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1
Kalpanapriya, D., M. Mubashir Unnissa, and Rakshanya Sekar. "A Case Study of Health Expenditure in India." International Journal of Engineering & Technology 7, no. 4.10 (October 2, 2018): 252. http://dx.doi.org/10.14419/ijet.v7i4.10.20907.
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The article aims in analysing healthcare expenditure of India, as it struggles to meet the health care requirements of all the citizens. In order to acheieve this, it is important to understand the trends in healthcare expenditure of the country to create a sustainable health expenditue model. Post millenium, with various reforms and increased awareness, a certain redistribution can be observed among different arms that contribute to total healthcare expenditure.This study reviews and summarise the expenditure trends between the years 2004 and 2014. Numerical illustrtions are also provided to show the government and private sectors contributions on the health care products.
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Shaikh, Imlak Shaikh, and Shabda Singh. "ON THE EXAMINATION OF OUT-OF-POCKET HEALTH EXPENDITURES IN INDIA, PAKISTAN, SRI LANKA, MALDIVES, BHUTAN, BANGLADESH AND NEPAL." Business: Theory and Practice 18 (May 3, 2017): 25–32. http://dx.doi.org/10.3846/btp.2017.003.
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The aim of this study is to analyze the healthcare expenditures in seven South Asian countries namely, India, Pakistan, Sri Lanka, Maldives, Bhutan, Bangladesh and Nepal. The longitudinal data has been taken for 19 years from 1995 to 2013. We specifically examine the out-of-pocket healthcare expenditure in these countries. The per-capita health expenditure differences have been compared. We also develop panel data pooled OLS model for out-of-pocket expenditure with the factors affecting it, i.e. per capita health expenditure, household final consumption expenditure and public health expenditure. The work is in line with the earlier studies of determinants of out-of-pocket health expenditures. The results suggest that Maldives has the highest per capita health expenditure while out-of-pocket health expenditure as a percentage of total expenditure on health is highest for the India. The fixed and random effect is evidenced on health expenses across the years and cross section based on various determinants. The novel aspect of the work is that, this is an attempt to explain healthcare financing in the developing economies. The key determinant of out-of-pocket expenditure is the final household expenditures as the percentage of gross domestic product.
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Bowser, Diana M., Rajesh Jha, Manjiri Bhawalkar, and Peter Berman. "The Challenge of Additionality: The Impact of Central Grants for Primary Healthcare on State-Level Spending on Primary Healthcare in India." International Journal of Health Policy and Management 8, no. 6 (February 18, 2019): 329–36. http://dx.doi.org/10.15171/ijhpm.2019.06.
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Background: In planning for universal health coverage, many countries have been examining their fiscal decentralization policies with the goal of increasing efficiency and equity via "additionalities." The concept of "additionality," when the government of a lower administrative level increases the funding allocated to a particular issue when extra funds are present, is often used in these contexts. Although the definition of "additionality" can be used more broadly, for the purposes of this paper we focus narrowly on the additional allocation of primary healthcare expenditures. This paper explores this idea by examining the impact of central level primary healthcare expenditure, on individual state level contributions to primary healthcare expenditure within 16 Indian states between 2005 and 2013. Methods: In examining 5 main variables, we compared differences between government expenditures, contributions, and revenues for Empowered Action Group (EAG) states, and non-EAG states. EAG states are normally larger states that have weaker public health infrastructure and hence qualify for additional funding. Finally, using a model that captured the quantity of central level primary healthcare expenditure distributions to these states, we measured its impact on each state’s own contributions to primary healthcare spending. Results: Our results show that, at the state level, growth in per capita central level primary healthcare expenditure has increased by 110% from 2005-2013, while state’s own contributions to primary healthcare expenditure per capita increased by 32%. Further analyses show that a 1% change disbursement from the central level leads to a -0.132%, although not significant, change by states in their own expenditure. The effect for wealthier states is -0.151% and significant and for poorer states the effect is smaller at -0.096% and not significant. Conclusion: This analysis suggests that increases in central level primary healthcare expenditure to states have an inverse relationship with primary healthcare expenditures by the state level. Furthermore, this effect is more pronounced in wealthier Indian states. This finding has policy implications on India’s decision to increase block grants to states in place of targeted program expenditures.
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Dehury, Ranjit Kumar, Janmejaya Samal, Shawnn Coutinho, and Parthsarathi Dehury. "How Does the Largely Unregulated Private Health Sector Impact the Indian Mass?" Journal of Health Management 21, no. 3 (September 2019): 383–93. http://dx.doi.org/10.1177/0972063419868561.
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Private hospitals in India are least monitored by the government, which leads to violation of the roles and responsibility they have to offer for the community. Indeed, it is a more serious issue in a country like India where people are forced below poverty line (BPL) after every hospitalization. Of the four different models of health expenditure, India and, in fact, many developing countries follow the out-of-pocket (OOP) expenditure model rampantly. This is very evident from the recent working article (2015) published by NITI Aayog-Health Division, which reveals that OOP expenditures are high in India accounting for 69.5 per cent of total health expenditure. These are catastrophic economic damages for the poor and push an estimated 37 million into poverty each year. Furthermore, 66.4 per cent of the total expenditure is on medicines. A major part of these expenditures are invariably the money spent by a huge section of the community, both rich–poor and rural–urban, on healthcare services availed from the privately run corporate hospitals in India. The sector needs to be sensitive for an inclusive healthcare. However, the situation appears to be the opposite in India and the private health sector creates a divide in the society by virtue of which the rich get medical care and the poor stay sick or die. This article discusses various ethical concerns and remedial measures relating to the functionality of private hospitals which poses serious pressure on the community and marginalized sections of the society.
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Yadav, Jeetendra, Shaziya Allarakha, Denny John, Geetha R. Menon, Chitra Venkateswaran, and Ravinder Singh. "Catastrophic Health Expenditure and Poverty Impact Due to Mental Illness in India." Journal of Health Management 25, no. 1 (March 2023): 8–21. http://dx.doi.org/10.1177/09720634231153210.
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Majority of people in low- and middle-income countries with mental illness do not receive healthcare, leading to chronicity, suffering and increased costs of care. This study estimated the out-of-pocket expenditure (OOPE), catastrophic health expenditure (CHE), and poverty impact due to mental illness in India. Data was acquired from the 76th round data of the National Sample Survey (NSS) on the theme ‘Persons with Disabilities in India Survey’, July–December 2018. Data of 6,679 persons who reported mental illness during the survey was included for analysis. OOPE, CHE, poverty impact and state differentials of healthcare expenditure on mental illness were analysed using standard methods. In total, 18.1% of the household’s monthly consumption expenditure was spent on healthcare on mental illness. About 59.5% and 32.5% of the households were exposed to CHE based on 10% and 20% thresholds, respectively. About 20.7% of the households were forced to become poor from non-poor due to treatment care expenditure on mental illness. Our study suggests the critical need to accelerate on various measures for early diagnosis and management of mental health issues along with financial risk protection for reducing financial impact of healthcare expenditure on mental illness among households in India.
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Sahay, Arushi. "COVID19: A STATEWISE ANALYSIS OF HEALTHCARE EXPENDITURE IN INDIA." International Journal of Social Science and Economic Research 5, no. 11 (November 30, 2020): 3490–95. http://dx.doi.org/10.46609/ijsser.2020.v05i11.013.
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Yadav, Jeetendra, Denny John, Geetha R. Menon, and Shaziya Allarakha. "Out-of-Pocket Payments for Delivery Care in India: Do Households face Hardship Financing?" Journal of Health Management 23, no. 2 (June 2021): 197–225. http://dx.doi.org/10.1177/09720634211011552.
