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Invest More in Public Healthcare Facilities

Data from National Sample Surveys (71st round, 2014 and 75th round, 2017–18) show that there is a significant increase in the utilisation of public facilities for both outpatient and inpatient services, across empowered action group states and non-EAG states. As a result, there is a dramatic fall in the overall financial burden on patients who would have otherwise used services of private healthcare providers. In light of this evidence, this paper argues that it is prudent to invest more directly to strengthen public healthcare delivery system in India.

Higher Disease Burden in India’s Elderly

The disease burden among the elderly population is significantly higher compared to the younger population, according to the data from the 75th round National Sample Survey, 2017–18, which increases their vulnerability during the COVID-19 pandemic. The footprint of elderly population in public facilities for inpatient and outpatient care has increased over the years. Financially, the elderly face far less burden in public facilities than in private facilities.

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

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

Healthcare Consumption in Uttar Pradesh

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