Declining Free Health Care and Rising Treatment Costs in India: An Analysis of National Sample Surveys 1986–2004

Abstract

The article focuses on trends in health-seeking behaviour of people and choosing between government and private sources, reasons for not accessing health care and the cost of treatment by examining three rounds of NSS data on health care use and morbidity pattern during 1986-87, 1995-96 and 2004. With variation across states, treatment-seeking from public providers has declined and preference for private providers has increased over the period. Although overall health-seeking behaviour has improved for both males and females, a significant percentage of people, more in rural than urban areas, do not seek treatment due to lack of accessibility and consider that the illness is not serious enough to require treatment. The financial reason for not seeking treatment was also an important issue in rural areas. There has also been change in the cost of health care over time. While the health care cost has increased, the gap between the public and the private has reduced, owing to perhaps increased cost of treatment in public health facilities following the levying of user-fees and curtailing distribution of free medicine care. Practically all states reported decline in availability of free both out-patient and in-patient care. The article concludes with supporting the adaptation of innovative public-private partnership in health sector for various services realizing the limitations of the state provision of health, particularly in rural and remote areas, and the growing preference of consumers for private health providers. As effectiveness of public spending also depends on the choice of health interventions, target population and technical efficiency partnering with private health providers could work towards reducing the health inequalities in the country.

Morbidity and Treatment-seeking Behaviour Among Scheduled Tribe in India: A Cross-sectional Study

“…For both acute and chronic illnesses, dependency on private clinic/hospitals for treatment is a major concern. The ST who consulted health providers/personnel for second time for treatment, availing medicines from chemist or going to government health personnel practising in private are concern found in the study and is high in case of Indigenous ST. Gumber et al (2011) study also confirms people reporting lack of access to medical facilities especially in rural areas supporting the evidence that there is a possibility of ensuring better quality of healthcare services for poor, as the better off can possibly afford private healthcare services but not the poor (Gulati et al, 2010).…”

“…A study by Subramanian, Smith, and Subramanyam (2006) examined pattern of health deprivation among Indigenous population and found higher mortality, and excess of tobacco and alcohol consumption among Indigenous population than non-Indigenous population. Moreover, studies have revealed that poor healthcare behaviour and low level of health services utilisation are directly linked with services availability, quality of care and confidence in institutions among different sections of the people (Duraisamy, 2001; Gulati, Singh, Raushan, & Arundhati, 2010; Gumber & Bermen, 1997; Gumber, Dhak, & Lalitha, 2011; Islam & Tahir, 2002; Nyamongo, 2002; Raushan & Mutharayappa, 2014). Second, due to distinctive culture and means (non-availability of healthcare facilities) most of the ailments either go untreated or are addressed through other means of treatment ranging from alternative systems to home remedies to witchcraft and so on.…”

Health Issues and Challenges among Indian Urban Poor

“…A significant percentage of Indians avoid seeking treatment when they are ill due to a lack of knowledge about the importance of sickness, accessibility and financial problems. The gap between private and public healthcare has been decreased by increasing the healthcare costs and reducing the availability of free in-patient and out-patient care (Gumber, Dhak & Lalitha, 2012). User charge has negative effects on hospitalization among the poor (Prinja, Aggarwal, Kumar & Kanavos, 2012).…”

“…Preference to seek treatment from private providers has increased, whereas preference to seek treatment from public providers has declined (Gumber et al, 2012). Indians receive low quality and quantity of healthcare services in the private and public sectors.…”

Situational Analysis of Healthcare Delivery and User Perspectives of Mobile Diagnostics (mDiagnostics) in Chennai, Tamil Nadu, India: A Mixed-Method Study

“…The healthcare disparities between rural and urban areas have been a longstanding concern, and efforts to bridge this gap have been a priority for policymakers and public health experts. In recent years, the introduction of mobile health services especially lab facilities has emerged as a potential solution to improve healthcare access and delivery in rural India [ 5 ].…”