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Background: Present study aims to examine the socioeconomic and demographic factors that affect health care utilization, health care expenditure and financing strategies for delivery care in India. Methods: The study uses data from National Family Health Survey (NFHS-4), 2015-2016. Descriptive, bivariate and multivariate regression analysis were carried out to examine health care utilization, out of pocket expenditure and financing strategies for delivery care in India. We used hardship financing as when people resort to borrowings, or sale of property/jewelry to pay for healthcare expenditure Results: Overall, Janani Suraksha Yojana (JSY) could cover less than 40% of the delivery care expenditure across all states. One-third of the households borrowed money or sold property/jewelry for delivery care expenditure. Highest exposure to hardship financing was observed in utilisation of private healthcare facilities for delivery. Women from the higher income quintiles are less likely to experience hardship financing as compared to women from the poorest wealth quintile. Conclusions: The study results will be useful for government to ensure that financing policies for delivery such as JSY are effective to provide availability and affordability of delivery healthcare in India.
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Khan, Mohd Imran, and Valatheeswaran C. "International Remittances and Private Healthcare in Kerala, India." Migration Letters 17, no. 3 (May 8, 2020): 445–60. http://dx.doi.org/10.33182/ml.v17i3.778.
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The inflow of international remittances to Kerala has been increasing over the last three decades. It has increased the income of recipient households and enabled them to spend more on human capital investment. Using data from the Kerala Migration Survey-2010, this study analyses the impact of remittance receipts on the households’ healthcare expenditure and access to private healthcare in Kerala. This study employs an instrumental variable approach to account for the endogeneity of remittances receipts. The empirical results show that remittance income has a positive and significant impact on households’ healthcare expenditure and access to private healthcare services. After disaggregating the sample into different heterogeneous groups, this study found that remittances have a greater effect on lower-income households and Other Backward Class (OBC) households but not Scheduled Caste (SC) and Scheduled Tribe (ST) households, which remain excluded from reaping the benefit of international migration and remittances.
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Sriram, Shyamkumar, and Muayad Albadrani. "A STUDY OF CATASTROPHIC HEALTH EXPENDITURES IN INDIA - EVIDENCE FROM NATIONALLY REPRESENTATIVE SURVEY DATA: 2014-2018." F1000Research 11 (February 3, 2022): 141. http://dx.doi.org/10.12688/f1000research.75808.1.
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Abstract Background: India is taking steps to provide Universal Health Coverage (UHC). Out-of-pocket (OOP) health care payment is the most important mechanism for health care payment in India. This study aims to investigate the effect of OOP health care payments on catastrophic health expenditures (CHE). Methods: Data from the National Sample Survey Organization, Social Consumption in Health 2014 and 2018 are used to investigate the effect of OOP health expenditure on household welfare in India. Three aspects of catastrophic expenditure were analyzed in this paper: (i) incidence and intensity of ‘catastrophic’ health expenditure, (ii) socioeconomic inequality in catastrophic health expenditures, and (iii) factors affecting catastrophic health expenditures. Results: The odds of incidence and intensity of CHE were higher for the poorer households. Using the logistic regression model, it was observed that the odds of incidence of CHE was higher among the households with at least one child aged less than 5 years, one elderly person, one secondary educated female member, and if at least one member in the household used a private healthcare facility for treatment. The multiple regression model showed that the intensity of CHE was higher among households with members having chronic illness, and if members had higher duration of stay in the hospital. Subsidizing healthcare to the households having elderly members and children is necessary to reduce CHE. Conclusion: Expanding health insurance coverage, increasing coverage limits, and inclusion of coverage for outpatient and preventive services are vital to protect households. Strengthening public primary health infrastructure and setting up a regulatory organization to establish policies and conduct regular audits to ensure that private hospitals do not increase hospitalizations and the duration of stay is necessary.
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Ram, Manokamana. "Determinants of Healthcare Expenditure in Eastern Uttar Pradesh, India: Through the lens of NSSO Data." Journal of Communicable Diseases 53, no. 03 (September 30, 2021): 118–26. http://dx.doi.org/10.24321/0019.5138.202147.
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This study aims to examine the determinants of health-care expenditure in the Eastern region of Uttar Pradesh. Secondary data from the National Sample Survey Office (NSSO) of 75th round on social consumption related to health were utilized. The Heckman two-step selection model was used to analyse household and individual decisions to seek care. Findings of this study reveal that having household head aged between 31 to 60 and above 60 years, household size greater than 5 members, belonging to religion other than Hindu, non-ST category as Schedule caste, Other backward class and others, people residing in urban area, people having higher economic status, private hospitals, upper primary and secondary+ schooling of household head and having household members with chronic illnesses were determinants contributing more health-care spending. However, female household head had less likely to incur healthcare expenditure as compared to male household in the region. An important finding indicates that the majority of people visited private hospitals in the region which increased the health-care spending at large and it burdened financially to the vulnerable section of the society. Based on the discussion, a few policy suggestions have been proposed to counter the above problems.
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Swargiary, Manali, Hemkhothang Lhungdim, and Mrinmoy Pratim Bharadwaz. "Multi-Layered Catastrophic Health Spending of Inpatient Women by Broad Group of Diseases in India." Journal of Population and Social Studies 30 (December 15, 2021): 183–206. http://dx.doi.org/10.25133/jpssv302022.012.
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Healthcare for Indian women needs prioritizing, as they continue to face social and economic discrimination over their healthcare, often with high out-of-pocket payments. The study examines the amount inpatient women have to pay for treatment of major diseases, re-classified into four groups as infectious, reproductive, non-communicable diseases (NCDs), and disabilities & injuries, across the country to comprehend the extent of catastrophic health spending (CHS) they experienced. The study is based on India’s 75th round of the National Sample Survey (NSS), i.e., Household Social Consumption: Health (2017-2018), consisting of 26,938 inpatient women aged 12 and above from India's urban and rural areas. We examine the prevalence of the four categories of diseases by individual, household, community, and healthcare characteristics. Expenditure estimates were derived from cross-tabulation, followed by binary logistic regression to assess the association between covariates and inpatient expenditures for the diseases. Indian women are more likely to be hospitalized for infectious diseases (43%), but the burden of CHS (overall) is highest for disabilities and injuries (INR 24,414), followed by NCDs (INR 23,053). Duration of hospitalization and possession of health insurance by women indicate maximum variation with medical spending. Almost 97% of women have incurred out-of-pocket expenditure on hospitalization, from which we identify three layers of CHS. A substantial proportion of women (23 to 50%) experienced CHS, i.e., up to 0-10%, 11-30%, and >30%, which varies distinctively by place of residence and across the six regions. Covariates like age, economic status, and healthcare are highly significant and associated with disease-wise CHS thresholds. Women in India face divergent financial hardships for healthcare. Given the heterogeneity of morbidities and socio-economic characteristics, the need for women-sensitive public health services and interventions are evident.
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John, Rijo M. "Economic costs of diseases and deaths attributable to bidi smoking in India, 2017." Tobacco Control 28, no. 5 (October 18, 2018): 513–18. http://dx.doi.org/10.1136/tobaccocontrol-2018-054493.
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ObjectiveTo estimate the economic burden of diseases and deaths attributable to bidi smoking in India for persons aged 30–69 years.MethodsThe National Sample Survey data on healthcare expenditures, data on bidi smoking prevalence from the Global Adult Tobacco Survey and relative risks of all-cause mortality from bidi smoking are used to estimate the economic burden of diseases and deaths attributable to bidi smoking in India using a prevalence-based attributable-risk approach. Costs are estimated under the following heads: (1) direct medical expenditure of treating diseases; (2) indirect morbidity costs and (3) indirect mortality costs of premature deaths.FindingsThe total economic costs attributable to bidi smoking from all diseases and deaths in India in the year 2017 for persons aged 30–69 years amount to INR805.5 billion (US$12.4 billion), of which 20.9% is direct and 79.1% is indirect cost. Men bear 93.7% of the total costs.ConclusionThe total annual economic costs of bidi smoking amount to approximately 0.5% of India’s gross domestic product, while the excise tax revenue from bidi is only half a per cent of its economic costs. The direct medical costs of bidi smoking amount to 2.24% of total health expenditure. Since the poor bear a disproportionately large share of the economic costs of bidi smoking, the unregulated use of bidi would potentially push more households in India, which incur heavy out-of-pocket expenditures on healthcare, into poverty.
