Paying Out-of-Pocket for Drugs, Diagnostics and Medical Services: A Study of Households in Three Indian States

202 Pages·2013·4.22 MB·English

by  Moneer Alam (auth.)

India Studies in Business and Economics
Moneer Alam
Paying Out-of-
Pocket for Drugs,
Diagnostics and
Medical Services
A Study of Households in Three Indian
States
Paying Out-of-Pocket for Drugs,
Diagnostics and Medical Services
India Studies in Business and Economics
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Moneer Alam
Paying Out-of-Pocket
for Drugs, Diagnostics
and Medical Services
A Study of Households in Three Indian States
Moneer Alam
Institute of Economic Growth
Delhi University
Delhi , India
ISBN 978-81-322-1280-5 ISBN 978-81-322-1281-2 (eBook)
DOI 10.1007/978-81-322-1281-2
Springer India Heidelberg New York Dordrecht London
Library of Congress Control Number: 2013940875
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Affectionately dedicated to my wife,
Shahida Moneer

Acknowledgements
This study is the outcome of work conducted during 2008–2009 to examine the
health-care expenses of low-income households in selected areas of UP, Rajasthan
and Delhi. The study, fi nanced by the SER Division of the Planning Commission
Government of India, was designed particularly to investigate many signifi cant
health-related issues. These included the access to medical services for low-income
people of the selected districts, how much they spend and to what effect, and the
role of public sector health facilities in helping these highly vulnerable groups
of population drawn from villages and smaller cities of the states concerned.
I am highly grateful to the Planning Commission offi cials of Govt. of India, in
particular Dr. Syeda Hameed, member, Planning Commission (Health), for her keen
interest and generous support. I am also very grateful to the Health Division of the
Planning Commission, especially Mr. Ambrish Kumar, Adviser (Minority Division),
for helping us all through, both academically and logistically. Mr. Kumar also took
keen interest in developing the overall concerns of the study and shared with us many
critical issues engaging the minds of planners and health mandarins of this apex body.
I am also grateful to my other professional friends, including Dr. A. B. Dey
(Professor, Department of Medicine, All India Institute of Medical Sciences,
New Delhi), Professor Nugroho Abikusno (WHO, SEARO, India), and my faculty
colleagues at Institute of Economic Growth (IEG) for providing me with many
useful inputs. M/S Fauzia Khan, a reputed data collection agency in New Delhi,
provided excellent fi eld support and arranged a team of well-trained investigators to
visit the sample households in UP, Rajasthan and Delhi. I sincerely acknowledge
their contributions to this study.
I also owe a debt of gratitude to my two colleagues, Mr. R. P. Tyagi and
Mr. Anup Karan. Mr. Tyagi remained associated until the end of this study, helped
to supervise fi eld operations and worked on fi nalising the executive summary of the
report. Though Mr. Anup Karan worked as a consultant to help in data analysis,
his contribution was far more—he helped me write two critical chapters on cata-
strophic spending and on the share of drugs and medical services in households’
out-of-pocket spending.
vii
viii Acknowledgements
Back home, at the Institute of Economic Growth, my thanks are due to Professor
Kanchan Chopra (Former Director, IEG) and Professor Manoj Panda (Director,
IEG), for their unconditional support and encouragement. Members of the IEG staff,
in particular those manning the fi nance, computer, library and project offi ces, were
also extremely helpful and gave their best in making this study a success.
Special appreciation is extended to my project staff and younger colleagues,
Mr. Sumit Gulati, Mr. S. Delka and Ms. Ayusmati Das, for their assistance in data
management and analysis.
Finally, a big ‘thank you’ goes to my friend and manager of the editorial team at
IEG, Mr. Surit Das, for all his excellent editorial support.
The entire Springer team, especially the Senior Editor Ms. Sagarika Ghosh and
Senior Editorial Assistant Ms. Sahadi Sharma, has helped the book see the light of
day. I owe a debt of gratitude to them.
The responsibility for any error or omissions, however, is mine and not of the
individuals or institutions that have so generously supported us.
New Delhi, India Moneer Alam
Contents
1 Introduction ............................................................................................... 1
1.1 Existing Health Situation: A Few Stylised Facts ............................... 2
1.2 Health Indicators and Underlying Issues ........................................... 4
1.2.1 Selected Health Indicators: All India ..................................... 5
1.2.2 Disease Burden and Deaths: WHO Estimates
(DALYs Rates and Death Rates) ............................................ 6
1.3 Health Financing by the Centre and States ........................................ 7
1.3.1 Per Capita Health Expenditure
During Post-reform Period ..................................................... 8
1.3.2 Share of Health in Revenue Budget: Centre and States ......... 9
1.3.3 Utilisation of Public and Private Health Facilities ................. 10
1.4 Out-of-Pocket Health Spending in India:
A Brief About Some Existing Literature ........................................... 12
1.5 Objectives of the Study and Spatial Coverage ................................... 14
1.5.1 Spatial Coverage .................................................................... 17
1.6 Collection of Primary Data: Survey Design
and Selection of Households .............................................................. 17
1.6.1 Selection of Study Areas and Sample Design ........................ 18
1.6.2 Selection of Sample Households: Delhi ................................. 19
1.6.3 Distribution of the Total Sample ............................................ 20
1.7 Research Questions and Profi le of Study Areas ................................ 20
1.7.1 Survey Protocol and Its Issues ............................................... 20
1.7.2 Districts’ Profi le ..................................................................... 23
Appendix ..................................................................................................... 25
References ................................................................................................... 27
ix