‘Having the card makes us feel worthless’:the negative value of government-funded health insurance in India

Since the 2000s, hundreds of government-funded health insurance (GFHI) schemes were introduced in India. These schemes are meant to prevent poorer households from incurring catastrophic health expenditures. Through GFHIs, policy-makers want to mobilize the decision-making powers of private consumers in a liberalized healthcare market. Patients are called upon to act as ‘co-creators’ of healthcare value by optimizing supply through demand. Based on long-term ethnographic fieldwork with insurance users in South India, we argue that GFHIs fail because people experience the value of insurance in drastically different ways that only partly overlap with how the policy assumes they value insurance. In addition, the hollow promises of health coverage can be experienced as so frustrating that signing up for health insurance actually makes people feel devalued.</p

Persistence of Non-Communicable Diseases, Affluence and Inequality in India

This study builds on the extant literature by highlighting the persistence of non-communicable diseases (NCDs), their cross-associations, and how these diseases are linked to different forms of inequality-socio-economic, gaps in affluence measured by asset quartile, and in the overall economic environment, based on a nation-wide panel survey, India Human Development Survey 2015. A multinomial probit specification is used to analyse NCD outcomes. Those at the bottom of the caste hierarchy and least wealthy exhibit lowest vulnerability to NCDs despite their deprivation and limited access to healthcare facilities while those at the higher end of the caste hierarchy and the wealthiest are most vulnerable. However, overall economic inequality, using Piketty’s (2013) measure, is insidious as it corrodes social cohesion and support, and the capability to live a healthy and productive life. New light is thrown on whether social networks are associated with better NCD outcomes. So policy interventions have to be not just medical but much broader in scope

Poverty Transitions, Health, and Socio-Economic Disparities in India

SDGs offer an inclusive and just vision for 2030, in which the interrelationships between (near) elimination of poverty, health reforms and elimination of socio-economic disparities play an important role. The present study focuses on the associations between poverty transitions over a period, and health indicators such as NCDs, disabilities, socio-economic disparities, state affluence and inequality in income distribution. These health indicators reflect their growing importance in recent years. We have used a Multinomial Probit specification which is an improvement on the methodologies used in earlier research. The analysis is based on panel data from the India Human Development Survey 2015. What our analysis emphasises is that changes in the prevalence of poverty/headcount ratio over time do not throw light on how poverty has evolved: whether there were escapes from poverty, whether there were descents into poverty, whether segments persisted in poverty, and whether (the relatively) affluent remained largely unaffected. A significant contribution of this study is to explore the relationships between such poverty transitions and NCDs and disabilities, socio-economic disparities and other covariates. The analysis confirms these linkages. Drawing upon this analysis and other relevant research, policy challenges in achieving the SDG vision of an inclusive and fair economy are delineated

Trust in Hospitals-Evidence from India

Various explanations have been offered for outbursts of violence against doctors and other staff in India, drawing attention to growing supply-demand imbalance in healthcare, quality deterioration, overburdened doctors, weak security for medical staff, high expectations of patients who come in advanced stages of chronic and other illnesses, overcrowding of public hospitals with limited sanitary facilities. But underlying all these explanations is lack of trust in doctors and hospitals-especially public. Our focus here is on trust and its covariates over the period 2005-2012. The motivation stems from the fact that the existing evidence is patchy and scattered. Our aim, therefore, is to build on the empirical evidence through a systematic state-of-art analysis of trust in public and private hospitals and doctors. Combining our analysis with other evidence, we identify specific challenges to build patient-hospital trust and how these could be overcome

Aging, Disability and Disease in India

Obtaining detailed evidence on disabilities and their covariates is important as India’s elderly population (60 years or more) is growing three times faster than the population as a whole. This study is the first of its kind to provide an analysis of disability and its covariates among the elderly in 2012, based on the India Human Development Survey 2015, a nationally representative panel survey. Our analysis throws light on factors associated with (reported) disabilities in 2012.Given better reporting of disabilities in 2012, we examine the role of their covariates in 2005. Variations in both disabilities by count and type are analysed. Based on probit and ordered probit specifications, we find that vulnerability of the elderly people to (reported) disabilities in 2012 is associated with important covariates in 2005: a largely rural population, low assets, non-communicable diseases (NCDs), disabilities, lack of school education, widowhood, aging, and lack of participation in social networks. Similar associations are found for variations in disabilities by type in 2012, using the covariates in 2005..Thus disabilities are not just a medical or social problem but an outcome of their interplay. While the Rights of Persons with Disabilities Act 2016 is laudable in its intent and procedural detail, it is largely silent on disabilities among the elderly. A major overhaul of the health system is proposed to address better the disabilities of India’s aging population

