Private health care in developing countries

Mather, Ian; Ramaiah, Sam; Crowley, Philip

doi:10.1136/bmj.324.7328.47

Cited by 6 publications

(3 citation statements)

References 2 publications

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“…The results of our study revealed that, during an attack of perceived serious morbidity of any kind, 41.4% of the patients visited organized private-sector facilities compared to 25.7% to the government facilities as the highest healthcare resources. A similar situation prevails in neighbouring India where results of a study of healthcare-seeking among the scheduled castes showed that 38% sought private medical help when their children became ill compared to only 28% from government health facilities (23). This is also apparent from the present study that, for more than one-fourth of rural populations even during their serious morbidities, the highest level of care was informal care providers.…”

Section: Discussionmentioning

confidence: 74%

Perceptions of Quality of Care for Serious Illness at Different Levels of Facilities in a Rural Area of Bangladesh

Anwar

2009

J Health Popul Nutr

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This study was conducted to explore care-seeking for perceived serious morbidities and users' perceptions about quality of care at different facilities in Matlab, Bangladesh. This is a secondary analysis of baseline community survey data of the Matlab Essential Obstetric Care Project conducted in 2001. Principal component and factor analysis methods were used for computing summary quality and socioeconomic indicators. During perceived serious morbidity of any household member within the last one year, 88.1% (776/881) used health resource outside home. Of them, 25.6% visited informal care providers, 17.8% peripheral public facilities, 7.9% tertiary hospitals, 7.3% facilities of non-governmental organizations, and 41.4% private facilities as the highest healthcare resources. Socioeconomic status and type of morbidity were significant predictors for choice of the highest level of care. Most (86.1%) of those who sought care outside the home were satisfied with the quality of services provided for their last serious morbidities. Users of organized private-sector and tertiary facilities perceived the quality of services better than users of informal care providers and peripheral public facilities. Behaviour and attitude of the service providers and availability of medicines were significant predictors for perceived quality of care. Peripheral public-health facilities were of poor quality and grossly under-used. Further research should explore the technical aspect of quality of care in different facilities, along with perceptions of service providers to design client-focused interventions to impact the use of healthcare services. There is no reason to overlook informal care providers, they should rather be trained and monitored.

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Section: Discussionmentioning

confidence: 74%

Perceptions of Quality of Care for Serious Illness at Different Levels of Facilities in a Rural Area of Bangladesh

Anwar

2009

J Health Popul Nutr

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“…Another important element that influences healthcare expenditures is the growing trend in the use of private services through non-governmental organizations and informal providers in slum settlements [ 17 , 126 , 127 ], which may lead to the high cost of care for acute conditions for slum-dwellers. This trend was observed for obstetric care in Nairobi, Kenya where women residents of poor settlements were more likely to give birth in private services compared with women residents of better-off settlements [ 127 ].…”

Section: Discussionmentioning

confidence: 99%

The economics of healthcare access: a scoping review on the economic impact of healthcare access for vulnerable urban populations in low- and middle-income countries

