Rising healthcare costs and universal health coverage in India: an analysis of national sample surveys, 1986-2014

This paper focuses on the trends in health seeking behaviour of people and the cost of treatment and key determinants of health insurance premium payments amongst BPL and APL households by examining the National Sample Survey data pertaining to four rounds of 1986-87, 1995-96, 2004 and 2014. With variation across states, it is found that treatment seeking from public providers has declined and preference for private providers increased over the period. Although overall health seeking behaviour has improved for male and female population, a significant percentage of people, more in rural than in urban areas, do not seek treatment due to lack of accessibility and a perception that illness is ‘not serious enough to require treatment’. While the health care cost has increased over time, the gap between public and private costs has reduced owing perhaps to the increased cost of treatment in public health facilities following the levying of users fees and restrictions on distribution of free medicine. Since the mid-2000s, to address healthcare needs of the poor section of society, the public insurance companies introduced low-cost hospitalisation insurance schemes such as Jan Arogya Bima Policy and Rashtriya Swasthya Bima Yojana. The analysis of the insurance premium showed that a larger proportion of households who had paid premium in 2004 as well as in 2014 belonged to higher Monthly Per Capita Expenditure (MPCE) group and was economically non-poor. Further, the inter-quintile MPCE differential (between the top and bottom quintile) shows vast inter-state inequalities in terms of both percentage of households who paid a premium and percentage having health insurance coverage. The determinants of a household getting enrolled for health insurance suggest that the gaps in odds ratios of several attributes either got reduced in magnitude or disappeared mainly due to encouraging enrollment from the poor households in RSBY. At all India level, the insured BPL/APL households on average had reported higher hospitalisation expenses than the non-insured households with much higher differential for urban households, thus indicating moral hazard and insurance collusions particularly in cities of economically prosperous states of Punjab, Haryana, Gujarat, and Maharashtra. The analysis further demonstrated that the insurance has provided a very minimal financial relief to BPL households especially living in rural India

Inter-state disparities in healthcare Costs, health insurance coverage and financial protection in India: a comparative analysis of national sample surveys for 1986-87, 1995-96, 2004 and 2014

By analysing data from the National Sample Survey for four rounds (1986–87, 1995–96, 2004 and 2014) this research focuses on changes in people's health seeking behaviour, the cost of treatment, and principal factors affecting health insurance premium payments by BPL and APL families. With variations between states, it is discovered that over time, less people sought care from public providers and more people preferred private providers. Despite the fact that both men and women are now more likely to seek treatment for their illnesses, a sizeable portion of the population (more in rural than in urban areas), still refuses treatment because they believe their illness is not serious enough to warrant it. Whilst the cost of healthcare has gone up over time, the difference between public and private costs of treatment has shrunk, possibly as a result of the higher recurring cost in public health facilities and imposing of user fees and cutting on the delivery of free medication. Since the middle of the 2000s, public insurance companies have offered low-cost hospitalisation insurance programmes like the Jan Arogya Bima Policy and Rashtriya Swasthya Bima Yojana (RSYB) to help with the healthcare needs of the underprivileged sector of society. According to the insurance premiums, more households that paid premiums in 2004 and 2014 belonged to groups with higher Monthly Per Capita Expenditures (MPCE) and were not economically in the poorest tier. The inter-quintile MPCE differential (between the top and bottom quintile) also reveals significant inter-state disparities in terms of the percentage of households that paid a premium and the percentage of households that had health insurance. The factors that determine whether a family enrols in health insurance imply that increasing enrolment from the poor households got coverage through RSBY. At the national level, BPL/APL households with insurance reported, on average, higher hospitalisation costs than non-insured households, with the difference being significantly higher for urban households. This finding suggests the prevalence of insurance collusion and moral hazard, particularly in the cities from developed states of Punjab, Haryana, Gujarat, and Maharashtra. Further, BPL households, particularly from rural India, have received very little financial relief as a result of the insurance

Trends and Patterns in Health Care Use and Treatment Costs in India during 1986 and 2004

