Health-care utilization and expenditure patterns in the rural areas of Punjab, India

Utilisation of services provided at an outreach healthcare facility and its associated factors among residents in a coastal taluk of southern Karnataka: A cross-sectional study

Introduction

Understanding the patterns of utilisation of primary health services can help to improve service delivery and utilisation, thereby reducing common morbidities in the community. The study aimed to assess the patterns of utilisation of services provided at an outreach healthcare centre.

Methods

A community-based survey was conducted among families residing in the field practice area of an outreach centre for more than a year. Data were collected using a questionnaire administered to adults aged >18 years. Collected data were entered into and analysed using the Statistical Package for the Social Sciences version 16.0.

Results

Approximately 65.1% of the respondents were aged 31-59 years, and 67.4% were women. Among 126 surveyed households, 50.7% had utilised services from the outreach centre. The facilitators of utilisation among 64 households included proximity to their area of residence (90.6%) and availability of good-quality services (40.6%). The most common barriers included a lack of awareness (30.9%) and inconvenient timings (18.2%) of the healthcare centre. The respondents aged <18 years (odds ratio [OR]=7.64; 95% confidence interval [CI]=4.37-13.37) and >45 years (OR=2.65; 95% CI=1.57-4.47) had higher odds of utilising services than those aged 18-45 years. The female respondents (OR=2.89; 95% CI=1.86-4.51) were more likely to utilise services than the male respondents.

Conclusion

Creating awareness regarding the outreach healthcare centre and designing services based on the observed needs of the community can further improve the utilisation of services provided at the healthcare centre.

Scourge of out-of-pocket expenditure on health: A study on its burden and predictors in a rural community of West Bengal

Introduction

Globally, one-third of current health expenditure had been out-of-pocket expenditure (OOPE). The health system financing of almost all low- and middle-income countries including India rely heavily on out-of-pocket (OOP) payments for health care. OOPE on health payments is particularly hard on any community, especially the poor leading to incomplete or even no treatment during their ill health. This study estimated OOPE among residents of a rural community in West Bengal and explored the associated factors with high OOP expenses.

Methods

A community-based cross-sectional study was conducted in a rural community in Singur, West Bengal from June 2019 to February 2020. The study was done among 398 villagers selected from 15 clusters or villages. Households were randomly selected in each village. All members of the selected households were interviewed. SPSS was used for data analysis both for descriptive and inferential statistics.

Results

Only 14.6% of morbid persons had catastrophic expenditure. The incidence of catastrophic expenditure was higher among those who opted for private practitioners and or ayurveda, yoga and naturopathy, unani, siddha, and homeopathy (AYUSH) facilities. There was zero catastrophic expenditure for the unqualified sector. There was an increasing trend of OOP payments among the lower socioeconomic groups. Again, low-income individuals had a higher share in cumulative expenditure (Gini coefficient of 0.35). Most of the participants (78.4%) had no health insurance coverage.

Conclusion

Promotion for higher utilization of public health facilities may reduce the burden of OOP expenses. Government health insurance schemes must be widened with the inclusion of coverage of outpatient services. Integrating AYUSH services in the public sector is another option to reduce OOP expenses.

Health insurance coverage and its impact on out-of-pocket expenditures at a public sector hospital in Kerala, India

Background

Health insurance coverage ensures protection from catastrophic health-care expenditure, especially to the underprivileged sections of society. Health insurance schemes such as Ayushman Bharat are coming up in addition to the existing schemes such as Rashtriya Swasthya Bima Yojana in India. The objectives are to find the health insurance coverage and its impact on out-of-pocket (OOP) expenditure for public sector tertiary health-care hospitalization.

Methods

A cross-sectional study was conducted at a tertiary care hospital in Kerala. Insurance coverage was assessed among patients seeking inpatient care in various medical and surgical departments. OOP expenses incurred for those receiving and not receiving insurance coverage were compared. In addition, factors influencing enrolment and availing of insurance schemes were determined.

Results

The coverage of health insurance was found to be 74%. Awareness campaigns and activities of local self-government (LSG) departments were the important reasons for enrolment and availing, respectively. Significantly lower OOP expenditures occurred in insured persons with regard to expenses incurred for treatment procedures (P = 0.019), investigations (P = 0.004), and medicines (P = 0.001). Among the enrolled patients, 45% expressed dissatisfaction regarding available services.

Conclusion

A quarter of patients still remain out of insurance coverage. All patients are incurring OOP expenditures, though the insured patients have significantly lower OOP expenses. The role of primary care providers and LSG is pivotal in creating awareness and ensuring enrolment. Availing services depend on the availability of resources at the respective institution. Improvements in enrolment and use of health insurance should ultimately result in improved patient satisfaction.