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Ngangbam, Sapana, and Archana K. Roy. "Public Healthcare Expenditure Needs in North-Eastern States of India." Journal of Rural Development 39, no. 3 (September 30, 2020): 366. http://dx.doi.org/10.25175/jrd/2020/v39/i3/140850.
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Varadarajan, Poornima, Lopamudra Moharana, and Murugan Venkatesan. "Health Care Expenditure of Rural Households in Pondicherry, India." International Journal of Medical Students 1, no. 2 (August 31, 2013): 74–79. http://dx.doi.org/10.5195/ijms.2013.208.
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Background: Shortcomings in healthcare delivery has led people to spend a substantial proportion of their incomes on medical treatment. World Health Organization (2005) estimates reveal that every year 25 million households are forced into poverty by illness and the struggle to pay for healthcare. Thus we planned to calculate the health care expenditure of rural households and to assess the households incurring catastrophic health expenditure. Methods: A cross-sectional study was conducted in the service area of Sri Manakula Vinayagar Medical College and Hospital from May to August 2011. A total of 100 households from the 4 adjoining villages of our Institute were selected for operational and logistic feasibility. The household’s capacity to pay, out of pocket expenditure and catastrophic health expenditure were calculated. Data collection was done using a pretested questionnaire by the principal investigator and the analysis was done using SPSS (version 16). Results: The average income in the highest income quintile was Rs 51,885 but the quintile ratio was 14.98. The median subsistence expenditure was Rs 4,520. About 18% of households got impoverished paying for health care. About 81% of households were incurring out of pocket expenditure and 66% were facing catastrophic health expenses of 40%. Conclusion: There was very high out of pocket spending and a high prevalence of catastrophic expenditure noted. Providing quality care at affordable cost and appropriate risk pooling mechanism are warranted to protect households from such economic threats.
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Harikrishnan, Sivadasanpillai, Sanjay Ganapathi, Salim Reethu, Ajay Bahl, Anand Katageri, Animesh Mishra, Anoop George Alex, et al. "Assessment of the impact of heart failure on household economic well-being: a protocol." Wellcome Open Research 6 (November 9, 2021): 167. http://dx.doi.org/10.12688/wellcomeopenres.16709.2.
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Background: Heart failure (HF), which is an emerging public health issue, adversely affects the strained health system in India. The adverse impact of HF on the economic well-being has been narrated in various anecdotal reports from India, with affected individuals and their dependents pushed into the vicious cycle of poverty. There is limited research quantifying how HF impacts the economic well-being of households from low- and middle-income countries. Methods: We describe the methods of a detailed economic impact assessment of HF at the household level in India. The study will be initiated across 20 hospitals in India, which are part of the National heart Failure Registry (NHFR). The selected centres represent different regions in India, stratified based on the prevailing stages of epidemiological transition levels (ETLs). We will collect data from 1800 patients with acute decompensated HF and within 6-15 months follow-up from the time of initial admission. The data that we intend to collect will consist of a) household healthcare expenditure including out-of-pocket expenditure, b) financing mechanisms used by households and (c) the impoverishing effects of health expenditures including distress financing and catastrophic health expenditure. Trained staff at each centre will collect data by using a validated and structured interview schedule. The study will have 80% power to detect an 8% difference in the proportion of households experiencing catastrophic health expenditures between two ETL groups. After considering a non-response rate of 5%, the target sample size is approximately 600 patients from each group and the total sample size is 1800 patients. Potential Impact: Our study will provide information on catastrophic health spending, distress financing and household expenditure in heart failure patients. Our findings will help policy makers in understanding the micro-economic impact of HF in India and aid in allocation of appropriate resources for prevention and control of HF.
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Rymbai, Motika S. "National rural health mission and the interstate variations in public healthcare spending in India: A study of the Indian North-Eastern states." Indian Journal of Economics and Development 8 (December 9, 2020): 1–6. http://dx.doi.org/10.17485/ijed/v8.149386.
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Background/Objectives: The North-Eastern region of India comprised of eight states of which seven states come under small states and special category states. The region has a very large rural population which is highly agrarian in nature. The performances of the states in many of the health indicators have been better than most of big Indian states yet the status of health infrastructure and health accessibility in the region are still a grave concern. The study aims to find the interstate variations before and after the implementation of National Rural Health Mission (NRHM) Act of 2005, on the public health expenditure in the North-Eastern states. Methodology: The data on public health expenditure has been obtained from the State Finance Reports of the Reserve Bank of India (RBI), on population from the office of the Registrar General & Census Commission of India and the Gross State Domestic Product (GSDP) from the Directorate of Economics and Statistics of respective state governments, Central Statistics Office. The study is of twenty-six years, 1990-91 to 2015-16. The study uses the coefficient of variation to determine the extent of interstate variations. Findings: The study found that the interstate variation in public healthcare expenditure with all the eight states in the region is on a decline. Further, the study found that post NRHM, the states have equalised their proportion of health spending. Novelty/Improvement: There have been no studies to compare the interstate disparity in public health expenditure in the North-Eastern states before and after the implementation of NRHM in recent years. Keywords: Public health expenditure; interstate variations; National rural health mission; North Eastern States; India
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Awasthi, Neha. "Health and Poverty Linkages for Population just above the Poverty Line: A Study done in Slums of Jaipur, India." Journal of Integrated Community Health 11, no. 1 (June 30, 2022): 11–21. http://dx.doi.org/10.24321/2319.9113.202202.
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Introduction: Underdeveloped and developing countries are unable to provide essential healthcare to all of their inhabitants, and those who remain uninsured are at a huge risk of financial hardship. It’s never easy to divide limited resources. Method: This study attempts to examine that, If urban poors, a vulnerable section of the society is protected against catastrophic health expenditure. Is there any deepening of poverty among urban poor of the city of Jaipur due to catastrophic health expenditure? 426 households in Jaipur’s urban slums were surveyed. Results: The incidences of Catastrophic Health Expenditure were 8.1% among urban slum households. The mean positive overshoot was 33%. Poverty increased by 1% at National Poverty Line and by 2.6% at International Poverty Line estimates. The increase in the normalised mean positive poverty gap from 29.8% to 45.3% suggests that the existing poor are becoming more impoverished. There was a significant association between increasing health spending and household cuts in food and apparel spending, at p = 0.0001 and p = 0.05, respectively. Conclusion: The results show a huge disparity between poverty estimates based on national poverty standards (2.8%) and international poverty standards (37.1%) indicating the necessity for developing sensitive poverty criteria. It is also vital to make an evidence-based decision on whether to employ assurance, insurance, or a combination of the two healthcare delivery systems. The assurance approach might expand accessibility while also lowering healthcare expenditures for the entire community. Rather than creating two distinct insurance or assurance systems, the government should pool its resources and efforts into one.
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Singh, Pushpendra, and Virendra Kumar. "The Rising Burden of Healthcare Expenditure in India: A Poverty Nexus." Social Indicators Research 133, no. 2 (June 17, 2016): 741–62. http://dx.doi.org/10.1007/s11205-016-1388-0.
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Loutfi, David, Jean-Frédéric Lévesque, and Subrata Mukherjee. "Impact of the Elderly on Household Health Expenditure in Bihar and Kerala, India." Journal of Health Management 20, no. 1 (January 13, 2018): 1–14. http://dx.doi.org/10.1177/0972063417747696.
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Ageing in India is leading to an increase in chronic diseases. Given the limited health insurance coverage, this could lead to a variety of economic- and access-related consequences for the households. Against this backdrop, this article aims at examining the impact of the presence of the elderly on household health expenditure, avoidance of treatment, loss of income and use of alternate sources of funding to pay for care. The article uses data from 2004 National Sample Survey Organisation survey on healthcare for two Indian states, namely, Bihar and Kerala. The rate of catastrophic health expenditure (CHE) is found to be higher in Kerala and is associated with a higher proportion of households having elderly members, who, in turn, have higher incidence of chronic disease. While the presence of elderly in the household, incidence of chronic disease and treatment from private sources are linked to CHE, our results suggest that other groups, such as households without elderly, may simply be delaying the economic consequences of paying for healthcare by borrowing. Though the ageing population is leading to increased health expenditure for households due to increased chronic illness, the impact of using private treatment is much less clear.
