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Strategies for coping with the costs of inpatient care: a mixed methods study of urban and rural poor in Vadodara District, Gujarat, India.

Ranson MK, Jayaswal R, Mills AJ - Health Policy Plan (2011)

Bottom Line: This study aims to explore and compare mechanisms employed by the urban and rural poor for coping with inpatient expenditures, in order to help identify formal mechanisms and policies to provide improved social protection for health care.Users of public hospitals, in both urban and rural areas, were poor relative to users of private hospitals.Past experience suggests that these efforts must be carefully monitored to ensure that the poorer among the insured are able to access scheme benefits, and the quality and quantity of health care provided must be monitored and regulated.

View Article: PubMed Central - PubMed

Affiliation: Alliance for Health Policy and Systems Research, World Health Organization, 20 avenue Appia, 1211 Geneva 27, Switzerland. ransonm@who.int

ABSTRACT

Background: In India, coping mechanisms for inpatient care costs have been explored in rural areas, but seldom among urbanites. This study aims to explore and compare mechanisms employed by the urban and rural poor for coping with inpatient expenditures, in order to help identify formal mechanisms and policies to provide improved social protection for health care.

Methods: A three-step methodology was used: (1) six focus-group discussions; (2) 800 exit survey interviews with users of public and private facilities in both urban and rural areas; and (3) 18 in-depth interviews with poor (below 30th percentile of socio-economic status) hospital users, to explore coping mechanisms in greater depth.

Results: Users of public hospitals, in both urban and rural areas, were poor relative to users of private hospitals. Median expenditures per day were much higher at private than at public facilities. Most respondents using public facilities (in both urban and rural areas) were able to pay out of their savings or income; or by borrowing from friends, family or employer. Those using private facilities were more likely to report selling land or other assets as the primary source of coping (particularly in rural areas) and they were more likely to have to borrow money at interest (particularly in urban areas). Poor individuals who used private facilities cited as reasons their closer proximity and higher perceived quality of care.

Conclusions: In India, national and state governments should invest in improving the quality and access of public first-referral hospitals. This should be done selectively-with a focus, for example, on rural areas and urban slum areas-in order to promote a more equitable distribution of resources. Policy makers should continue to explore and support efforts to provide financial protection through insurance mechanisms. Past experience suggests that these efforts must be carefully monitored to ensure that the poorer among the insured are able to access scheme benefits, and the quality and quantity of health care provided must be monitored and regulated.

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Mechanisms for coping with financial shocks. Source: World Bank (2001)
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Figure 1: Mechanisms for coping with financial shocks. Source: World Bank (2001)

Mentions: The term ‘coping strategies’ was coined during the 1980s in the literature on household responses to lack of food and nutrition. The term refers to the mechanisms or activities undertaken by members of a household that help them survive through a crisis situation (McIntyre and Thiede 2007). Figure 1 lists some of the measures available for coping with financial shocks. The strategies have been categorized as informal (or traditional) and formal, i.e. market-based or publicly provided (World Bank 2001). In India, formal mechanisms are largely inaccessible to the poor. In theory, government provision of universal and free health care should cover the poor, but in practice it often does not. Private-for-profit health insurance and government social insurance are geared primarily towards India’s formal sector, comprising less than 10% of the total population (Gupta and Trivedi 2005).Figure 1


Strategies for coping with the costs of inpatient care: a mixed methods study of urban and rural poor in Vadodara District, Gujarat, India.

Ranson MK, Jayaswal R, Mills AJ - Health Policy Plan (2011)

Mechanisms for coping with financial shocks. Source: World Bank (2001)
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3375767&req=5

Figure 1: Mechanisms for coping with financial shocks. Source: World Bank (2001)
Mentions: The term ‘coping strategies’ was coined during the 1980s in the literature on household responses to lack of food and nutrition. The term refers to the mechanisms or activities undertaken by members of a household that help them survive through a crisis situation (McIntyre and Thiede 2007). Figure 1 lists some of the measures available for coping with financial shocks. The strategies have been categorized as informal (or traditional) and formal, i.e. market-based or publicly provided (World Bank 2001). In India, formal mechanisms are largely inaccessible to the poor. In theory, government provision of universal and free health care should cover the poor, but in practice it often does not. Private-for-profit health insurance and government social insurance are geared primarily towards India’s formal sector, comprising less than 10% of the total population (Gupta and Trivedi 2005).Figure 1

Bottom Line: This study aims to explore and compare mechanisms employed by the urban and rural poor for coping with inpatient expenditures, in order to help identify formal mechanisms and policies to provide improved social protection for health care.Users of public hospitals, in both urban and rural areas, were poor relative to users of private hospitals.Past experience suggests that these efforts must be carefully monitored to ensure that the poorer among the insured are able to access scheme benefits, and the quality and quantity of health care provided must be monitored and regulated.

View Article: PubMed Central - PubMed

Affiliation: Alliance for Health Policy and Systems Research, World Health Organization, 20 avenue Appia, 1211 Geneva 27, Switzerland. ransonm@who.int

ABSTRACT

Background: In India, coping mechanisms for inpatient care costs have been explored in rural areas, but seldom among urbanites. This study aims to explore and compare mechanisms employed by the urban and rural poor for coping with inpatient expenditures, in order to help identify formal mechanisms and policies to provide improved social protection for health care.

Methods: A three-step methodology was used: (1) six focus-group discussions; (2) 800 exit survey interviews with users of public and private facilities in both urban and rural areas; and (3) 18 in-depth interviews with poor (below 30th percentile of socio-economic status) hospital users, to explore coping mechanisms in greater depth.

Results: Users of public hospitals, in both urban and rural areas, were poor relative to users of private hospitals. Median expenditures per day were much higher at private than at public facilities. Most respondents using public facilities (in both urban and rural areas) were able to pay out of their savings or income; or by borrowing from friends, family or employer. Those using private facilities were more likely to report selling land or other assets as the primary source of coping (particularly in rural areas) and they were more likely to have to borrow money at interest (particularly in urban areas). Poor individuals who used private facilities cited as reasons their closer proximity and higher perceived quality of care.

Conclusions: In India, national and state governments should invest in improving the quality and access of public first-referral hospitals. This should be done selectively-with a focus, for example, on rural areas and urban slum areas-in order to promote a more equitable distribution of resources. Policy makers should continue to explore and support efforts to provide financial protection through insurance mechanisms. Past experience suggests that these efforts must be carefully monitored to ensure that the poorer among the insured are able to access scheme benefits, and the quality and quantity of health care provided must be monitored and regulated.

Show MeSH
Related in: MedlinePlus