Employment, Aging and Disease in India

The literature on the associations between NCDs and disabilities, and loss of employment in India is patchy and sparse. Although insightful, these studies are long on economic losses through high out of pocket expenditure (OOP) and cutbacks in non-medical expenditure, but they are short on employment losses. Besides, most are based on not-so-recent data. The present study seeks to fill these gaps using a nation-wide panel survey, the India Human Development Survey 2015, that covers the period between 2005-2012. A state-of-art econometric analysis confirms that substantial employment losses are associated with non-communicable diseases such as diabetes, heart disease and high blood pressure (NCDs) and disabilities (or limitations in carrying out ADL) with appropriate controls. The economic burden of NCDs is already enormous and is set to grow rapidly. Scaling-up the prevention and control of NCDs is very low cost compared to this burden, and would provide substantial returns to health and productivity. Prevention of NCDs should be thus a major priority for India. Health and labour market policies have considerable potential for mitigating the detrimental labour market impacts of ill-health, and thus enable better lives and a more inclusive economy

The Role of Public Trust in People\u27s Subjective Well-Being

Kenneth Arrow, perhaps the most influential economist after John Maynard Keynes in the 20th century, viewed trust as a lubricant that fosters cooperative behaviour and thus facilitates mutually advantageous economic exchanges in the presence of incomplete contracts and imperfect information. Recent research has confirmed the beneficial effects of trust in government on economic performance. The obverse, that an erosion of trust in public institutions (state, judiciary and police) has deleterious effects on economic performance, is equally true. Various recent accounts do not just corroborate an erosion of trust in governance, but also point to the imperative of strengthening it to break out of the deep recession that India’s economy is in. The fiscal stimulus has been too little, too late

RT-kNNS Unbound: Using RT Cores to Accelerate Unrestricted Neighbor Search

The problem of identifying the k-Nearest Neighbors (kNNS) of a point has proven to be very useful both as a standalone application and as a subroutine in larger applications. Given its far-reaching applicability in areas such as machine learning and point clouds, extensive research has gone into leveraging GPU acceleration to solve this problem. Recent work has shown that using Ray Tracing cores in recent GPUs to accelerate kNNS is much more efficient compared to traditional acceleration using shader cores. However, the existing translation of kNNS to a ray tracing problem imposes a constraint on the search space for neighbors. Due to this, we can only use RT cores to accelerate fixed-radius kNNS, which requires the user to set a search radius a priori and hence can miss neighbors. In this work, we propose TrueKNN, the first unbounded RT-accelerated neighbor search. TrueKNN adopts an iterative approach where we incrementally grow the search space until all points have found their k neighbors. We show that our approach is orders of magnitude faster than existing approaches and can even be used to accelerate fixed-radius neighbor searches.Comment: This paper has been accepted at the International Conference on Supercomputing 2023 (ICS'23

Generalized Neighbor Search using Commodity Hardware Acceleration

Tree-based Nearest Neighbor Search (NNS) is hard to parallelize on GPUs. However, newer Nvidia GPUs are equipped with Ray Tracing (RT) cores that can build a spatial tree called Bounding Volume Hierarchy (BVH) to accelerate graphics rendering. Recent work proposed using RT cores to implement NNS, but they all have a hardware-imposed constraint on the type of distance metric, which is the Euclidean distance. We propose and implement two approaches for generalized distance computations: filter-refine, and monotone transformation, each of which allows non-euclidean nearest neighbor queries to be performed in terms of Euclidean distances. We find that our reductions improve the time taken to perform distance computations during the search, thereby improving the overall performance of the NNS

Growing Burden of Non-Communicable Diseases in India

The present study provides detailed evidence on NCDs and their covariates. This is particularly relevant in the present Indian context, as the elderly population ≥ 60 years is growing three times faster than the population as a whole. It is projected that the percentage of elderly people will more than double between 2010-2050. Alongside, old age morbidity (NCDs and their multi-morbidities) has risen significantly during 2004-2014. Using National Sample Survey data for 2004 and 2014, and ordered probit models, the underlying covariates are uncovered. There is a marked shift of NCDs and multi-morbidities from the younger to the old population. Some of the covariates associated with lower prevalence of NCDs and their multi-morbidities include women, education, physical activity, drinking water through tubewells and hand pumps, Scheduled Castes/Scheduled Tribes (the lowest rung of socio-economic hierarchy), while those associated with higher prevalences include urbanisation, widowed and divorced/separated, and being affluent. Above all, there is a (residual) positive time effect confirming higher prevalences of NCDs and their multi-morbidities. On current evidence, given the increases in life expectancy, it is uncertain whether the additional years have translated into healthier and longer lives or longer years of morbidity. The policy challenge, however, is daunting, requiring greater funding for health care, reorientation of the health care system to serve the old better and tackle the growing burden of NCDs and their multi-morbidities, expansion of pension and health insurance, and behavioural changes (e.g., curbing of alcohol consumption, smoking and lifestyle changes) necessary for healthy living