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

Socio-demographic differentials of adult health indicators in Matlab, Bangladesh: self-rated health, health state, quality of life and disability level

Background: Mortality has been declining in Bangladesh since the mid- twentieth century, while fertility has been declining since the late 1970s, and the country is now passing through the third stage of demographic transition. This type of demographic transition has produced a huge youthful population with a growing number of older people. For assessing health among older people, this study examines self-rated health, health state, quality of life and disability level in persons aged 50 and over. Data and methods: This is a collaborative study between the World Health Organization Study on global AGEing and adult health and the International Network for the Demographic Evaluation of Populations and Their Health in developing countries which collected data from eight countries. Two sources of data from the Matlab study area were used: health indicator data collected as a part of the study, together with the ongoing Health and Demographic Surveillance System (HDSS) data. For the survey, a total of 4,000 randomly selected people aged 50 and over (HDSS database) were interviewed. The four health indicators derived from these data are self-rated health (five categories), health state (eight domains), quality of life (eight items) and disability level (12 items). Self-rated health was coded as dummy while scores were calculated for the rest of the three health indicators using WHO-tested instruments. Results: After controlling for all the variables in the regression model, all four indicators of health (self-rated health, health state, quality of life and disability level) documented that health was better for males than females, and health deteriorates with increasing age. Those people who were in current partnerships had generally better health than those who were single, and better health was associated with higher levels of education and asset score. Conclusions: To improve the health of the population it is important to know health conditions in advance rather than just before death. This study finds that all four health indicators vary by socio-demographic characteristics. Hence, health intervention programmes should be targeted to those who suffer and are in the most need, the aged, female, single, uneducated and poor

Guidelines for pilot study on introducing pay-for-performance (P4P) approach to increase utilization of maternal, newborn and child health services in Bangladesh

The Population Council launched a pilot study to test two Pay-for-Performance (P4P) strategies to improve MNCH services in Bangladesh. This document presents guidelines for offering incentives to providers, distributing coupons, and forming P4P and/or Coupon Committees and Quality Assurance Groups. The guidelines were developed over the course of five policy-level and consensus-building workshops with national and local-level program managers and service providers, organized under the leadership of the DGHS, in consideration of the local context and sustainability in case of nationwide replication in the country. These guidelines will come into effect upon receiving approval from the DGHS, Ministry of Health and Family Welfare, Government of Bangladesh, and remain effective during the pilot project’s intervention period