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

T SundararamanSubscribe to T Sundararaman

Social and Systemic Determinants of Utilisation of Public Healthcare Services in Uttar Pradesh

Building on an earlier publication using the same data set plus case studies of three facilities, the reasons for the low utilisation of public health facilities in Uttar Pradesh despite the prohibitively high costs of care in the private sector are explored. The likelihood of choosing a public provider for hospitalisation care was 4.8 times higher in the poorest quintile and 3.4 times as high for women. Where access to public sector services is an issue, many go without any treatment and this could appear in the data to be a higher proportion of private sector utilisation. Inadequate facility density is one barrier to access. Facilities, which are by policy designed to offer very limited types of services—to collect user fees and prescribe drugs and diagnostics to be bought outside, and with no continuity of care between primary and secondary levels—lead to the diminishing of credibility of the public healthcare services. When services are available and there are incentives that facilitate access, like for childbirth, the choice shifts in favour of public services. Market-defined perceptions of what is good healthcare and an understaffed and demoralised workforce also contribute to poor utilisation.

Healthcare Consumption in Uttar Pradesh

C S Verma ( verma.cs@gmail.com ) is a senior fellow and Shivani Singh ( ssshivani15@gmail.com ) is a research associate at the Giri Institute of Development Studies, Lucknow. Alok Ranjan (alokranjancmc@ gmail.com) is a junior research fellow at the Indian Council of Medical Research and T Sundararaman ( sundar2016@gmail.com ) teaches at the School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai.

No Respite for Public Health

Health allocations in Budget 2016-17, which show a modest increase in nominal terms, must be viewed against the virtual stagnation of allocations since 2010-11, and the major cuts of 2015-16. Meanwhile, state governments' investments in health grew steadily. The centre has only prioritised initiatives that stimulate private health sector growth. This approach will have immediate adverse effects on availability and quality of public health services and will cause impoverishment due to healthcare costs, compromising economic growth in the long run.

NSSO 71st Round Data on Health and Beyond

The overarching policy question in private expenditure on health that we should all be addressing is, “What must the government do to reduce the debilitating (financial) effects of out-of-pocket healthcare expenditure of people?” A response to a comment (EPW, 21 November 2015) on the authors’ earlier piece (EPW, 15 August 2015).

Falling Sick, Paying the Price

The decennial National Sample Survey on health and education provides useful information on the health and education of the population. The summary report on health from the 71st round conducted in 2014 allows us to make an initial assessment of three sets of issues. One, the trends in morbidity rates and patterns of morbidity, two, the effectiveness of the public sector in ensuring access to healthcare, and three, the cost of healthcare across public and private sectors.

Measuring Progress towards Universal Health Coverage

This paper proposes an approach to periodically measure the extent of progress towards universal health coverage using a set of indicators that captures the essence of the factors to be considered in moving towards universalisation. It presents the rationale for the approach and demonstrates its use, based on a primary household survey carried out at the district level. Discussing the strengths and limitations of the approach, it points to how these measures could be further refined. The effort is to find a method of measurement that will apply to any of the alternative ways of progressing towards universal health coverage, however defined and implemented.
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