Abstract
Provision of affordable health care to all, irrespective of their paying capacity, is the fundamental duty of a welfare state like India. However, the state has failed to fulfill its promise to provide health security to all. Post liberalization, there is a shift from welfare-oriented government health policies to market-oriented policies. This has further resulted in unregulated and unaccountable expansion of private health care sector. With the involvement of corporate players, the scenario has clearly shifted from ‘mere privatization’ to commercialization and corporatization of the healthcare sector. The new National Health Policy (2017) also promotes such health policies that will further promote the commercialization of services even within public facilities. Although the country has emerged as one of the leading destinations for high-end private healthcare facilities, the private healthcare sector is heterogeneous, widely mal-distributed, and is hardly able to provide minimum quality of care. In a state like Uttar Pradesh, the increasing out-of-pocket expenditure on health is among one of the biggest causes of impoverishment. This article analyzes the pattern of healthcare expenditure in public and private healthcare sectors in the state and how private healthcare market is flourishing at the cost of public healthcare sector. For this, out-of-pocket expenditure (OOPE) on ambulatory care and inpatient care in public and private sectors has been assessed across a sample of 3338 household spread across 47 villages and 13 wards in three districts of Uttar Pradesh. Recall period for inpatient care was 365 days and for outpatient care was 30 days. The findings from the study suggest that although majority of people prefer private healthcare, the choice of private provider depends on the economic status of the people. People from lower economic group seek care from RMPs, unregistered, and informal providers while people from higher income groups seek care from high-end private facilities. The OOPE is high in both public as well as private, more so in private sector. Lack of trained personnel, drugs, and equipment in public healthcare sector is the cause of high OOPE there. The high costs of good quality private healthcare services further deprive the people of lower economic strata from proper healthcare services because of their lack of affordability. Low coverage under health insurance schemes like Rashtriya Swasthya Bima Yojana (RSBY) and dominance of private hospitals in providing treatment under the schemes has also resulted in failure of health insurance in reducing OOPE. Lack of proper regulatory and monitoring authority and legal provisions further leads to exorbitant prices and corrupt practices in private sector. In order to provide universal health coverage and ensure healthcare for all, it is the need of the hour to promote private healthcare sector, but at the same time, it needs to be properly regulated and monitored. The government should strengthen public health system by increasing the public expenditure on preventive and primary healthcare in order to reduce the OOPE on health.
Keywords
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Notes
- 1.
Pre poverty Headcount = \( {\text{Pre}}\;H_{\text{p}} = 1/n\sum {1\,(C_{\text{i}} \le {\text{PL}})} \), where Ci is per capita consumption expenditure, PL is official state poverty line, and n is number of individuals.
- 2.
Post poverty Headcount = \( {\text{Post}}\;H_{\text{p}} = 1/n\sum {1\,(C_{\text{i}} - {\text{OOP}} \le {\text{PL}})} \).
References
8th Common Review Mission, Uttar Pradesh. (2014). NRHM, Ministry of health and family welfare. Government of India.
Basu, S., Andrews, J., Kishore, S., Panjabi, R., & Stuckler, D. (2012). Comparative performance of private and public healthcare systems in low- and middle-income countries: A systematic review. PLoS Med, 9(6), e1001244. https://doi.org/10.1371/journal.pmed.1001244.
Bhojani, U., et al. (2012). Out-of-pocket healthcare payments on chronic conditions impoverish urban poor in Bangalore, India. BMC Public Health, 12(1), 990.
Das, J., & Mohpal, A. (2016). Socioeconomic status and quality of care in rural India: New evidence from provider and household surveys. Health Affairs, 35(10), 1764–1773. https://doi.org/10.1377/hlthaff.2016.0558.
Dholakia, R. H., & Iyengar, S. (2011). Access to rural poor to primary health care in India. Review of Market Integration, 4, 71–109. April, 2012. Sage Working Paper No. 2011-05-03. Ahmadabad: Institute of Management.
Dilip, T. R. (2010). Utilization of inpatient care from private hospitals: Trends emerging from Kerala, India. Health Policy and Planning, 25, 437–446.
Duggal, R. (2006). Utilization of health care services in India. In S. Prasad & C. Sathyamala (Eds.), Securing health for all, dimensions and challenges. New Delhi: Institute for Human Development.