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Harikrishnan, Sivadasanpillai, Sanjay Ganapathi, Salim Reethu, Ajay Bahl, Anand Katageri, Animesh Mishra, Anoop George Alex, et al. "Assessment of the impact of heart failure on household economic well-being: a protocol." Wellcome Open Research 6 (June 30, 2021): 167. http://dx.doi.org/10.12688/wellcomeopenres.16709.1.
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Background: Heart failure (HF), which is an emerging public health issue, adversely affects the strained health system in India. Additionally, the adverse impact of HF on the economic well-being of affected individuals and their families has been narrated in various anecdotal reports, with affected individuals and their dependents pushed into poverty. However, there is limited research quantifying how HF impacts the economic well-being of households from low- and middle-income countries. Methods: We describe the methods of a detailed economic impact assessment of HF at the household level in India. The study will be initiated across 20 hospitals in India. The selected centres represent different regions in India stratified based on the prevailing stages of epidemiological transition levels (ETLs). We will collect data from 1800 patients with acute decompensated HF and within 6-15 months follow-up from the time of initial admission. The data that we intend to collect will consist of a) household healthcare expenditure including out-of-pocket expenditure, b) financing mechanisms used by households and (c) the impoverishing effects of health expenditures including distress financing and catastrophic health expenditure. Trained staff at each centre will collect relevant data by using a validated and structured interview schedule. The study will have 80% power to detect an 8% difference in the proportion of households experiencing catastrophic health expenditures between two ETL groups. After considering a non-response rate of 5%, the target sample size is approximately 600 patients from each group and the total sample size is 1800 patients with heart failure. Impact: The results from our study will help policy makers in understanding the micro-economic impact of HF in India and aid in allocation of appropriate resources for prevention and control of HF.
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Prinja, Shankar, Jyoti Dixit, Nidhi Gupta, Nikita Mehra, Ashish Singh, Manjunath Nookala Krishnamurthy, Dharna Gupta, et al. "Development of National Cancer Database for Cost and Quality of Life (CaDCQoL) in India: a protocol." BMJ Open 11, no. 7 (July 2021): e048513. http://dx.doi.org/10.1136/bmjopen-2020-048513.
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IntroductionThe rising economic burden of cancer on healthcare system and patients in India has led to the increased demand for evidence in order to inform policy decisions such as drug price regulation, setting reimbursement package rates under publicly financed health insurance schemes and prioritising available resources to maximise value of investments in health. Economic evaluations are an integral component of this important evidence. Lack of existing evidence on healthcare costs and health-related quality of life (HRQOL) makes conducting economic evaluations a very challenging task. Therefore, it is imperative to develop a national database for health expenditure and HRQOL for cancer.Methods and analysisThe present study proposes to develop a National Cancer Database for Cost and Quality of Life (CaDCQoL) in India. The healthcare costs will be estimated using a patient perspective. A cross-sectional study will be conducted to assess the direct out-of-pocket expenditure (OOPE), indirect cost and HRQOL among cancer patients who will be recruited at seven leading cancer centres from six states in India. Mean OOPE and HRQOL scores will be estimated by cancer site, stage of disease and type of treatment. Economic impact of cancer care on household financial risk protection will be assessed by estimating prevalence of catastrophic health expenditures and impoverishment. The national database would serve as a unique open access data repository to derive estimates of cancer-related OOPE and HRQOL. These estimates would be useful in conducting future cost-effectiveness analyses of management strategies for value-based cancer care.Ethics and disseminationApproval was granted by Institutional Ethics Committee vide letter no. PGI/IEC-03/2020-1565 of Post Graduate Institute of Medical Education and Research, Chandigarh, India. The study results will be published in peer-reviewed journals and presented to the policymakers at national level.
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Dixit, Avika, Neeta Kumar, and Sanjiv Kumar. "Use of Generic Medicines." Journal of Health Management 20, no. 1 (January 23, 2018): 84–90. http://dx.doi.org/10.1177/0972063417747747.
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The government is committed to make healthcare affordable as stated in the National Health Policy 2017. An estimated 94 million people in India are pushed into poverty due to expenditure on healthcare. About two thirds of the expenditure is incurred on medicines. Generic medicines are as effective as branded medicines. The initiative of the government and Medical Council of India by making it mandatory for doctors to write generic medicines has raised many concerns related to generic drugs availability and quality. Experience in the USA and Canada support the argument in favor of generic medicine. India is the main supplier of the generic medicines to the USA. There is a need to curtail inducement by pharmaceutical companies to promote their branded drugs as is being done in the USA. The government needs to make generic drugs easily available, strengthen quality control and educate doctors on benefits of using generic drugs.
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Sridevi, M., and A. Laxmaiah. "Healthcare Financing and Under-5 Child Mortality Among the BRICS Nations." Indian Journal of Human Development 14, no. 3 (December 2020): 507–17. http://dx.doi.org/10.1177/0973703020976717.
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This article explores longitudinal trends of healthcare financing and mortality levels among the children under 5 (U5) years of age in the BRICS nations between 2000 and 2015. This analysis is based on the relevant secondary data obtained from the WHO data repository and various other publicly available sources. Inferential statistical tools like linear regression analysis was carried out to test the relationship between dependent and independent variables. The results indicate an inverse relationship between current health expenditure and U5 child deaths, revealing a decline of 29,000 U5 child deaths and 19,000 infant deaths for every US$1increase in per capita healthcare expenditure. Further, neonatal deaths declined by 1.74% and infant deaths 2.8%, while U5 child deaths declined by 4.6% per annum. India spends lowest among the BRICS nations—about US$63 per capita, while out-of-pocket expenditure (OOPE) is highest at 69.3%. Countries with higher per capita government health expenditure have better health indicators. This article, therefore, calls for strengthening public investment in healthcare to improve health outcomes.
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Patterkadavan, Fasalurahman P. K., and Syed Hasan Qayed. "Determinants Of Maternal Mortality: An Empirical Study of Indian States Based on The Random Effect Model Analysis." National Journal of Community Medicine 13, no. 08 (August 31, 2022): 532–41. http://dx.doi.org/10.55489/njcm.130820222203.
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Background: Healthcare for mothers and children is a significant indicator of a country's well-being. India is one of the nations that were experiencing a rather slow improvement in maternal and child health. Aims: The objective of this study is to analyse the changes in maternal healthcare in India from 2010-11 in health inputs like health infrastructure and government expenditure, health outcomes like antenatal care, postnatal care, institutional delivery, and health impact like Maternal Mortality Ratio (MMR). Methodology: The study is based on secondary data. It employs Average Increasing Rate (AIR) and Average Reduction Rate (ARR), as well as a panel data random effect model, on key health indicators for Indian states. Results: Empirical results say MMR has a statistically significant inverse relationship with female literacy, Per capita Net State Domestic Product (PNSDP), and institutional delivery. The study concludes that after the introduction of NRHM and its constituent elements like JSY and JSSK, government expenditure on health, infrastructure, the percentage of antenatal care, post-natal care, and institutional delivery increased in most of the Indian states, thus helping to increase the pace of the reduction of MMR. However, state performance varies greatly. Conclusions: Policy alone will not provide the desired results; it is also critical to focus on education, particularly female literacy, and economic empowerment. We can make a difference in the health sector if these come together.
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Senthil kumar V, Mahesh kumar V P, Senthil kumar S K, and Rajalingam D. "Role of community pharmacy in public health." International Journal of Review in Life Sciences 10, no. 3 (November 16, 2020): 77–81. http://dx.doi.org/10.26452/ijrls.v10i3.1325.
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Currently, in every country, community pharmacists play an essential role as they take responsibility for access to healthcare for the medicine-related needs of patients. In India, however, only the provision of medicines remains the central movement of the group pharmacist. In the country, patient-oriented treatment is still rarely given by most community pharmacists. As domestic medicine development and national healthcare expenditure rise rapidly, the role of pharmacists in society and, with it, their management of medicines will change. The aim of this editorial is to examine the genesis of the private-owned Indian community pharmacy and to outline its education, training and prospects.
