BackgroundTo achieve the Sustainable Development Goals, Indian States have implemented different strategies to arrest high out-of-pocket expenditure (OOPE) and to increase equity into healthcare system. Tamil Nadu (TN) and Rajasthan have implemented free medicine scheme in all public hospitals and West Bengal (WB) has devised Fair Price Medicine Shop (FPMS) scheme, a public-private-partnership model in the state. In this background, the objectives of the paper are to -Study the utilization pattern of public in-patient care facilities for the states,Examine the effectiveness of the strategies adopted by the states to arrest high OOPE andAnalyze the extent of equity in public in-patient care services in the states.MethodsNational Sample Survey (71st and 60th round) data, Detailed Demand for Grants of the state governments and the National Rural/Urban Health Mission data have been used for the study. Exploratory data analysis and benefit incidence analysis have been applied to estimate the utilization, OOPE and extend of equity in the states.ResultsThe results show that overall utilization of public facilities in TN and Rajasthan has increased substantially; whereas, utilization of public facility has decreased in WB even among the poorest. In addition, OOPE for both medical and medicine is the highest in WB among three states for public sector hospitalizations. Surprisingly, OOPE on medicine is the highest for the poorest class of WB. Analysis showed that the mismatch between actual need and FPMS drug-list has led to high OOPE in the state. Overall, benefit incidence of public subsidy is the highest among the poorest class in all the states. However, geographical sector-wise inequity in public subsidy distribution persists in the states. Analysis of cost of inpatient care shows that TN provides the maximum subsidy for hospitalization and WB provides the minimum. An inverse relationship between utilization of inpatient care and public subsidy has been observed from the analysis.ConclusionIn conclusion we could say that TN & Rajasthan have successfully implemented their health financing strategies to reduce the health expenditure burden. However, policy-level changes are required to improve the situation in WB.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3633-5) contains supplementary material, which is available to authorized users.

Background: Out of eight commonly agreed Millennium Development Goals (MDG), six are related to the attainment of Universal Health Coverage (UHC) throughout the globe. This universalization of health status suggests policies to narrow the gap in access and benefit sharing between different socially and economically underprivileged classes with that of the better placed ones and a consequent expansion of subsidized healthcare appears to be a common feature for most of the developing nations. The National Health Policy in India (2002) suggests expansion of market-based care for the affording class and subsidized care for the deserving class of the society. So, the benefit distribution of this limited public support in health sector is important to examine to study the welfare consequences of the policy. This paper examines the nature of utilization to inpatient care by different socio-economic groups across regions and gender in West Bengal (WB), India. The benefit incidence of public subsidies across these socio-economic groups has also been verified for different types of services like medicines, diagnostics and professional care etc. Methods: National Sample Survey Organization (NSSO) has collected information on all hospitalized cases (60 th round, 2004) with a recall period of 365 days from the sampled households through stratified random sampling technique. The data has been used to assess utilization of healthcare services during hospitalization and the distribution of public subsidies among the patients of different socio-economic background; a Benefit Incidence Analysis (BIA) has also been carried out. Results: Analysis shows that though the rate of utilization of public hospitals is quite high, other complementary services like medicine, doctor and diagnostic tests are mostly purchased from private market. This leads to high Out-of-Pocket (OOP) expenditure. Moreover, BIA reveals that the public subsidies are mostly enjoyed by the relatively better placed patients, both socially and economically. The worse situation is observed for gender related inequality in access and benefit from public subsidies in the state. Conclusion: Focused policies are required to ensure proper distribution of public subsidies to arrest high OOP expenditure. Drastic change in policy targeting is needed to secure equity without compromising efficiency.

