Cost and Utilisation of Hospital Based Delivery Care in Empowered Action Group (EAG) States of India

Department of Fertility Studies, International Institute for Population Sciences (IIPS), Govandi Station Road, Deonar, Mumbai, 400088, India, .
Maternal and Child Health Journal (Impact Factor: 2.24). 10/2012; 17(8). DOI: 10.1007/s10995-012-1151-3
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Large scale investment in the National Rural Health Mission is expected to increase the utilization and reduce the cost of maternal care in public health centres in India. The objective of this paper is to examine recent trends in the utilization and cost of hospital based delivery care in the Empowered Action Group (EAG) states of India. The unit data from the District Level Household Survey 3, 2007-2008 is used in the analyses. The coverage and the cost of hospital based delivery at constant price is analyzed for five consecutive years preceding the survey. Descriptive and multivariate analyses are used to understand the socio-economic differentials in cost and utilization of delivery care. During 2004-2008, the utilization of delivery care from public health centres has increased in all the eight EAG states. Adjusting for inflation, the household cost of delivery care has declined for the poor, less educated and in public health centres in the EAG states. The cost of delivery care in private health centres has not shown any significant changes across the states. Results of the multivariate analyses suggest that time, state, place of residence, economic status; educational attainment and delivery characteristics of mother are significant predictors of hospital based delivery care in India. The study demonstrates the utility of public spending on health care and provides a thrust to the ongoing debate on universal health coverage in India.

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Available from: Sanjay Mohanty, Oct 05, 2015
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    • "One possible explanation for this is that the implementation of the National Rural Health Mission, a broad programme launched in 2005 to improve rural health services in the public sector [15], may have helped decrease the direct expenses on medical care by the most vulnerable households. This possibility is supported by a recent report which has suggested that the utilization of delivery care from public health facilities has increased in less developed states of India during 2004–08, and that the household cost of delivery care has declined for the poor after adjusting for inflation [16]. Another programme aimed at health protection of the poor, the Rashtriya Swastha Bima Yojna or the National Health Insurance Scheme, was launched in April 2008 to provide cashless insurance for hospitalization to households below the poverty line [17]. "
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    ABSTRACT: Inequities in a population in spending on food and non-food items can contribute to disparities in health status. The Mahatma Gandhi National Rural Employment Guarantee Scheme (MGNREGS) was launched in rural India in 2006, aimed at providing at least 100 days of manual work to a member in needy households. We used nationally representative data from the consumer expenditure surveys of 2004--05 and 2009--10 and the employment survey of 2009--10 conducted by National Sample Survey Organisation to assess the effect of MGNREGS in reducing inequities in consumption of food and non-food items between poor and non-poor households in the states of India. Variations among the states in implementation of MGNREGS were examined using the employment and unemployment survey data, and compared with official programme data up to 2012--13. Inequity in spending on food and non-food items was assessed using the ratio of monthly per capita consumer expenditure (MPCE) between the most vulnerable (labourer) and least vulnerable categories of households. The survey data suggested 1.42 billion person-days of MGNRGES employment in the 2009--10 financial year, whereas the official programme data reported 2.84 billion person-days. According to the official data, the person-days of MGNRGES employment decreased by 43.3% from 2009--10 to 2012--13 for the 9 large less developed states of India. Survey data revealed that the average number of MGNREGS work days in a year per household varied from 42 days in Rajasthan to less than 10 days in 14 of the 20 major states in India in 2009--10. Rajasthan with the highest implementation of MGNRGES among the 9 less developed states of India had the highest relative decline of 10.4% in the food spending inequity from 2004--05 to 2009--10 between the most vulnerable and less vulnerable households. The changes in inequity for non-food spending did not have any particular pattern across the less developed states. In the most vulnerable category, the households in Rajasthan that got 100 or more days of work in a year under MGNREGS had a 25.9% increase in MPCE. MGNREGS seems to have contributed to the reduction in food consumption inequity in rural Rajasthan in 2009--10, and has the potential of making a similar contribution with higher level of implementation of this programme in other states. Non-food consumption inequities benefited less from MGNRGES until 2009--10. The reported decrease in the MGNRGES employment person-days in the less developed states of India from 2009--10 to 2012--13 is of concern.
    International Journal for Equity in Health 10/2013; 12(1):84. DOI:10.1186/1475-9276-12-84 · 1.71 Impact Factor
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    • "The increased public spending on health care and increased access to health insurance can significantly reduce the OOP expenditure on health care. The National Rural Health Mission (NRHM), India is illustrative in this context that has significantly reduced the OOP expenditure on delivery care (Mohanty and Srivastava 2012). With rise in elderly population and the commitment to increase the public spending on health, there is a greater need to reallocate the resources to reduce the burden of OOP health expenditures on elderly. "
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    ABSTRACT: Using the consumption expenditure data, National Sample Survey, 2009–2010, this paper test the hypothesis that the monthly per capita household health spending of elderly households is significantly higher than non-elderly households in India. The households are classified into three mutually exclusive groups; households with only elderly members (elderly households), households with elderly and non-elderly members and households without any elderly member. The health spending include the institutional (hospitalization) and non-institutional health expenditure of the households, standardized for 30 days. Descriptive statistics and a two part model are used to understand the differentials in health expenditures across households. Results indicate that the monthly per capita health spending increases with economic status, occupation, age and educational attainment of the head of the household. The monthly per capita health spending of elderly households is 3.8 times higher than that of non-elderly households. While the health spending accounts 13 % of total consumption expenditure for elderly households, it was 7 % among households with elderly and non-elderly members, and 5 % among non-elderly households. Controlling for socio-economic and demographic correlates, the per-capita household health spending among elderly households and among household with elderly and non-elderly members was significantly higher than non-elderly households. The health expenditure is catastrophic for poorer households, casual labourer and households with elderly members. Based on the finding we suggest to increased access to health insurance and public spending on geriatric care to reduce the out-of-pocket expenditure on health care in India. Keywords Out-of-pocket expenditure � Elderly � Non-elderly � Health care � India
    Social Indicators Research 02/2013; 115(3). DOI:10.1007/s11205-013-0261-7 · 1.40 Impact Factor
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    ABSTRACT: Aim Using the Demographic and Health Survey datasets from India (2005–2006), Bangladesh (2007) and Pakistan (2006–2007), this study attempts to analyze the factors associated with utilization of maternal health-care services among Muslim women residing in each country. Subject and methods Three crucial components of maternal health care were considered: women having four or more antenatal care (ANC) visits, deliveries conducted in a health facility, and deliveries conducted by a skilled health attendant (SBA). Descriptive statistics and binomial logistic regression methods were applied to understand the net effect of predictor variables on selected outcomes. Results This study identified that the place of residence, a woman’s education, the partner’s education, respondent’s age at birth, birth order, and wealth quintile were significantly associated with the utilization of selected maternal health-care services. Muslim women in India were more likely to have at least four or more ANC visits and opt for the SBA care than in Bangladesh and Pakistan. Also, India performed better in extending medically facilitated delivery care compared to Bangladesh. Conclusion The programs and policies formulated for improving maternal health-care utilization need to be understood in depth across these countries. For example, factors associated with increasing uptake of maternal health care services among Muslim women in India may be understood in the context of strengthening the Health and Population Sector Program (HPSP) in Bangladesh, and intensification of maternal health care programs undertaken in Pakistan at the upzilla (sub-district) level.
    02/2015; 23(1). DOI:10.1007/s10389-014-0651-6