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Danovi, Alessandro, Stefano Olgiati, and Alessandro D’Amico. "Living Longer with Disability: Economic Implications for Healthcare Sustainability." Sustainability 13, no. 8 (April 16, 2021): 4467. http://dx.doi.org/10.3390/su13084467.
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This work focuses on the economic implications of the relationship between life expectancy, the number of years lost to disability and per-capita total health expenditure. The primary goal of the paper is to identify and plot the correlation between healthcare expenditure and the global increase in life expectancy, in order to assess if, and how, the way longer average lifespans are achieved affects healthcare sustainability. Datasets regarding the United States, the European Union and the five largest emerging healthcare systems (i.e., Brazil, the Russian Federation, India, China and South Africa) were obtained from the Institute for Health Metrics and Evaluation and the WHO Health Expenditure Statistics Repository. All analysis was performed on 2017 data. The results of the analysis showed the number of years lost to disability to be a linear function of life expectancy at birth (male R2 = 0.61; female R2 = 0.47), and per-capita total health expenditure to be an exponential function of the number of years lost to disability (male R2 = 0.60; female R2 = 0.65). This implies that improving life expectancy via social policies bears negative consequences in terms of healthcare sustainability, unless the number of years lost to disability is reduced too. Further studies should narrow the sample of countries and causes of years lost due to disability, to better inform future policy efforts.
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Sriram, S. "Prenatal Healthcare Expenditure and Health Services in India: an Analysis of Nsso Data." Value in Health 21 (September 2018): S60. http://dx.doi.org/10.1016/j.jval.2018.07.457.
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Das, Dhiman. "Public expenditure and healthcare utilization: the case of reproductive health care in India." International Journal of Health Economics and Management 17, no. 4 (July 12, 2017): 473–94. http://dx.doi.org/10.1007/s10754-017-9219-7.
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Singh, Pushpendra, and Virendra Kumar. "Erratum to: The Rising Burden of Healthcare Expenditure in India: A Poverty Nexus." Social Indicators Research 138, no. 1 (June 19, 2017): 403–4. http://dx.doi.org/10.1007/s11205-017-1667-4.
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Arora, Rhythm, Nikhil Dugar, Vandit Saxena, Sunil K. Jaiswal, Chitresh Kumari, Nigel Cook, and Olga Furio. "PP66 Increasing Burden Of Out-Of-Pocket Healthcare Expense On Patients." International Journal of Technology Assessment in Health Care 35, S1 (2019): 50. http://dx.doi.org/10.1017/s0266462319002162.
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IntroductionWe conducted an analysis of the key factors triggering cost-sharing mechanisms to understand the status of out-of-pocket (OOP) healthcare expense in the United States (US), Europe, and emerging markets and better appreciate the implications of OOP healthcare expense on patients’ health management.MethodsA review of literature and databases including The Organisation for Economic Co-operation and Development (OECD) and World Bank was performed to understand different cost-sharing mechanisms, factors triggering OOP expenditure and the country-wise trends of OOP expenditure. Additionally, the impact of OOP expenditure on healthcare budget and on patients in terms of medication adherence, uptake of newer therapies and generic substitution was explored.ResultsThe findings reveal that patients are concerned about rising healthcare OOP costs, and we observed an increase of 134 percent in the number of articles published on OOP from 2005 to 2017. The percentage of household spending that goes OOP as healthcare expense is higher in Brazil, Russia, India, and China (BRIC countries; ~11 percent) compared to France, Germany, Italy, United Kingdom, US, Japan, and Canada (G7 countries; ~2 percent). In addition, OOP expenditure increased with age (1.9 percent of take home income in 55-64 age group versus 1.2 percent in 18-25 age group) and is higher in the low-income population (2.8 percent of take home income versus 1 percent in high-income group). Whereas, increasing OOP expenditure reduces the overall healthcare expenditure due to generic substitution (28 percent reduction) and reduction in excessive consumption of supplementary medicines, it also reduces patient adherence (~20 percent decline in dispensed prescriptions) and may foster a reluctance to adopt newer therapies.ConclusionsThe population groups most impacted by increasing OOP expense are the older population, those in the low-income bracket and in poorer countries. While OOP expense may help in the effective and judicious utilization of healthcare system resources and medicines usage, its implementation requires a cautious and considered approach.
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Saha, Amiya, and Dipti Govil. "MORBIDITY PATTERN OF HOSPITALIZATION AND ASSOCIATED OUT OF POCKET EXPENDITURE: EVIDENCE FROM NSSO (2017-2018)." International Journal of Research -GRANTHAALAYAH 9, no. 11 (December 2, 2021): 138–55. http://dx.doi.org/10.29121/granthaalayah.v9.i11.2021.4401.
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In 2018, according to the National Sample Survey Report, the number of cases of hospitalization per 1000 persons in 365 days was 29 in India (26 per 1000 in rural and 34 per 1000 in urban areas). Between 2004 and 2014, for example, the average medical expenditure per hospitalization for urban patients increased by about 176%, and for rural patients, it jumped by a little over 160%. Most of these hospitalizations are for infections, but a significant number also for treatment for cancer and blood-related diseases. The increase in access to healthcare has also brought with it a massive spike in costs. India is rapidly undergoing an epidemiological transition with a sudden change in the disease profile of its population. This study aimed to analyze hospitalization due to different factors like age and morbidity and its effect on health care utilization from nationally representative data from 2018 among the total population of India. 75th round of National Sample Survey Organisation (NSSO) conducted in July 2017- June 2018 has been used to examine what are the determinant factors that affect the hospitalization and mean monthly disease-specific expenditure in the different age group populations in India. We have used cross-tabulation to understand the association between morbidity patterns and healthcare utilization with other socio-demographic variables. A set of logistic regression analyses was carried out to understand the role of age patterns on hospitalization. A log-linear regression model was used to understand the significant predictors of out-of-pocket expenditure (OOPE).
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Ghosh, Sujoy, Pradip Mukhopadhyay, and Sarita Bajaj. "Diabetes and Insurance." Journal of Social Health and Diabetes 7, no. 02 (December 2019): 50–53. http://dx.doi.org/10.1055/s-0039-3401979.
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AbstractIndia has healthcare expenditure of more than 5 billion dollars on diabetes-related healthcare management. Globally, approximately 12% of health expenditure is spent on diabetes and related comorbidities. Hospitalization includes hospital and laboratory expenses and cost of medications as the direct cost. India is among the countries, where if the insured dies during the time period specified in the insurance policy and the policy is active, or in force, then a death benefit will be paid. Studies in India reported that medical reimbursement is availed by 21.3% in the high-income group and only 6.4% of the urban low-income group. An average cost of management of diabetic complications like diabetic foot, retinopathy, and patients with two complications was almost close to the average cost of claimed amount. Patients may be advised to take insurance for diabetes when there is any indication of future disease and risk factors contributing to diabetes like a strong family history, obesity, hypertension, and other vascular diseases. Diabetes Safe from Star Health and Varistha Mediclaim from National Insurance were among the first insurance policies to be launched in India.
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Tripathy, JP, J. Jagnoor, BM Prasad, and R. Ivers. "Cost of injury care in India: cross-sectional analysis of National Sample Survey 2014." Injury Prevention 24, no. 2 (July 19, 2017): 116–22. http://dx.doi.org/10.1136/injuryprev-2017-042318.
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BackgroundInjuries account for nearly 10% of total deaths in India and this burden is likely to rise. We aimed to estimate the out-of-pocket (OOP) expenditure and catastrophic expenditure due to hospitalisation or outpatient care as a result of any injury and factors associated with incurring catastrophic expenditure.MethodsSecondary analysis of nationally representative data for India collected by National Sample Survey Organization in 2014, reporting on health service utilisation and healthcare-related OOP expenditure by income quintiles and by type of health facility (public or private).ResultsThe median expenditure per episode of hospitalisation due to any injury was US$156, and it was three times higher among the richest quintile compared with the poorest quintile (p<0.001). There was a significantly higher prevalence (p<0.001) of catastrophic expenditure among the poorest quintile (32%) compared with the richest (21%). Mean private sector OOP hospitalisation expenditure was five times higher than in the public sector (p<0.001). Medicines accounted for 37% and 58% of public sector hospitalisation and outpatient care, respectively. Patients treated in a private facility, hospitalised for over 7 days, in the poorest wealth quintiles and of general caste had higher odds of incurring catastrophic expenditure.ConclusionPeople who sustain an injury have a high risk of catastrophic household expenditure, particularly for those in lowest income quartiles. There is a clear need for publicly funded risk protection mechanisms targeting the poor. Promotion of generic medicines and subsidisation for the poorest wealth quintile may also reduce OOP expenditure in public sector facilities.
