Health Sector Reforms and Changes in Prevalence of Untreated Morbidity, Choice of Healthcare Providers among the Poor and Rural Population in India

Document Type: Original Article

Author

Centre for Health Policy, Planning and Management, School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, India

Abstract

Background
India’s health sector witnessed some major policy changes in 1990s that aimed at making health services more accessible to the population.
 
Methods
In this paper, I tried to present some preliminary results of the significant changes that occurred between 1995/6 and 2004, especially in relation to the question of access to healthcare for the poor and rural population using data from 52nd (1995–6) and 60th round (2004) of National Sample Survey Organization on ‘morbidity and healthcare’.
 
Results
The analysis suggests that overall utilization of healthcare services have declined and the odds of not seeking care due to financial inability has further increased among the poor and rural population during the period of reforms. Results of the multivariate logit regression model indicate that the non-poor, middle and above educated people were having greater likelihood of using services from private health care provider.
 
Conclusion
Interestingly, poor and rural residents were more likely to have used healthcare from public facilities in 2004 than in 1995–6, suggesting that the shift from private to public sector is encouraging, provided they receive good quality health care services at public facilities and do not face catastrophic health expenditures.

Keywords

Main Subjects


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1.  Lindelow M. The Utilization of Curative Health Care in Mozambique: Does Income Matter? [internet]. 2003. Available from: http://www.economics.ox.ac.uk/Centre-for-the-Study-of-African-EconomiesSeries/the-utilization-of-curative-health-care-in-mozambiquedoes-income-matter

2.  Mbatia PN, Bradshaw YW. Responding to Crisis: Patterns of Health Care Utilisation in Central Kenya Amid Economic Decline. Afr Stud Rev2003; 46: 69–92. doi: 10.2307/1514981

3.  Sarma S, Simpson S. A micro-econometric analysis of Canadian health care utilisation. Health Econ2006; 15: 219–39.

4.  Trivedi PK. Patterns of health care utilization in Vietnam: analysis of 1997-98 Vietnam Living Standards Survey Data [internet]. 2002. Available from: http://elibrary.worldbank.org/doi/book/10.1596/1813-9450-2775 doi: 10.1596/1813-9450-2775

5.  Mwabu G, Ainsworth M, Nyamete A. Quality of medical care and choice of medical treatment in Kenya: an empirical analysis. J Hum Resour 1993; 28: 838–62. doi: 10.2307/146295

6.  Paul G, Locay L, Sanderson W, Dor A, van der Gaag J. Health Care Financing and the Demand for Medical Care (LSMS Working Paper). Washington, DC: World Bank; 1990.

7.  Government of India. Health Sector Reforms in India: Initiatives from Nine States.New Delhi: Directorate General of Health Services, Ministry of Health and Family Welfare; 2003.

8.  Sen G, Iyer A, George A. Structural Reforms and Health Equity: A Comparison of NSS Surveys, 1986-87 and 1995-96. Econ Polit Wkly2002; 37: 1342–52.

9.  Sekher TV, Bhide S, Islam MN, Das Gupta M. Public Health and Panchayati Raj Institutions in Karnataka. Bangalore: Institute for Social and Economic Change; 2006.

10.  Mooij J, Dev M. Social sector priorities: an analysis of budgets and expenditures in India in the 1990s. Dev Policy Rev2002; 22: 97–120. doi: 10.1111/j.1467-8659.2004.00240.x

11.  Peters DH, Yazbeck AS, Sharma RR, Ramana GNV, Lant H. Pritchett and Adam Wagstaff. Better Health Systems for India’s Poor: Findings, Analysis and Options. Washington, DC: World Bank; 2002. doi: 10.1596/0-8213-5029-3

12.  Bhat R. Regulation of the private health sector in India. Int J Health Plann Manage 1996; 11: 253–74. doi: 10.1002/(SICI)1099-1751(199607)11:3<253::AID-HPM435>3.0.CO;2-N

13.  National Sample Survey Organisation (NSSO). Morbidity and Treatment of Ailments.New Delhi: Ministry of Statistics and Programme Implementation; 1998.

14.  Government of India. Drugs (Prices Control) Order 1995. Department of Chemicals and Petrochemicals. Bombay: Organisation of Pharmaceutical Producers of India; 1996.

15.  National Commission on Macroeconomics and Health (NCMH). Financing and delivery of health care services in India.New Delhi: Government of India; 2005.

16.  Culyer AJ. Need: The Idea Won’t Do—But We Still Need It. Soc Sci Med 1995; 40: 727–30. Doi: 10.1016/0277-9536(94)00307-F

17.  Culyer AJ, Wagstaff A. Equity and Equality in Health and Health Care. J Health Econ1993; 12: 431–57. doi: 10.1016/0167-6296(93)90004-X

18.  Murray CJL, Chen LC. Understanding morbidity changes. Popul Dev Rev 1992; 18: 481–503.

19.  Ghosh S. Equity in the utilzation of healthcare services in India: evidence from National Sample Survey. Int J Health Policy Manag 2014; 2: 29–38. doi: 10.15171/ijhpm.2014.06

20.  Madhiwala N, Nandraj S, Sinha R. Health of households and women’s lives: study of illness and child bearing among women in Nashik district. Mumbai: Centre for Enquiry into Health and Allied Themes; 2000.

21.  Bhatia J, Cleland J. Determinants of maternal care in a region of India. Health Transit Rev1995; 5: 127–42.

22.  Bang RA, Bang AT, Baitule M, Choudhary Y, Sarmukaddam S, Tale O. High prevalence of gynaecological diseases in rural Indian women. Lancet1989; 1: 85–8. doi:10.1016/S0140-6736(89)91438-4

23.  Ghosh S, Arokiasamy P. Emerging patterns of reported morbidity and hospitalisation in West Bengal, India. Glob Public Health 2010; 5: 427–40. doi: 10.1080/17441692.2010.480845

24.  Thakur H, Ghosh S. User-fees in India’s health sector: Can the poor hope for any respite? Artha Vijnana 2009; 51: 139–58.

25.  Sodani PR, Kumar RK, Srivastava J, Sharma L. Measuring patient satisfaction: a case study to improve quality of care at public health facilities. Indian J Community Med 2010; 35: 52–6. doi: 10.4103/0970-0218.62554

26.  Ghosh S. Catastrophic payments and impoverishment due to out of pocket health spending. Econ Polit Wkly[serial on the internet]. 2011. Available from: http://www.epw.in/special-articles/catastrophic-payments-and-impoverishment-due-out-pockethealth-spending.html doi: 10.2139/ssrn.1658573

27.  Government of India. National Rural Health Mission Document. New Delhi: Ministry of Health and Family Welfare; 2005.