to specific healthcare choices in slum settings, and the relative balance of socio-cultural and socio-economic factors underpinning patients’ preferences. This article adopts a mixed-method approach to investigate the determinants of BOP patients’ choice between private and public hospitals. Quantitative analysis of a database, composed of 436 patients from five hospitals in Ahmedabad, India, indicates that BOP patients visit a public hospital significantly more than top-of-the-pyramid (TOP) patients. However, no significant difference emerges between BOP and TOP patients for inpatient or outpatient treatments. Qualitative findings based on 21 interviews with BOP consumers from selected slum areas led to the development of a grounded theory model, which highlights the role of aspirational demand of BOP patients toward private healthcare providers. Overall, healthcare provider choice emerges as the outcome of a collective socio-cultural decision-making process, which often assigns preference for private healthcare services because of the higher perceived quality of private providers, while downplaying affordability concerns. Implications for healthcare providers, social entrepreneurs, and policy-makers are discussed.

Understanding self‐construction of health among the slum dwellers of India: a culture‐centred approach

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Application of digital technologies in health insurance for social good of bottom of pyramid customers in India

“…About 15 per cent of the 1.3bn population in India has a health insurance coverage and outof-pocket health expenditure is high at 69 per cent of total healthcare expenditure (Chatterjee et al, 2018). Indian consumers in the BoP category spend about 3 per cent of their household expenditure on healthcare and 76 per cent of this amount is for medicines (Angeli et al, 2018). It is necessary to provide a healthcare framework that can address the healthcare needs and health financing needs of the BoP category supported by technological innovations (Matsumoto, 2018).…”

Systematic review of lay consultation in symptoms and illness experiences in informal urban settlements of low-income and middle-income countries

“…30 Non-kin associates These refer to persons connected to an individual through friendship ties, engagement in similar activities or physical proximity. We found three groups under this category: friends, 34 35 neighbours [36][37][38][39] and colleagues. 30 35 Neighbours in shared structures were sometimes consulted or volunteered health advice when they noticed unusual symptoms in others.…”

“…33 Influence positive attitudes towards formal health providers Social networks' influence in encouraging positive attitudes towards formal health providers was discussed in one study. 39 The study explored the decision-making behaviours of bottom-of-the pyramid patients (individuals with comparatively weaker earnings) and found that some patients chose and committed to healthcare providers recommended by their family members and neighbours as trustworthy. This was particularly useful as there was a general attitude of mistrust and uncertainties about formal healthcare services.…”