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Bhatt, Sanjai. "Strong and Vibrant Social Sector is sine qua non for Social Development." Space and Culture, India 9, no. 3 (November 30, 2021): 1–5. http://dx.doi.org/10.20896/saci.v9i3.1237.
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As the largest country, India faces several social issues, and all governments— central or states, have supported several welfare and developmental programmes and schemes. Unfortunately, many of these programmes were politicised and resulted in politicising interest and farewell to welfare. As a result, the social sector expenditure has grown just 7.7% of the GDP between 2015 and 2019, and of the total 7.7% GDP expenditure, 3.1% went to education, 1.6% to healthcare and the rest to other social services segments. India has a large social sector compared to many other countries having around 3.9 million NGOs and a substantial social service workforce. While India has announced its vision 2030 to become and is poised to become a five trillion-dollar economy in the next five years, it needs to emphasise that a healthy, strong and vibrant social sector is essential necessity to ensure its citizens' quality of life and happiness.
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Ladusingh, Laishram, Sanjay Kumar Mohanty, and Melody Thangjam. "Triple burden of disease and out of pocket healthcare expenditure of women in India." PLOS ONE 13, no. 5 (May 10, 2018): e0196835. http://dx.doi.org/10.1371/journal.pone.0196835.
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Gauttam, Priya, Nitesh Patel, Bawa Singh, Jaspal Kaur, Vijay Kumar Chattu, and Mihajlo Jakovljevic. "Public Health Policy of India and COVID-19: Diagnosis and Prognosis of the Combating Response." Sustainability 13, no. 6 (March 19, 2021): 3415. http://dx.doi.org/10.3390/su13063415.
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(1) Background: Society and public policy have been remained interwoven since the inception of the modern state. Public health policy has been one of the important elements of the public administration of the Government of India (GOI). In order to universalize healthcare facilities for all, the GOI has formulated and implemented the national health policy (NHP). The latest NHP (2017) has been focused on the “Health in All” approach. On the other hand, the ongoing pandemic COVID-19 had left critical impacts on India’s health, healthcare system, and human security. The paper’s main focus is to critically examine the existing healthcare facilities and the GOI’s response to combat the COVID-19 apropos the NHP 2017. The paper suggests policy options that can be adopted to prevent the further expansion of the pandemic and prepare the country for future health emergency-like situations. (2) Methods: Extensive literature search was done in various databases, such as Scopus, Web of Science, Medline/PubMed, and google scholar search engines to gather relevant information in the Indian context. (3) Results: Notwithstanding the several combatting steps on a war-footing level, COVID-19 has placed an extra burden over the already overstretched healthcare infrastructure. Consequently, infected cases and deaths have been growing exponentially, making India stand in second place among the top ten COVID-19-infected countries. (4) Conclusions: India needs to expand the public healthcare system and enhance the expenditure as per the set goals in NHP-17 and WHO standards. The private healthcare system has not been proved reliable during the emergency. Only the public health system is suitable for the country wherein the population’s substantial size is rural and poor.
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Sharma, Vijay, and Richa Sharma. "SUCCESS OF INDIAN NATIONAL HEALTH PROTECTION SCHEME NEEDS CREATIVE DESTRUCTION OF MINES OF HEALTHCARE CORRUPTION." EPH - International Journal of Business & Management Science 2, no. 1 (March 27, 2016): 15–25. http://dx.doi.org/10.53555/eijbms.v2i1.47.
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We need Universal healthcare in India, Government has launched world’s biggest health insurance programme covering half billion population with risk cover of INR 500,000 ($ 7500). Free healthcare will take away one major worry of poor masses. Things are going to change over the years with better healthcare, less sickness, less work loss, no medical expenditure related bankruptcy, better economic prospects & more food availability. This scheme will lead to enhanced business activities at all level, will create the job at many levels, there will the expansion of healthcare industry, but later it will lead to increased pollution and climate change leading to the new spectrum of diseases, increased health care use and increased insurance expenditure. Major problem is that corruption involves various layers of the healthcare system, including care providers, pharmacies, laboratories, corporate hospitals, mom and pop hospitals, clinics, pharmaceutical and instrument companies. Policymakers should use all technologies based measures including artificial intelligence, block chain technology, universal biometrics in healthcare, global positioning system, digital monitoring, mobile applications, point of care technologies, system reforms, big data collection, nudging, mobile health, telehealth, mass education, culture change and strong laws to prevent corruption as well as illness. Avoidance of inspector policy is best. For the success of the programme mines of healthcare, corruption must be destroyed.
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Hakeem, Naz-E.-Farha, Shruthi Eshwar, B. K. Srivastava, and Vipin Jain. "Micro-health insurance in dentistry: the road less travelled." International Journal Of Community Medicine And Public Health 6, no. 3 (February 22, 2019): 1364. http://dx.doi.org/10.18203/2394-6040.ijcmph20190629.
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Oral health is indeed a challenge for the urban poor. Majority of the patients spend from their pocket, which aggravates their financial condition. It is paramount for the government and the healthcare industry to adopt a value-based approach to redress the oral health lapses for the underserved population. Micro health insurance (MHI) can have a game changing effect on the oral healthcare space too, if concerned stakeholders build the right partner network. Aim of the study was to discuss the principal features, basic structure, and functioning of a few MHI schemes, and presents a hypothetical model of MHI which can be implemented in dentistry. Literature search was conducted in two main databases, pubmed and cochrane, using key phrases such as “community based health insurance,” “micro health insurance,” micro or community based health insurance,” and “health insurance and financial protection”. Articles published in last ten years with full texts were considered. 23 schemes were eligible for the systematic review. Our analysis shows that MHI, in the majority of cases, contributes to the financial protection of its beneficiaries, by reducing out of pocket health expenditure, catastrophic health expenditure, household borrowings and poverty. However, the studies did not affirm oral health benefits. The importance of oral healthcare in India is superficial. Focus on oral healthcare can be achieved only if the impending cost due to out of pocket payments can be supplanted with a more affordable and dynamic payment model. With MHI extended to oral healthcare, India can certainly achieve its SDG goal. It’s time to look beyond.
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Basargekar, Prema, Sushmita Priyadarshini, Shubham Seth, and Vaibhav Ganjoo. "Impact of Socio-economic Factors in Reducing Malnutrition among Children: A comparative study of India, Bangladesh and Sri Lanka." Asia Pacific Journal of Health Management 16, no. 3 (September 29, 2021): 21–28. http://dx.doi.org/10.24083/apjhm.v16i3.959.
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Objective: To assess the impact of economic and gender factors on malnutrition among children below 5 years age by making a comparative study between India, Bangladesh and Sri Lanka Design and setting: The study uses data and information on economic and gender status parameters taken from the secondary sources for three South Asian Countries between the years 2000 to 2018. The study uses ANOVA, Post Hoc test and Fixed Effects Panel Regression analysis to arrive at the conclusions. Results: Comparative analysis between the three countries shows that the extent of malnutrition among children is lowest in Sri Lanka and highest in India. The study finds that economic factors such as domestic government’s expenditure of healthcare as percentage of total health expenditure and gender factors measured in terms of female labour force participation, and school enrolment of girls at secondary level significantly impact the level of malnutrition among children. Conclusion: Malnutrition among children is a complex challenge which cannot be solved by emphasizing on only economic growth. Policies emphasising on gender parity and empowerment integrated in healthcare policies will positively impact nutritional level of children.
