ISSN (Print) - 0012-9976 | ISSN (Online) - 2349-8846

Articles By Samik Chowdhury

Urbanicity and Health

Urban health outcomes are characterised by an epidemiologically diverse disease burden and an unequal distribution of the same, which mirrors these contrasts. This paper does a preliminary investigation of disease profiles across size-class of urban settlements in India, with a special focus on non-communicable diseases, using data from the 75th round of the National Sample Survey. This is the first such attempt using nationally representative data. This work has the potential to inform health as well as integrated urban development policies in the country. The work also holds lessons for the expansionary private health sector, which often underserves the smaller urban settlements.

Ayushman Bharat

The Pradhan Mantri Jan Arogya Yojana is an ambitious health insurance scheme that has been touted as an important tool to achieve universal health coverage. However, there is still no clarity regarding the financial implications of this scheme. Based on National Sample Survey data of 2004 and 2014 on hospitalisation rates and average medical expenditures, three alternate scenarios have been analysed based on different assumptions about these two parameters, to estimate the total costs of the programme. The results indicate a potentially high burden of the programme on the state and union government finances, especially if it is successful in covering all the intended beneficiaries.

Designing a Framework for Benefit Packages

Development of an essential health package requires explicit prioritisation on the basis of a country’s characteristics. A practical framework is presented to determine an EHP, considering coverage and equity perspectives for service delivery, financial protection and morbidity burden in the population. An analysis of morbidity data, unmet need for treatment, and impoverishment due to out-of-pocket spending reveals that a significant reduction in oop expenditure and impoverishment is possible through targeted inclusion of potentially high impoverishment-causing morbidities in EHPs. Such an approach may offer the desired flexibility in decision-making to policymakers, without compromising on benefits transferred to the needy.

Financial Burden of Transient Morbidity: A Case Study of Slums in Delhi

Morbidity and its treatment can be potentially burdensome or even catastrophic for poor households. While public policy has shown some response to this phenomenon, there is scope for improvement of the coverage of the programmes. Health insurance schemes like the Rashtriya Swasthya Bima Yojana cover only conditional hospitalisation expenses. This paper argues that treatment cost incurred on ailments not requiring hospitalisation is also a substantial burden on the urban poor. Based on a case study of 150 slum households in south Delhi with a history of treated ailments within a specific recall period, the study estimates the degree and distribution of this burden across socio-economic and disease characteristics in the sample. The paper argues for a more holistic approach in social safety nets like the RSBY, and for explicitly including uncovered healthcare payments in measurement of the poverty lines for a more accurate estimation of the marginalised.