Public and Private Divide in Health Care Spending in India: What Factors Explains the Gap?

Ram, Harchand (2019): Public and Private Divide in Health Care Spending in India: What Factors Explains the Gap?

Abstract

The rising healthcare cost in low-income countries (LIC) got sparked attention during the last decades. A large part of healthcare expenditure is Out of Pocket (OOP) paid by households. The high cost of treatment was found to reduce essential household expenditure in low and middle-income countries. The burden of the high cost of illness resulting in their catastrophic health expenditure and affect health-seeking behavior with delayed treatment. This study has tried to understand how the hospitalization rate and health care spending are differential in the public and private healthcare facility, and with different types of morbidities. The nationwide survey NSS’s 71st round data has been used for this study. Both Bivariate and multivariate analyses were used. The Oaxaca decomposition has been applied to explain the gap in the means of healthcare expenditure between public and private facilities. The result of this study reveals that that 62 % patient used private facilities, while only 38 % used public health services for inpatient care. The patients with diseases of the genitourinary system preferred more for the private facility (75 %) than the public facility (25 %) among all diseases. The results from the multilevel analysis that the Doctors fees (26.9 %, p<0.001), Bed charges (21.6, p<0.001), expenses on medicines (16.5%, p<0.001) are the significant contributors in explaining the difference in mean expenditure in private and public health facility center in India.

• Item Type: MPRA Paper
• Language: English
• Keywords: Health expenditure, Out of Pocket (OOP), Public and Private Healthcare
• Subjects: H - Public Economics > H0 - General; H - Public Economics > H5 - National Government Expenditures and Related Policies > H51 - Government Expenditures and Health; I - Health, Education, and Welfare > I1 - Health > I10 - General; I - Health, Education, and Welfare > I1 - Health > I13 - Health Insurance, Public and Private

References

Bajpai, V. (2014). The challenges confronting public hospitals in India, their origins, and possible solutions. Advances in Public Health, 2014.

Berman, P., Ahuja, R., & Bhandari, L. (2010). The impoverishing effect of healthcare payments in India: new methodology and findings. Economic and Political Weekly, 65-71.

Binnendijk, H. (2014). Designing Community-Based Health Insurance among Rural Poor in India: A novel time-and cost-effective method for data sourcing. https://repub.eur.nl/pub/50282/

Blinder, A. S. (1973). Wage discrimination: reduced form and structural estimates. Journal of Human resources, 436-455.

Bonu, S., Bhushan, I., Rani, M., & Anderson, I. (2009). Incidence and correlates of ‘catastrophic’ maternal health care expenditure in India. Health policy and planning, 24(6), 445-456.

Daymont, T. N., & Andrisani, P. J. (1984). Job preferences, college major, and the gender gap in earnings. Journal of Human Resources, 408-428.

Dercon, S., Hoddinott, J., & Woldehanna, T. (2005). Shocks and consumption in 15 Ethiopian villages, 1999-2004. Journal of African economies, 14(4), 559.

Duggal, A. R., Srivastava, A. M., Davenport, J. M., Soules, T. F., & Beers, W. W. (2001). U.S. Patent No. 6,294,800. Washington, DC: U.S. Patent and Trademark Office.

Garg, C. C., & Karan, A. K. (2008). Reducing out-of-pocket expenditures to reduce poverty: a disaggregated analysis at rural-urban and state level in India. Health policy and planning, 24(2), 116-128.

Ghosh, S. (2011). Catastrophic payments and impoverishment due to out-of-pocket health spending. Economic and Political Weekly, 63-70.

Hammer, J., Aiyar, Y., & Samji, S. (2007). Understanding government failure in public health services. Economic and Political Weekly, 4049-4057.

Jann, B. (2008). The Blinder-Oaxaca decomposition for linear regression models. The Stata Journal, 8(4), 453-479.

Jones, F. L., & Kelley, J. (1984). Decomposing differences between groups: A cautionary note on measuring discrimination. Sociological Methods & Research, 12(3), 323-343.

KPMG (2010). Health Care: Reaching out to the masses. Pan IIT Conclave 2010. Available from http://www.kpmg.com/IN/en/Pages/default.aspx. Accessed 5 July 2014.

Kumar, Shailender. 2015. PRIVATE SECTOR IN HEALTHCARE DELIVERY MARKET IN INDIA: Structure, Growth and Implications. Working paper 185, Institute for Studies in Industrial Development (ISID).

Ladusingh, L., & Pandey, A. (2013). High inpatient care cost of dying in India. Journal of Public Health, 21(5), 435-443.

Leive, A., & Xu, K. (2008). Coping with out-of-pocket health payments: empirical evidence from 15 African countries. Bulletin of the World Health Organization, 86, 849-856C.

Mohanty, S. K., & Srivastava, A. (2012). Out-of-pocket expenditure on institutional delivery in India. Health policy and planning, 28(3), 247-262.

MoHFW (2002), National Health Policy 2002. Ministry of Health and Family Welfare, Government of India. https://www.nhp.gov.in/sites/default/files/pdf/NationaL_Health_Pollicy.pdf

MoHFW (2005). National Rural Health Mission. Ministry of Health and Family Welfare, Government of India. http://www.nipccd-earchive.wcd.nic.in/sites/default/files/PDF/NRHM%20-%20Framework%20for%20Implementation%20-%20%202005-MOHFW.pdf

MoHFW (2012). National Urban Health Mission Framework for Implementation. Ministry of Health and Family Welfare, Government of India. http://nhm.gov.in/nhm/nuhm.html

MoSPI, 2016. National Sample Survey Organisation, Social Consumption: Health; NSS 71st Round (January-June 2014). 2016, New Delhi: Ministry of Statistics and Programme Implementation, Government of India, [http://microdata.gov.in/nada43/index.php/catalog/135/related_materials]

Oaxaca, R. (1973). Male-female wage differentials in urban labor markets. International economic review, 693-709.

OECD Statistics. (2018). OECD Health Statistics 2018 is available at www.oecd.org/health/healthdata.

Purohit, B. C. (2001). Private initiatives and policy options: recent health system experience in India. Health policy and planning, 16(1), 87-97.

Quintussi, M., Van de Poel, E., Panda, P., & Rutten, F. (2015). Economic consequences of ill-health for households in northern rural India. BMC health services research, 15(1), 179.

Raban, M. Z., Dandona, R., & Dandona, L. (2013). Variations in catastrophic health expenditure estimates from household surveys in India. Bulletin of the World Health Organization, 91, 726-735.

Rao, K. S. (2016). Do We Care?: India’s Health System. Oxford University Press.

Ravi, S., Ahluwalia, R., & Bergkvist, S. (2016). Health and Morbidity in India (2004-2014). Brookings India.

Selvaraj, S., & Karan, A. K. (2009). Deepening health insecurity in India: evidence from national sample surveys since 1980s. Economic and Political Weekly, 55-60.

Sengupta, A., & Nundy, S. (2005). The private health sector in India. https://www.bmj.com/content/331/7526/1157.short

Sharma D 2015Concern over private sector tilt in India’s new health policy

Winsborough, H. H., & Dickinson, P. (1971). Components of negro-white income differences. Age, 25(34), 35-44.

World Health Organization. (2017). Tracking universal health coverage: 2017 global monitoring report.

World Health Statistics. (2013). World Health Statistics 2013. World Health Organization, Geneva, 2013. https://www.who.int/gho/publications/world_health_statistics/EN_WHS2013_Full.pdf