Filha

Phillips‐Howard

et al. 2022

Int J Equity Health

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Background The growing urban population imposes additional challenges for health systems in low- and middle-income countries (LMICs). We explored the economic burden and inequities in healthcare utilisation across slum, non-slum and levels of wealth among urban residents in LMICs. Methods This scoping review presents a narrative synthesis and descriptive analysis of studies conducted in urban areas of LMICs. We categorised studies as conducted only in slums, city-wide studies with measures of wealth and conducted in both slums and non-slums settlements. We estimated the mean costs of accessing healthcare, the incidence of catastrophic health expenditures (CHE) and the progressiveness and equity of health expenditures. The definitions of slums used in the studies were mapped against the 2018 UN-Habitat definition. We developed an evidence map to identify research gaps on the economics of healthcare access in LMICs. Results We identified 64 studies for inclusion, the majority of which were from South-East Asia (59%) and classified as city-wide (58%). We found severe economic burden across health conditions, wealth quintiles and study types. Compared with city-wide studies, slum studies reported higher direct costs of accessing health care for acute conditions and lower costs for chronic and unspecified health conditions. Healthcare expenditures for chronic conditions were highest amongst the richest wealth quintiles for slum studies and more equally distributed across all wealth quintiles for city-wide studies. The incidence of CHE was similar across all wealth quintiles in slum studies and concentrated among the poorest residents in city-wide studies. None of the definitions of slums used covered all characteristics proposed by UN-Habitat. The evidence map showed that city-wide studies, studies conducted in India and studies on unspecified health conditions dominated the current evidence on the economics of healthcare access. Most of the evidence was classified as poor quality. Conclusions Our findings indicated that city-wide and slums residents have different expenditure patterns when accessing healthcare. Financial protection schemes must consider the complexity of healthcare provision in the urban context. Further research is needed to understand the causes of inequities in healthcare expenditure in rapidly expanding and evolving cities in LMICs.

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“…Cancer treatment in India is high-priced and health insurance only benefi ts the upper-and-middle classes but not the poor. Therefore impoverished cancer victims have a higher probability of dying of cancer 3 . Besides, there are no public-funded tertiarycare cancer hospitals in rural India, leaving the poor without any coverage.…”

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confidence: 99%

Elderly and impoverished cancer patients need urgent help in India

Agoramoorthy¹,

Shieh²,

Horng³

2012

Rev. méd. Chile

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Un modelo asistencial para pacientes ancianos y pobres con cánceres, en la India Dear Editor: India leads the world in the number of cases of oral and throat cancer. Moreover, 900,000 people are diagnosed with cancer each year and 50% of them are destined to die within the fi rst year 1 . This letter presents new data on how a nonprofi t center called the Kailash Cancer Hospital in India (Goraj, Gujarat State) provides cost-effective cancer treatment for the poor people. The model presented here has the potential to be replicated in other developing nations.A total of 81 patients (54% females) were treated for cancer from January 2008 to August 2009. More patients came from towns (55.6%) than villages (44.4%) showing increased awareness in urban areas. The patients' occupation included farming (27.2%), followed by homemaking (21.0%), daily abor in construction jobs (14.8%), factory working (14.8%), unemployed (8.6%), retired (3.7) and miscellaneous (driver, maid, tailor, priest, etc; 9.9%). The mean age of the 81 patients was 53.7 ± 5.0 years (range 50-71, 81.5% aged between 50 to 59 years, 16.1% aged between 60 to 69 years and 2.4% over 70 years).The average cost of treatment was USD 582.7 ± 231.7, (range 177.1-1458.3), which is four times cheaper than other hospitals. There were no gender differences in costs. Radiotherapy was the form of treatment mostly used (77.8%) followed by surgery (12.3%) and chemotherapy (9.9%). The original bill and actual amount paid by patients differed signifi cantly (Kruskal-Wallis test, p < 0.05) among the three treatment types and the poor received signifi cant discounts for treatment (Figure 1).Radiotherapy was the most expensive form of treatment, (USD 608.1 ± 208.8 n = 63), which was 1.6 times the cost of chemotherapy (USD 382.8 ± 180.2, n = 8,). Patients paid the highest amounts for radiotherapy (USD 404.6 ± 195.4, n = 63), representing nearly 1.4-1.9 times of the costs of surgery and chemotherapy (Figure 1). The differences of total costs and the actual amount paid, were signifi cantly different between radiotherapy and chemotherapy (Wilcoxon rank test, P < 0.01).

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Private health care in developing countries

Cited by 6 publications

References 2 publications

Perceptions of Quality of Care for Serious Illness at Different Levels of Facilities in a Rural Area of Bangladesh

Perceptions of Quality of Care for Serious Illness at Different Levels of Facilities in a Rural Area of Bangladesh

The economics of healthcare access: a scoping review on the economic impact of healthcare access for vulnerable urban populations in low- and middle-income countries

Elderly and impoverished cancer patients need urgent help in India

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