Gadre, A. (2015). India’s private healthcare sector treats patients as revenue generators. BMJ, 350, h826, https://doi.org/10.1136/bmj.h826 (Published February 24, 2015).
Ghosh, S. (2011). Catastrophic payments and impoverishment due to out-of-pocket health spending. Economic and Political Weekly, 46(47), 63–70.
Hooda, S. (2013). Changing pattern of public expenditure on health in India: Issues and challenges (Working Paper Series 1, ISID‐PHFI Collaborative Research Programme).
Hooda, S. K. (2014). Out of pocket expenditure on health and households wellbeing in India: Examining the role of health policy interventions (Working Paper No. 165, ISID-PHFI collaborative research programme).
India Brand Equity Foundation Report. (2017). Healthcare Industry in India, 2017. Retrieved July 23, 2017 from https://www.ibef.Org/industry/healthcare-india.aspx.
Iyengar, S., & Dholakia, R. H. (2012). Access of the rural poor to primary healthcare in India. Review of Market Integration, 4(1), 71–109.
Mills, A., Bennett, S., & Russel, S. (2001). The challenges of health sector reform: What must governments do?. New York: Palgrave Macmillan.
Mohanan, M., Hay, K., & Mor, N. (2016). Quality of health care in india: challenges, priorities, and the road ahead. Health Affairs, 35(10), 1753–1758. https://doi.org/10.1377/hlthaff.2016.0676.
National Sample Survey Office (NSSO). (2014). Economic characteristics of … Ministry of statistics & programme implementation. Government of India.
Planning Commision. (2014). Report of the expert group to review the methodology for measurement of poverty. New Delhi: Government of India.
Prinja, S., et al. (2012). Health care inequities in North India: Role of public sector in universalizing health care. Indian Journal of Medical Research, 136(3), 421–431.
Quadeer, I. (2011). Public health in India: critical reflections. New Delhi: Daanish Books.
Roy, B. (2017). Why public private collaboration is bad news for healthcare in India. The Wire. Retrieved March 20, 2017 from https://thewire.in/117527/ppphealthcarehealthpolicy/.
Saksena, P., et al. (2010). Health services utilization and out-of-pocket expenditure at public and private facilities in low-income countries (World Health Report, Background Paper 20, World Health Organization).
Scott, K. W., & Jha, A. K. (2014). Putting quality on the global health agenda. The New England Journal of Medicine, 371(1), 3–5. https://doi.org/10.1056/nejmp1402157.
Shah, U., & Mohanty, R. (2010). Private sector in Indian healthcare delivery: Consumer perspective and government policies to promote private sector. Information Management and Business Review, 1(2), 79–87.
Shahrawat, R., et al. (2012). Insured yet vulnerable: Out-of-pocket payments and India’s poor. Health Policy and Planning, 27(3), 213–221.
SRS Statistical Report. (2014). Maternal mortality ratio. Bulletin 2011–13. SRS Bulletin.
Sundararaman, T., & Muraledharan, V. R. (2015). Falling sick, paying the price; NSS 71st round on morbidity and costs of healthcare. Economic and Political Weekly, 50(33), 17–20.
Verma, C. S., Singh, Shivani, Ranjan, Alok, & Sundararaman, T. (2017). Healthcare consumption in Uttar Pradesh; Iniquitous growth and the social factors contributing to impoverishment. Economic and Political Weekly, 52(9), 73–81.
The World Bank Annual Report. (2007).
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Singapore Pte Ltd.
About this chapter
Cite this chapter
Verma, C.S., Singh, S. (2019). Burden of Private Healthcare Expenditure: A Study of Three Districts. In: Mamgain, R. (eds) Growth, Disparities and Inclusive Development in India. India Studies in Business and Economics. Springer, Singapore. https://doi.org/10.1007/978-981-13-6443-3_17
Download citation
DOI: https://doi.org/10.1007/978-981-13-6443-3_17
Published:
Publisher Name: Springer, Singapore
Print ISBN: 978-981-13-6442-6
Online ISBN: 978-981-13-6443-3
eBook Packages: Economics and FinanceEconomics and Finance (R0)