2 In rural areas close to 20 of the health expenses for outpatent care is

2 in rural areas close to 20 of the health expenses

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2. In rural areas, close to 20% of the health expenses for outpatent care is fnanced through borrowing ; the corresponding percentage for hospitalisaton is much higher at around 40% (NSSO2006). 3. The recourse to borrowing , while being substantal even in the urban areas, is of a lower order compared to the rural areas . The reliance on borrowing is signifcantly higher for the poorer sectons of the populaton compared to the beter-of with sharp diferentals , especially in urban areas (NSSO2006). a. Several of these observatons are corroborated by a study of 482 poor households in Udaipur , Rajasthan which showed that nearly 29% of the households identfed health expenditure as the major source of fnancial stress (Banerjee and Dufo 2007). 4. Faced with the reality that healthcare costs to the households have been rising, the poor ofen fnance such expenditure by cutng down consumpton levels of other members of the household (Iyer et al 2007). 5. Thus, illness of a member of the household can have deleterious consequences for the household towards further impoverishment of the households (Sen et al 2002; Garg and Karan 2005). 4. FACTORS AFFECTING EQUITY IN ACCESS TO HEALTH SERVICES 1. The previous secton has presented the inequites in availability, utlisaton and afordability of health services. 2. We identfy and discuss 5 key health service factors that afect equity in access to health services. These include – a. insufcient investments in public sector; b. variable quality of care in public and private sectors; c. unregulated commercialisaton and rising costs; d. health sector reforms; 14 Downloaded by Vicky Gupta ([email protected]) lOMoARcPSD|3929542
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e. lack of accountability in the public and private sector. INSUFFICIENT INVESTMENTS IN PUBLIC SECTOR 1.The per capita expenditure on health in India is low compared with other countries with same levelof income, and the government expenditure is even lower. a.The per capita bilateral and multlateral donor funding for health is among the lowest forb.The per capita aid over a three-year average, from 2004 to 2006 = approximately $0.80c.government spending per capita = $6.50 d.total per capita health expenditure = around $35.00. countries at the same income level. 2. These fgures on health expenditure , along with external per capita aid, are lower than many of the poorer African and south-east Asian countries (OECD2008). a. Government spending , at approximately 19%-20% of health expenditure, is among the lowest in the world (WHO 2008). b. Further, due to federalism, large variatons in fnancing across states induce variability in availability of health services. 3. The long-standing weakness in public health services has been partly responsible for acceleratng expansion in the private sector , and for the public-private mix. a. The private sector has expanded by drawing upon public subsidies in the form of i. human resources from subsidised medical educaton, ii. allowing those with public appointments to undertake private practce, and iii. ofering tax concessions for import of medical technology and infrastructural facilites (Bhat 1993, 1999; Baru 1998; 2002)
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