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Kumar, Manoj. "Utilisation and Out-of-Pocket Expenditure for AYUSH Outpatient Care among Older Adults in India." Chettinad Health City Medical Journal 12, no. 1 (March 31, 2023): 54–64. http://dx.doi.org/10.24321/2278.2044.202310.
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Background: Traditional, complementary, and alternative medicine are known to be used across the world for many types of diseases. In India, they are referred to as AYUSH and are known to be used for promotive, preventive, and curative purposes for healthy living and well-being. This study looks at the levels, patterns, and determinants of utilisation and out-of-pocket expenditure for AYUSH outpatient care among older adults in India. Method: Descriptive analysis, data visualisation, and bivariate and multivariate logistic regression analysis have been used. Results: The utilisation for AYUSH care is found to be quite low at 8.2% among 52% of respondents in the sample who sought outpatient care during the reference period. The study found the mean OOPE for AYUSH to be ₹ 687 per episode, in comparison with the overall mean OOPE of ₹ 1239 per episode for all types (allopathic and AYUSH combined) of outpatient care. Conclusions: Despite the policy support for the promotion of AYUSH by the Government of India for a long time, and the common knowledge about the affordability and low cost of AYUSH care, utilisation of AYUSH healthcare remains low. Evidence-based studies on the efficacy and safety of AYUSH treatment, promotion of cross-referral between different streams of medicine, and standardisation of AYUSH medicines can help to build trust and boost utilisation of AYUSH care.
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Pati, Sanghamitra, Abhinav Sinha, Shishirendu Ghosal, Sushmita Kerketta, John Tayu Lee, and Srikanta Kanungo. "Family-Level Multimorbidity among Older Adults in India: Looking through a Syndemic Lens." International Journal of Environmental Research and Public Health 19, no. 16 (August 10, 2022): 9850. http://dx.doi.org/10.3390/ijerph19169850.
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Most evidence on multimorbidity is drawn from an individual level assessment despite the fact that multimorbidity is modulated by shared risk factors prevailing within the household environment. Our study reports the magnitude of family-level multimorbidity, its correlates, and healthcare expenditure among older adults using data from the Longitudinal Ageing Study in India (LASI), wave-1. LASI is a nationwide survey amongst older adults aged ≥45 years conducted in 2017–2018. We included (n = 22,526) families defined as two or more members coresiding in the same household. We propose a new term, “family-level multimorbidity”, defined as two or more members of a family having multimorbidity. Multivariable logistic regression was used to assess correlates, expressed as adjusted odds ratios with a 95% confidence interval. Family-level multimorbidity was prevalent among 44.46% families, whereas 41.8% had conjugal multimorbidity. Amongst siblings, 42.86% reported multimorbidity and intergenerational (three generations) was 46.07%. Family-level multimorbidity was predominantly associated with the urban and affluent class. Healthcare expenditure increased with more multimorbid individuals in a family. Our findings depict family-centred interventions that may be considered to mitigate multimorbidity. Future studies should explore family-level multimorbidity to help inform programs and policies in strategising preventive as well as curative services with the family as a unit.
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Kaur, Sukhpreet. "Generic prescribing in India: a stumbling block." International Journal of Research in Medical Sciences 8, no. 9 (August 26, 2020): 3426. http://dx.doi.org/10.18203/2320-6012.ijrms20203707.
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In India, there is 62% out-of-pocket health expenditure per capita and only 15% are covered by health insurance. The use of generics can save a lot of money which can be used for other health issues. But lack of knowledge about cost effectiveness of generic medicines among various health-care professionals had led to a low rate of generic medicine prescription in India. This review aims to identify the barriers in adoption of generic prescribing in clinical practice in India. A systematic literature review was conducted using various healthcare databases such as PubMed and google scholar. The literature search using various combination of keywords retrieved 2360 articles. After excluding duplicates, articles in languages other than English and based on relevance to subject only 15 articles were selected. The barriers to generic prescribing identified from reported literature can be broadly classified based on stakeholders of healthcare setting such as physicians, patients, pharmacist and government policies. The major barriers to generic prescribing identified were negative perception of various stakeholders, lack of awareness of regulatory standards, maturity of health care system, vulnerability of patients, lack of standard guidelines in brand substitution, incentives and influence of drug advertisements. In Indian set up, studies on impact evaluation of generic prescription, emphasizing the quality and cost saving by their use in clinical practice should be conducted. This evidence will help to build the confidence of various stakeholders towards implementing generic prescribing in clinical practice.
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Prasad, BanuruMuralidhara, JayaPrasad Tripathy, OmPrakash Bera, and Namita Shanbhag. "National sample surveys show poor households face catastrophic expenditure for oral healthcare services in India." Journal of Family Medicine and Primary Care 10, no. 8 (2021): 2853. http://dx.doi.org/10.4103/jfmpc.jfmpc_2322_20.
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Nanjunda, Devajana Chinnappa. "Universal Health Coverage in India: Where Rubber Hits the Road?" Annals of the National Academy of Medical Sciences (India) 56, no. 04 (June 30, 2020): 208–13. http://dx.doi.org/10.1055/s-0040-1713708.
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AbstractPoverty and healthcare issues are the most debatable topics today. Developing countries like India have as much as 45% of its population trapped in poverty because of various urgent healthcare needs. Universal health coverage (UHC) is a unique insurance system to provide financial protection to the marginalized groups of the country. It facilitates appropriate and immediate health needs, including required diagnostic, therapeutic and operational costs. However, UHC, a unique plan which focuses on the disadvantaged sections of the society, has some serious lacunae when it comes to its implementation in real life. This includes finances and human resources. Experts are reallocating adequate budgetary expenditure on healthcare issues, and in the meantime, a shortage of skilled health manpower is hunting down the UHC scheme in India. In recent times, different state governments are increasing budget allocation for the health sector. UHC is targeting low-income and poor families, forgetting the affordable and timely healthcare by way of improving services offered at the primary health centers and rapid expansion of the skilled health manpower across the country. UHC needs to focus on health paradigm systems, including improved healthcare-seeking behavior, nutrition, sanitation, potable water, reducing maternal and infant mortality, and dissemination of information of current technology to provide quality health services to the underserved and marginalized population of the country. These changes would symbolize a real way forward toward the immediate fulfillment of UHC goals for India.
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Choudhary, Tarun Shankar, Sarmila Mazumder, Oystein A. Haaland, Sunita Taneja, Rajiv Bahl, Jose Martines, Maharaj Kishan Bhan, et al. "Effect of kangaroo mother care initiated in community settings on financial risk protection of low-income households: a randomised controlled trial in Haryana, India." BMJ Global Health 7, no. 11 (November 2022): e010000. http://dx.doi.org/10.1136/bmjgh-2022-010000.
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IntroductionMany families in low-income and middle-income countries have high out-of-pocket expenditures (OOPE) for healthcare, and some face impoverishment. We aimed to assess the effect of Kangaroo Mother Care initiated in community setting (ciKMC) on financial risk protection estimated by healthcare OOPE, catastrophic healthcare expenditure (CHE) and impoverishment due to healthcare seeking for low birthweight infants, using a randomised controlled trial design.MethodsWe included 4475 low birthweight infants randomised to a ciKMC (2491 infants) and a control (1984 infants) arm, in a large trial conducted between 2017 and 2018 in Haryana, India. We used generalised linear models of the Gaussian family with an identity link to estimate the mean difference in healthcare OOPE, and Cox regression to estimate the HRs for CHE and impoverishment, between the trial arms.ResultsOverall, in the 8-week observation period, the mean healthcare OOPE per infant was lower (US$20.0) in the ciKMC arm compared with the control arm (US$25.6) that is, difference of −US$5.5, 95% CI −US$11.4 to US$0.3, p=0.06). Among infants who sought care it was US$8.5 (95% CI −US$17.0 to −US$0.03, p=0.03) lower in the ciKMC arm compared with the control arm. The HR for impoverishment due to healthcare seeking was 0.56 (95% CI 0.36 to 0.89, p=0.01) and it was 0.91 (95% CI 0.74 to 1.12, p=0.37) for CHE.ConclusionciKMC can substantially reduce the cost of care seeking and the risk of impoverishment for households. Our findings show that supporting mothers to provide KMC to low birthweight infants at home, in addition to reducing early infant mortality, may provide financial risk protection.Trial registration numberCTRI/2017/10/010114
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Reshmi, Bhageerathy, Bhaskaran Unnikrishnan, Eti Rajwar, Shradha S. Parsekar, Ratheebhai Vijayamma, and Bhumika Tumkur Venkatesh. "Impact of public-funded health insurances in India on health care utilisation and financial risk protection: a systematic review." BMJ Open 11, no. 12 (December 2021): e050077. http://dx.doi.org/10.1136/bmjopen-2021-050077.