This paper focuses on trends in health seeking behaviour of people and choosing between government and private sources, reasons for not accessing health care and the cost of treatment by examining three Rounds of NSS data on health care use and morbidity pattern during 1986-87, 1995-6 and 2004. With variation across states, treatment seeking from public providers has declined and preference for private providers has increased over the period. Although overall health seeking behaviour has improved for both male and females, a significant percentage of people, more in rural than urban areas, do not seek treatment due to lack of accessibility and think illness not serious enough requiring treatment. The financial reason for not seeking treatment was also an important issue in rural areas. There has also been change in the cost of health care over time. While the health care cost has increased, the gap between public and private has reduced owing to perhaps increased cost of treatment in public health facility following the levying of users fees and curtailing distribution of free medicine. Practically all states reported decline in availability of free both outpatient and inpatient care. The paper concludes with supporting the adaptation of innovative public-private partnership in health sector for various services realizing the limitations of the state provision of health particularly in rural and remote areas and the growing preference of consumers for the private health providers. As effectiveness of public spending also depends on the choice of health interventions, target population and technical efficiency partnering with private health providers could work towards reducing the health inequalities in the country

Trends and Patterns in Health Care Use and Treatment Costs in India during 1986 and 2004

This paper focuses on trends in health seeking behaviour of people and choosing between government and private sources, reasons for not accessing health care and the cost of treatment by examining three Rounds of NSS data on health care use and morbidity pattern during 1986-87, 1995-6 and 2004. With variation across states, treatment seeking from public providers has declined and preference for private providers has increased over the period. Although overall health seeking behaviour has improved for both male and females, a significant percentage of people, more in rural than urban areas, do not seek treatment due to lack of accessibility and think illness not serious enough requiring treatment. The financial reason for not seeking treatment was also an important issue in rural areas. There has also been change in the cost of health care over time. While the health care cost has increased, the gap between public and private has reduced owing to perhaps increased cost of treatment in public health facility following the levying of users fees and curtailing distribution of free medicine. Practically all states reported decline in availability of free both outpatient and inpatient care. The paper concludes with supporting the adaptation of innovative public-private partnership in health sector for various services realizing the limitations of the state provision of health particularly in rural and remote areas and the growing preference of consumers for the private health providers. As effectiveness of public spending also depends on the choice of health interventions, target population and technical efficiency partnering with private health providers could work towards reducing the health inequalities in the country

Declining free healthcare and rising treatment costs in India: an analysis of national sample surveys 1986-2004

The article focuses on trends in health-seeking behaviour of people and choosing between government and private sources, reasons for not accessing health care and the cost of treatment by examining three rounds of NSS data on health care use and morbidity pattern during 1986–87, 1995–96 and 2004. With variation across states, treatment-seeking from public providers has declined and preference for private providers has increased over the period. Although overall health-seeking behaviour has improved for both males and females, a significant percentage of people, more in rural than urban areas, do not seek treatment due to lack of accessibility and consider that the illness is not serious enough to require treatment. The financial reason for not seeking treatment was also an important issue in rural areas. There has also been change in the cost of health care over time. While the health care cost has increased, the gap between the public and the private has reduced, owing to perhaps increased cost of treatment in public health facilities following the levying of user-fees and curtailing distribution of free medicine. Practically all states reported decline in availability of free both out-patient and in-patient care. The article concludes with supporting the adaptation of innovative public-private partnership in health sector for various services realizing the limitations of the state provision of health, particularly in rural and remote areas, and the growing preference of consumers for private health providers. As effectiveness of public spending also depends on the choice of health interventions, target population and technical efficiency partnering with private health providers could work towards reducing the health inequalities in the country

Contraceptive use and its effect on Indian women\u27s empowerment: Evidence from the National Family Health Survey-4

The positive effect of women’s empowerment on the use of contraceptives is well established. However, the reverse effect, i.e. the potential effect of use of contraceptives on women’s empowerment, is relatively unexplored. This study examined the direct impact of contraceptive use on women’s empowerment in currently married women aged 15–49 years in India using data from the National Family Health Survey-4 conducted in 2015–16. A two-stage least squares (2SLS) regression model was used to account for the issue of endogeneity that appears in a general logit model. The use of contraceptives by the sample women was found to be associated with greater women’s empowerment in terms of both their mobility and decision-making power. The pathways to greater women’s empowerment are often presumed to be factors such as changing perception of their domestic role and sense of control over their own body. While these are integral, this paper highlights how the possible control over family size and birth interval through use of contraception may also be critical pathways to increasing women’s empowerment