Background: Despite large investment in central and state sponsored schemes for maternal care, out-of-pocket expenditure (OOPE) and catastrophic health spending (CHS) on institutional delivery remain high over time, across states and across socioeconomic groups. Though many studies have examined the OOPE and CHS, few studies have examined the nature and extent of distress financing on institutional delivery in India. Data: Data from the fourth round of National Family Health Survey (NFHS 4), 2015-16 was used for the analysis. Distress financing was defined as borrowing money or selling assets to meet the OOPE on delivery care. Composite variables, descriptive analyses, concentration index (CI), concentration curve (CC) and predicted probability were used to estimate the extent of distress financing for institutional delivery in India. Results: The OOPE on institutional delivery has strong economic and educational gradient. One in four mothers resorted to borrowing or selling to meet the OOPE on institutional delivery. The extent of distress financing on institutional delivery was high in poorer state of Bihar and Odisha and in the state of Telangana that had highest prevalence of caesarean delivery. Savings was more prevalent among mothers compared to those who met the OOPE by borrowing/selling of assets. Finding are robust across the states of India. The predicted probability of incurring distress financing was 0.31 among mothers belonging to the poorest wealth quintile compared to 0.09 in the richest quintile, and 0.40 for those who incurred OOPE of more than INR 20,000. The probability of incurring distress financing was higher for mothers who had caesarean birth, delivered in private health centers and incurred high OOPE on institutional delivery. Conclusion: Distress financing on institutional delivery was higher among the less educated, poor and in private health centers. Increasing use of public health centers, reducing caesarean births, improving the availability of medicine and diagnostic services can reduce the extent of distress financing in India.
The purpose of this article is to identify the dimensions of service quality (SQ) in the banking sector and examine the effect of SQ dimensions on customer satisfaction (CS), and therefore the effect of CS on corporate image (CI) in the selected public sector banks (PSBs) in India. The sample of the study consists of 640 retail customers of PSBs in the National Capital Region (NCR) of India and the data were collected through a structured questionnaire using a 7-point Likert scale based on purposive sampling. Therefore, the authors empirically validate a measurement model using structural equation modelling (SEM) through path analysis. The findings revealed that ‘tangibility’ and ‘assurance’ dimensions were most important predictors of CS among all five dimensions of SQ. In addition, the results also validate that CS is an important antecedent for influencing CI, and therefore CS acts as a linkage between SQ dimensions and CI in the Indian context. Finally, the research article presents the conclusion, implications and limitations and the possible directions for further research.
Despite the continuous global and national effort, India is far away from achieving universal immunization coverage. The primary objective of this paper is to find the spatial pattern and correlates of the full immunization coverage gap in the districts of India. Data and methods: We used data from the fourth round of the National Family Health Survey (NFHS-4) conducted in 2015-16. Moran's I, univariate and bivariate Local Indicator of Spatial Association (LISA) analysis had been used to assess the spatial autocorrelation, clustering, and risk factors of the full immunization coverage gap in the districts of India. Results: The full immunization coverage gap among children has reduced by 33% over 2005-15. Around half of the children in 163 districts of India were deprived of full immunization. The spatial pattern of immunization coverage identified 99 districts as hot spots, whereas 111 as cold spots. Results from the bivariate LISA map signifies that the districts with higher coverage gap in full immunization also had higher deficit in pre-natal and post-natal care and skilled birth attendant. The spatial regression model revealed that female literacy, femaleheaded households, antenatal, and post-natal care have a significant association with full immunization coverage in India. Conclusion:The existence of clusters indicates the presence of unevenness in immunization coverage and has several implications that should be addressed for better health of the population. Efforts are to be made to ensure the universalization of education, along with accessible and affordable healthcare for all ensuring universal health coverage in India.
Background The National Health Mission (NHM), the largest ever publicly funded health programme worldwide, used over half of the national health budget in India and primarily aimed to improve maternal and child health in the country. Though large scale public health investment has improved the health care utilization and health outcomes across states and socio-economic groups in India, little is known on the equity concern of NHM. In this context, this paper examines the utilization pattern and net benefit of public subsidy for institutional delivery by the level of care in India. Methods Data from the most recent round of the National Family Health Survey (NFHS 4), conducted during 2015–16, was used in the study. A total of 148,645 last birth delivered in a health centre during the 5 years preceding the survey were used for the analyses. Out-of-pocket (OOP) payment on delivery care was taken as the dependent variable and was analysed by primary care and secondary level of care. Benefits Incidence Analysis (BIA), descriptive statistics, concentration index (CI), and concentration curve (CC) were used to do the analysis. Results Institutional delivery from the public health centres in India is pro-poor and has a strong economic gradient. However, about 28% mothers from richest wealth quintile did not pay for delivery in public health centres compared to 16% among the poorest wealth quintile. Benefit incidence analyses suggests a pro-poor distribution of institutional delivery both at primary and secondary level of care. In 2015–16, at the primary level, about 32.29% of subsidies were used by the poorest, 27.22% by poorer, 20.39% by middle, 13.36% by richer and 6.73% by the richest wealth quintile. The pattern at the secondary level was similar, though the magnitude was lower. The concentration index of institutional delivery in public health centres was − 0.161 [95% CI, − 0.158, − 0.165] compared to 0.296 [95% CI, 0.289, 0.303] from private health centres. Conclusion Provision and use of public subsidy for institutional delivery in public health centres is pro-poor in India. Improving the quality of service in primary health centres is recommended to increase utilisation and reduce OOP payment for health care in India.
Background: Large scale public investment in family welfare programme has made female sterilization a free service in public health centers in India. Besides, it also provides financial compensation to acceptors. Despite these interventions, the use of contraception from private health centers has increased over time, across states and socioeconomic groups in India. Though many studies have examined trends, patterns, and determinants of female sterilization services, studies on out-of-pocket payment (OOP) and compensations on sterilisation are limited in India. This paper examines the trends and variations in out-of-pocket payment (OOP) and compensations associated with female sterilization in India. Methods: Data from the National Family Health Survey-4, 2015-16 was used for the analyses. A composite variable based on compensation received and amount paid by users was computed and categorized into four distinct groups. Multivariate analyses were used to understand the significant predictors of OOP of female sterilization. Results: Public health centers continued to be the major providers of female sterilization services; nearly 77.8% had availed themselves of free sterilization and 61.6% had received compensation for female sterilization. About two-fifths of the women in the economically well-off state like Kerala and one-third of the women in a poor state like Bihar had paid but did not receive any compensation for female sterilization. The OOP on female sterilization varies from 70 to 79% across India. The OOP on female sterilization was significantly higher among the educated and women belonging to the higher wealth quintile linking OOP to ability to pay for better quality of care. Conclusion: Public sector investment in family planning is required to provide free or subsidized provision of family welfare services, especially to women from a poor household. Improving the quality of female sterilization services in public health centers and rationalizing the compensation may extend the reach of family planning services in India.
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