Better to Reflect Than Shoot the Messenger

There was a significant reduction in the overall estimated footfall for outpatient and inpatient care at the all-India level between 2014 and 2017–18. However, the reduction in estimated footfalls was significantly higher in private facilities as compared to public facilities. Also, states with better health infrastructure observed a relatively lesser reduction in the overall footfall under public facilities than states with weaker health infrastructure. Across all economic deciles, there was no significant fall in the proportion of patients utilising public healthcare facilities in 2017–18 compared to 2014.

The article “Utilisation of Public Healthcare Facilities: Have They Improved?” (Dilip et al 2021) makes comments on our original article titled “Invest More in Public Healthcare Facilities: What Do NSSO 71st and 75th Rounds Say?” (Muraleedharan et al 2020). We welcome their comments and observations, and would like to respond to and add further reflections on the following four points they have raised: (i) fall in morbidity and hospitalisation; (ii) public healthcare utilisation; (iii) use of government facilities and out-of-pocket expenditure (OOPE); and (iv) efficiency of public healthcare facilities and government financing.

Fall in morbidity and hospitalisation: There was a considerable fall in morbidity, also called the proportion of ailing population (PAP), from 9.8% in 2014 to 7.5% in 2017–18, and the hospitalisation rate from 3.7% in 2014 to 2.8% 2017–18. In our original article, one of the possible reasons behind the PAP fall was inferred to the exclusion of minor ailments (skin, body aches, and abdominal pain) as mentioned under the concept and definition section (Appendix B, page B1, first paragraph) of the National Sample Survey (NSS) report (Government of India 2019). Dilip et al draw our attention to survey instructions to field staff, which remains the same in both the rounds, and we agree with them. However, Dilip et al offer an alternative explanation for this fall as due to “probably a flaw in the weightage provided to the data sets” (p 62).