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Effect of User Charges on Secondary Level Surgical Care Utilization and Out-of-Pocket Expenditures in Haryana State, India

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  • Deepak Balasubramanian
  • Shankar Prinja
  • Arun Kumar Aggarwal

Abstract

Background: Generation of resources for providing health care services is an important issue in developing countries. User charges in the form of Surgical Package Program (SPP) were introduced in all district hospitals of Haryana to address this problem. We evaluate the effect of this SPP program on surgical care utilization and out-of-pocket (OOP) expenditures. Methods: Data on 25437 surgeries, from July 2006 to June 2013 in 3 districts of Haryana state, was analyzed using interrupted time series analysis to assess the impact of SPP on utilization of services. Adjustment was made for presence of any autocorrelation and seasonality effects. A cross sectional survey was undertaken among 180 patients in District hospital, Panchkula during June 2013 to assess the extent of out of pocket (OOP) expenditure incurred, financial risk protection and methods to cope with OOP expenditure. Catastrophic health expenditure, estimated as any expenditure in excess of 10% of the household consumption expenditure, was used to assess the extent of financial risk protection. Results: User charges had a negative effect on the number of surgeries in public sector district hospitals in all the 3 districts. The mean out-of-pocket expenditure incurred by the patients was Rs.4564 (USD 74.6). The prevalence of catastrophic expenditure was 5.6%. A higher proportion among the poorest 20% population coped through borrowing money (47.2%), while majority (86.1%) of those belonging to richest quintile paid from their monthly income or savings, or had insurance. Conclusion: There is a need to increase the public financing for curative services and it should be based on the needs of population. Any form of user charge in public sector hospitals should be removed.

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  • Deepak Balasubramanian & Shankar Prinja & Arun Kumar Aggarwal, 2015. "Effect of User Charges on Secondary Level Surgical Care Utilization and Out-of-Pocket Expenditures in Haryana State, India," PLOS ONE, Public Library of Science, vol. 10(5), pages 1-15, May.
  • Handle: RePEc:plo:pone00:0125202
    DOI: 10.1371/journal.pone.0125202
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    1. McPake, Barbara, 1993. "User charges for health services in developing countries: A review of the economic literature," Social Science & Medicine, Elsevier, vol. 36(11), pages 1397-1405, June.
    2. Galina Besstremyannaya, 2014. "Heterogeneous effect of coinsurance rate on healthcare costs: generalized finite mixtures and matching estimators," Discussion Papers 14-014, Stanford Institute for Economic Policy Research.
    3. Planning Commission, India, 2011. "Faster, Sustainable and More Inclusive Growth: An Approach to the 12th Five Year Plan," Working Papers id:4452, eSocialSciences.
    4. Saksena, Priyanka & Antunes, Adélio Fernandes & Xu, Ke & Musango, Laurent & Carrin, Guy, 2011. "Mutual health insurance in Rwanda: Evidence on access to care and financial risk protection," Health Policy, Elsevier, vol. 99(3), pages 203-209, March.
    5. Rama Joglekar, 2008. "Can insurance reduce catastrophic out-of-pocket health expenditure?," Indira Gandhi Institute of Development Research, Mumbai Working Papers 2008-016, Indira Gandhi Institute of Development Research, Mumbai, India.
    6. Menno Pradhan & Nicholas Prescott, 2002. "Social risk management options for medical care in Indonesia," Health Economics, John Wiley & Sons, Ltd., vol. 11(5), pages 431-446, July.
    7. Shankar Prinja & Pankaj Bahuguna & Andrew D Pinto & Atul Sharma & Gursimer Bharaj & Vishal Kumar & Jaya Prasad Tripathy & Manmeet Kaur & Rajesh Kumar, 2012. "The Cost of Universal Health Care in India: A Model Based Estimate," PLOS ONE, Public Library of Science, vol. 7(1), pages 1-9, January.
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    1. Grigorakis, Nikolaos & Floros, Christos & Tsangari, Haritini & Tsoukatos, Evangelos, 2016. "Out of pocket payments and social health insurance for private hospital care: Evidence from Greece," Health Policy, Elsevier, vol. 120(8), pages 948-959.

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