Abstract

Background and Objective: Quality of public healthcare service is one of the major issues in the rural areas of India. Though integrated healthcare is provided by the government, the utilization of the same has been low due to various reasons and one could be the quality of service itself. Therefore, it is important that quality is assessed to constantly improve upon the health care services. This will help in more health care utilization by the rural people, which will help meeting the targets of the Sustainable Development Goals (SDGs) in health care domain.

Data and Methodology: The data have been collected from the field in the summer of 2015. We have used Principal Component Analysis (PCA) to examine the structure of the relationship among variables representing the perceived quality dimensions of the rural public health care. The assessment is based on Likert scale of 1 to 5; where 1= strongly disagree, 2=disagree, 3=neither agree nor disagree, 4=agree and 5=strongly agree on access, usage, reliability and satisfaction factors. We also assessed the quality difference between Primary Health Centres (PHCs) and Community Health Centres (CHCs) by using t-test.

Results and Applications: Easy accessibility is a problem with the public health care service in the rural areas of Assam. Usage of the public health care service is poor even though reliability and satisfaction of the service are adequate. PHCs are found to be better than CHCs except in the reliability aspect. This could be due to the fact that accessibility of PHCs is better than the CHCs. The findings of the study suggest that the rural public health care needs to be improved and they should not act only as referral units. In order to improve the usage of the publicly provided health care service, awareness on health care utilization needs to be created which would also improve the health status of the people and also reduce the out of pocket spending on health care. However, for this to happen, improvement in the service provided is necessary.

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Abstract

Introduction: Out-of-Pocket (OOP) spending is a prominent health care payment mechanism in India and other developing countries. However, it is more common amongst the lower income group of people especially in the rural areas. And due to this type of payments mechanisms (OOP) many households incur catastrophic payments and possibility of falling into poverty trap is high. To avoid such an impoverishment situation, some households forgo the needed health care when get health shocks. This study analyses the various issues related to treatment forgone and its major determinants.

Data and Methods: The empirical analysis is based on the primary survey conducted in the last quarter of 2015 in rural Chirang districts of Assam (India). It is based on the data collected on OOP payments, income of the households, and treatment forgone due to lack of money or unbearable cost for the last one year preceding the survey date. The analysis is descriptive as well as based on binary logistic regression model.

Results/Application: It has been found that the households with lower income groups are more likely to forgo treatment than the higher income groups. The treatment forgone by the households whose annual income is up to ₹75,000 is higher relative to the income group greater than ₹2,00,000 (OR=15.96, p< 0.001), and the households in the income group of between ₹75,001-2,00,000 relative to the income group of greater than ₹2,00,000 (OR=8.86, p<0.01). The results also show that the households which incurred catastrophic OOP expenditure on health care are more likely to forgo health care subsequently. Population size of the households also plays an important role in determining the treatment forgone. Female headed households are less likely to forgo treatment than the male headed households, though the result is not statistically significant. 

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