BackgroundRapid ageing of the population and increasing non-communicable diseases (NCDs) among the elderly is one of the major public health challenges in India. To achieve the Universal Health Coverage, ever-growing elderly population should have access to needed healthcare, and they should not face any affordability related challenge. As most of the elderly suffers from NCDs and achieving health-equity is a priority, this paper aims to - study the utilization pattern of healthcare services for treatment of NCDs among the elderly; estimate the burden of out-of-pocket expenditure for the treatment of NCDs among the elderly and analyze the extent of equity in distribution of public subsidy for the NCDs among the elderly.MethodsNational Sample Survey data (71st round) has been used for the study. Exploratory data analysis and benefit incidence analysis have been applied to estimate the utilization, out-of-pocket expenditure and distribution of public subsidy among economic classes. Concentration curves and indices are also estimated.ResultsResults show that public-sector hospitalization for NCDs among the elderly has a pro-rich trend in rural India. However, in urban sector, for both inpatient and outpatient care the poorest class has substantial share in utilization of public facilities. Same result is also observed for rural outpatient care. Analysis shows that out-of-pocket expenditure is very high for both medicine and medical care even in public facilities for all economic groups. It is also observed that medicine has the highest share in total medical expenses during treatment of NCDs among the elderly in both the region. Benefit incidence analysis shows that the public subsidy has a pro-rich distribution for inpatient care treatment in both the sectors. In case of outpatient care, subsidy share is the maximum among the richest in the urban sector and in the rural region the poorest class gets the maximum subsidy benefit.ConclusionsIt is evident that a substantial share of the public subsidies is still going to the richer sections for the treatment of NCDs among the elderly. Evidences also suggest that procuring medicines and targeted policies for the elderly are needed to improve utilization and equity in the public healthcare system.

BackgroundThe National Health Mission (NHM) aims to improve maternal and child health by community mobilisation, increased health workforce and structural strengthening of health infrastructure, especially in high-focus Empowered Action Group (EAG) and North East (NE) states. NHM focuses on the continuum of care approach, particularly by increasing institutional deliveries. Increasing fund allocation from central and state governments has operationalised NHM interventions. Little is known about the utilisation, equity and distribution of benefits of public sector deliveries. This study presents a benefit incidence analysis of childbirth subsidies in EAG, NE and other Indian states, before and after NHM implementation.MethodsBenefit incidence analysis of childbirth in public hospitals was estimated using nationally representative data collected by the National Sample Survey Organization from 73,868 (2004) and 65,932 (2014) households. Information on childbirth by public and private facilities was used to estimate childbirth utilisation rates, net subsidy of public utilisation (private minus public prices) and benefit incidence. Net benefit was estimated by mean public and private-sector childbirth expenditures disaggregated by region, economic quartile and rural/urban residence. Benefit incidence was estimated for household expenditure quintiles for EAG, NE, and other states, separately for 2004 and 2014.ResultsIn 2004, 76% of total deliveries in EAG, 61% in NE and 32% in other states occurred at home. In the same year, 11% of all deliveries in EAG, 21% in NE and 33% in other states were attended in public facilities. In 2014, public institutional deliveries (as a share of total deliveries) increased to 56% in EAG, 74% in NE and 47% in other states. Mean out-of-pocket spending on childbirth in public facilities declined from INR 1163 in 2004 to INR 815 in 2014 (at a constant 2004 prices). In 2004, childbirth utilisation rates were highest in the third and the fourth economic quintiles in NE, the first and the second economic quintiles in EAG, and the second and the third economic quintiles in other states. In 2014, highest public facility utilisation rates were in the first economic quintile in all states. In NE states, there was a 78% increase in utilisation in the first quintile and 47% increase in the second quintile. In EAG states, highest increase in utilisation was in the middle quintile. In all other states, there was 61% increase in the first quintile utilisation rates. For the poorest (the first and the second) quintiles, the share of benefit incidence increased from 16% to 47% in NE, 31% to 47% in EAG, and 16% to 60% in other states, between 2004 and 2014. Nationally, this increased from 20% to 53%. In NE states, the majority share of benefit incidence was by the fourth quintile in 2004 (34%), which reduced to 17% with the highest share by the lowest quintile (28%) in 2014. In EAG states, the lowest quintile share of benefit incidence increased from 13% to 27% while the share of the second lowest quintile...

No abstract