Health financing strategies to reduce out-of-pocket burden in India: a comparative study of three states View Full Text


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Article Info

DATE

2018-12

AUTHORS

Montu Bose, Arijita Dutta

ABSTRACT

BACKGROUND: To achieve the Sustainable Development Goals, Indian States have implemented different strategies to arrest high out-of-pocket expenditure (OOPE) and to increase equity into healthcare system. Tamil Nadu (TN) and Rajasthan have implemented free medicine scheme in all public hospitals and West Bengal (WB) has devised Fair Price Medicine Shop (FPMS) scheme, a public-private-partnership model in the state. In this background, the objectives of the paper are to - 1. Study the utilization pattern of public in-patient care facilities for the states, 2. Examine the effectiveness of the strategies adopted by the states to arrest high OOPE and 3. Analyze the extent of equity in public in-patient care services in the states. METHODS: National Sample Survey (71st and 60th round) data, Detailed Demand for Grants of the state governments and the National Rural/Urban Health Mission data have been used for the study. Exploratory data analysis and benefit incidence analysis have been applied to estimate the utilization, OOPE and extend of equity in the states. RESULTS: The results show that overall utilization of public facilities in TN and Rajasthan has increased substantially; whereas, utilization of public facility has decreased in WB even among the poorest. In addition, OOPE for both medical and medicine is the highest in WB among three states for public sector hospitalizations. Surprisingly, OOPE on medicine is the highest for the poorest class of WB. Analysis showed that the mismatch between actual need and FPMS drug-list has led to high OOPE in the state. Overall, benefit incidence of public subsidy is the highest among the poorest class in all the states. However, geographical sector-wise inequity in public subsidy distribution persists in the states. Analysis of cost of inpatient care shows that TN provides the maximum subsidy for hospitalization and WB provides the minimum. An inverse relationship between utilization of inpatient care and public subsidy has been observed from the analysis. CONCLUSION: In conclusion we could say that TN & Rajasthan have successfully implemented their health financing strategies to reduce the health expenditure burden. However, policy-level changes are required to improve the situation in WB. More... »

PAGES

830

References to SciGraph publications

  • 2012-03. Measuring incidence of catastrophic out-of-pocket health expenditure: with application to India in INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT
  • 2013-06. Refining estimates of catastrophic healthcare expenditure: an application in the Indian context in INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT
  • 2012-09. State health insurance and out-of-pocket health expenditures in Andhra Pradesh, India in INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT
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    http://scigraph.springernature.com/pub.10.1186/s12913-018-3633-5

    DOI

    http://dx.doi.org/10.1186/s12913-018-3633-5

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1108013900

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/30390701


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