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ObjectiveUniversal Health Coverage aims to address the challenges posed by healthcare inequalities and inequities by increasing the accessibility and affordability of healthcare for the entire population. This review provides information related to impact of public-funded health insurance (PFHI) on financial risk protection and utilisation of healthcare.DesignSystematic review.Data sourcesMedline (via PubMed, Web of Science), Scopus, Social Science Research Network and 3ie impact evaluation repository were searched from their inception until 15 July 2020, for English-language publications.Eligibility criteriaStudies giving information about the different PFHI in India, irrespective of population groups (above 18 years), were included. Cross-sectional studies with comparison, impact evaluations, difference-in-difference design based on before and after implementation of the scheme, pre–post, experimental trials and quasi-randomised trials were eligible for inclusion.Data extraction and synthesisData extraction was performed by three reviewers independently. Due to heterogeneity in population and study design, statistical pooling was not possible; therefore, narrative synthesis was performed.OutcomesUtilisation of healthcare, willingness-to-pay (WTP), out-of-pocket expenditure (including outpatient and inpatient), catastrophic health expenditure and impoverishment.ResultsThe impact of PFHI on financial risk protection reports no conclusive evidence to suggest that the schemes had any impact on financial protection. The impact of PFHIs such as Rashtriya Swasthy Bima Yojana, Vajpayee Arogyashree and Pradhan Mantri Jan Arogya Yojana showed increased access and utilisation of healthcare services. There is a lack of evidence to conclude on WTP an additional amount to the existing monthly financial contribution.ConclusionDifferent central and state PFHIs increased the utilisation of healthcare services by the beneficiaries, but there was no conclusive evidence for reduction in financial risk protection of the beneficiaries.RegistrationNot registered.
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Yadav, Priyanka, and Amit Shovon Ray. "Private Sector Presence in Healthcare in India: Econometric Analysis of Patterns and Consequences." South Asia Economic Journal 23, no. 2 (September 2022): 171–200. http://dx.doi.org/10.1177/13915614221113406.
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The presence of private providers in the Indian healthcare sector remains one of the most debated issues. This article attempts to contribute to this debate from the angle of the ultimate goal of healthcare provision—a healthy population. We explore whether private sector presence (PSP) has improved the general health status of the people. We develop a theoretical argument to hypothesize that PSP in India would lead to better health status through the route of competition-driven quality, which in turn could lead to adverse economic consequences. We use district-level secondary data from government sources to confirm our hypotheses using robust tools of applied econometrics, correcting for serious problems of endogeneity. Constructing a district-level index of PSP, we identify distinct spatial/geographical clusters, explained by socio-economic prosperity as well as demonstration effect. We also find a robust positive association between PSP and general health outcomes, accompanied by an adverse economic consequence of rising catastrophic out-of-pocket expenditure. In terms of policy, the article concludes that rather than restricting the growth of the private sector, the government must strengthen the quality of the existing public healthcare delivery system and ensure effective monitoring and regulation. JEL Codes: 110, 111, 112, 115
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Dsouza, Brayal, Ravindra A. Prabhu, B. Unnikrishnan, Avinash Shetty, and Bhageerathy Reshmi. "A Qualitative Study on Factors Affecting Adherence Among Indian Haemodialysis Patients at a Tertiary Teaching Hospital of Southern India." Journal of Health Management 21, no. 3 (September 2019): 417–26. http://dx.doi.org/10.1177/0972063419868583.
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Non-adherence to treatment regimen can have a detrimental effect on the heath of dialysis patients, increase mortality, morbidity and increase in healthcare service utilization and cost of hospitalization. This qualitative study explores the factors affecting adherence among the dialysis population visiting a tertiary care teaching hospital in southern India by conducting one-to-one in-depth interviews with the patients as well as key informant interview with the caregivers at the outpatient dialysis facility of a tertiary care teaching hospital. Interview transcripts were thematically analyzed using ATLAS.ti. Patient factors, health financing, cultural beliefs, caregivers’ burden and health systems factors were identified. Understanding the factors affecting adherence can help the healthcare providers and the government to devise strategies to promote adherence and improved well-being among dialysis patients. Universal health coverage for dialysis, regulations to safeguard employment, creating awareness about opting for critical illness policies through private insurance companies when the disease is not pre-existing can reduce the out-of-pocket expenditure; these are some of the important areas for consideration to promote adherence.
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Gupta, Uma, Sanyam Khurana, and Abhilasha Sampagar. "The effect of COVID-19 pandemic on quality of life of family caregivers of chronically ill patients, health expenditure and home-based medical devices in India: a cross sectional study." International Journal Of Community Medicine And Public Health 10, no. 8 (July 29, 2023): 2827–30. http://dx.doi.org/10.18203/2394-6040.ijcmph20232372.
Full textAbstract:
Background: The novel coronavirus had a severe impact on India, with cases ranging from mild disease to severe multiple-organ failure syndrome. Caregivers of high-risk individuals face additional responsibilities that have detrimental effects on their mental and physical health. This study aimed to assess the quality of life of family caregivers, the impact on health expenditure, and the role of home-based medical devices during the pandemic in India. Methods: This retrospective study collected data from 358 participants using a validated caregiver self-assessment questionnaire and demographic details. The data were processed using the statistical tool chi-square, with p-value <0.05 considered significant, and analyzed using SPSS 11. The data is depicted using pie charts and bar diagrams. Results: 93.02% of our participants assumed a caregiver role. Among these, 58.26% reported mental distress. 7.21% of caregivers reported using telemedicine facilities, and 32% reported an increase in health-related expenditure in an attempt to provide better medical care to their loved one. More than 80% of the participants reported having a family member suffering from diabetes, while 70% reported old age or hypertension. Less than 10% had a loved one who was a pregnant woman or a frontline worker. Conclusions: The study highlights the significant impact of the COVID-19 pandemic on the mental health of family caregivers of chronically ill patients in India. The use of telemedicine facilities and the increase in health-related expenditure reflect the need for advancement in healthcare infrastructure in India.
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Patrick, Mugenzi, Muhammad Sami uz Zaman, Ghazala Afzal, Minhas Mahsud, and Mumuni Napari Hanifatu. "Factors That Affect Maternal Mortality in Rwanda: A Comparative Study with India and Bangladesh." Computational and Mathematical Methods in Medicine 2022 (April 9, 2022): 1–9. http://dx.doi.org/10.1155/2022/1940188.
Full textAbstract:
Healthcare sector is one of the most pivotal pillars of the administrative setup of a country. It addresses one of the most important dilemmas that countries have to face: provision of quality healthcare to public in affordable prices. Africa lags behind in many health indicators. One of the contemporary health issues faced by countries, especially for those in sub-Sahara countries, is maternal mortality rate (MMR). It has had a significant part to play in the social conditions of the population and needs immediate attention. In spite of many years of civil war and the terrible genocide in the mid-1990s, as of late, Rwanda is showing signs of improvement in healthcare sector. This research is aimed at studying the current state of maternal mortality rate in Rwanda and the factors behind its performance, in a comparative study with India and Bangladesh for a cross-section of time mainly between 1990 and 2015. After a literature review, pivotal indicators that affect healthcare are shortlisted and a comparative analysis of the three countries is made on the basis of these indicators. A regression is run between historical MMR data and these indicators. A directly significant relationship is found between MMR and healthcare expenditure per capita and government commitment to health, closely followed by female literacy and healthcare infrastructure.