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Inpatient Healthcare Financing Strategies: Evidence from India

Abstract

Limited availability and accessibility of the public health care facilities have resulted in an increased burden of financing healthcare in developing countries. Therefore, we analyse the inpatient-care financing strategies in India using healthcare and morbidity rounds (1994/1995, 2004, and 2014). Although income and saving is the predominant source of financing healthcare expense constituting a major channel in 70% of the inpatient episodes; the poorest 40% of the households rely more on borrowings, which pushes low-income families into debt and poverty trap. The educated, wealthy, and female tend to rely more on income/saving, while a greater number of visits to the hospital, long duration of stay, and chronic illness are positively associated with the borrowing and sales of assets. Hence, the health care policy, guided by the agenda of Universal Health Cover, should aim to extend health insurance for the chronic recurring illnesses that entail distressed financing strategies.

Résumé

La disponibilité et l'accessibilité limitées des établissements de santé publics ont entraîné une augmentation du fardeau du financement des soins de santé dans les pays en développement. Par conséquent, nous analysons les stratégies de financement des soins hospitaliers en Inde à l'aide des cycles de soins de santé et de morbidité (1994/1995, 2004 et 2014). Bien que le revenu et l'épargne soient la principale source de financement des dépenses de santé, constituant une part majeure dans 70% des cas d'hospitalisation, 40% des ménages les plus pauvres dépendent davantage des emprunts, ce qui précipite les familles à faible revenu dans le cercle vicieux de l'endettement et de la pauvreté. Les personnes instruites, les riches et les femmes ont tendance à dépendre davantage du revenu / de l'épargne, tandis qu'un plus grand nombre de visites à l'hôpital, une longue durée de séjour et une maladie chronique sont positivement associés à l'emprunt et à la vente de biens. Par conséquent, la politique de soins de santé, guidée par l'agenda de la couverture maladie universelle, devrait viser à étendre l'assurance maladie pour les maladies chroniques récurrentes qui entraînent des stratégies de financement désespérées.

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Notes

  1. 1.

    https://indianexpress.com/article/india/of-indias-healthcare-spend-23-out-of-patients-pockets-study.

  2. 2.

    https://nhm.gov.in/index1.php?lang=1&level=1&sublinkid=795&lid=195.

  3. 3.

    Effective income is primarily taken to be a household’s consumption expenditure, which is considered to be a more accurate reflection of purchasing power than income reported in many countries’ household surveys.

  4. 4.

    Sub-groups include rural/urban sector, social group, sex, consumption expenditure quintiles.

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Correspondence to Dil Bahadur Rahut.

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Appendix

Appendix

See Tables 8, 9, 10, 11, 12, 13 and 14.

Table 8 Characteristics of RSBY
Table 9 Multinomial logistic regression: factors influencing the financing strategies for health shocks with insurance and consumption expenditure interaction term
Table 10 Marginal effects from multinomial logistic regression: factors influencing the financing strategies for health shocks by rural and urban
Table 11 Marginal effects from multinomial logistic regression: factors influencing the financing strategies for health shocks by year
Table 12 Marginal effects from ordered logit regression: factors influencing the financing strategies for health shocks (by rural and urban)
Table 13 Marginal effects from ordered logit regression: factors influencing the financing strategies for health shocks (by year)
Table 14 Coefficients from Multivariate Probit Regression: Factors influencing the financing strategies for health shocks

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Manchanda, N., Rahut, D.B. Inpatient Healthcare Financing Strategies: Evidence from India. Eur J Dev Res (2020). https://doi.org/10.1057/s41287-020-00312-w

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Keywords

  • Household
  • Healthcare
  • Financing strategy
  • India

JEL Classification

  • D10
  • I10