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

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Out-of-pocket Expenditure on Healthcare among the Urban Poor in India

Focus on healthcare patterns and their determinants among the urban poor is crucial in order to move towards universal health coverage. However, published literature on these aspects in India is scarce. This study was undertaken to estimate out-of-pocket healthcare expenditures and resultant...

Cost-effectiveness Threshold and Health Opportunity Cost

With the setting up of the health technology assessment board, evidence from cost-effectiveness analysis will play an important role in decision-making. This raises the fundamental question: How much extra cost per unit of health gained is considered cost-effective? Various approaches for assessing the appropriate cost-effectiveness threshold for India are discussed. A robustly determined opportunity cost of healthcare spending should serve as a proxy for setting up a CET, and it should be used to advocate for greater resources towards achieving universal health coverage.

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.

Equity in Hospital Services Utilisation in India

Studies from a number of low-income countries have found that the wealthy often use publicly financed health services at a higher rate than the poor. To examine the situation in India, the use of public and private sector hospital services by economic class was analysed and the relationship between utilisation and public spending on health services and the reported out-of-pocket payments were assessed. Not surprisingly, hospital services in the private sector were found to be significantly pro-rich. In contrast to previous studies, it was found that India's poor report using hospital services in the public sector at a higher rate than the wealthy, particularly in urban areas. However, this varied across states. High OOP expenditure correlated with higher degrees of inequity, and was a likely barrier to accessing care for the poor. Further work is required to explore the significant variation seen between states and to understand the history of its development. A number of policy options are discussed to reduce inequities in access to public health services in India.
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