66 Table 4.6 Distribution of households by family size in Bamuni Pathar revenue village, in number and. 66 Table 4.8 Distribution of basic facilities for the households in Bamuni Pathar revenue village, in numbers.
BACKGROUND OF THE STUDY
Dreze and Sen (2002), while identifying some of the reasons for the low status of health in India, drew attention to two disadvantages of the Indian health system. The Draft National Health Policy 2015 categorizes Assam as one of the states facing 'bigger challenges'.
BASIC HEALTH IS A MERIT GOOD: THEORETICAL FRAMEWORKS Kenneth Arrow’s (1963) paper on “Uncertainty and the Welfare Economics of Medical
Some of the characteristics associated with market failure are the presence of externalities and information asymmetry. This committee made an evaluation of the public health programs and found that there is a need to improve disease surveillance in the country.
INDIAN HEALTH SECTOR IN THE POST REFORMS PERIOD
One of the main factors behind the low levels of health outcomes in India is the low levels of public health expenditure in the country. Also, there is the problem of proper utilization of available resources in the health sector in the country.
JUSTIFICATION OF THE STUDY The study focuses on the state of Assam because
Claims for subsidies, various questions Department for Health and Family Welfare Claims for subsidies, various questions Department for Public Works. Published reports on public finances, various issues Center for Monitoring Indian Economy demand for subsidies, various issues Ministry of Health and Family Welfare Household Consumer Expenditure Survey in India,.
Introduction and review of literature
Chapter 5: Prevalence of morbidity among rural households examines the extent of morbidity (acute and chronic) in the study area. The factors causally affecting morbidity are
Health related out of pocket expenditure among rural households studies the impoverishment effect of out of pocket expenditure on health among the households
Public health facilities in the study villages discuss the hierarchy of public health facilities in the context of rural areas in Assam. The state of public facilities in the
Summary and Conclusions
INSTITUTIONAL SET UP OF MEDICAL AND PUBLIC HEALTH ADMINISTRATION IN ASSAM
The management and administration include expenditure on the State Secretariat Cell, State Family Welfare Office and District Family Welfare Office. The Directorate of Medical Education, Research and Training was established in 1984 under the Ministry of Health and Family Welfare.
EXTENT AND PATTERN OF PUBLIC HEALTH EXPENDITURE IN ASSAM One of the important indicators of the inadequacy of public health spending in India is
There has been a continuous increase in the share of M&PH expenditure in total healthcare since 1990-91 to 2011-12. However, a sudden increase has been observed in the share of maternity and child health expenditure.
NATIONAL HEALTH MISSION IN ASSAM
Before the introduction of the NHM, the Centre's healthcare expenditure at the state level came mainly from the public purse. Therefore, adding the state share of NHM and the central share will lead to an overestimation of the state's total healthcare expenditure.
CONCLUSION
While the expenditure through non-treasury routes increased in the form of autonomous bodies and implementing agencies, expenditure through treasury routes decreased specifically after implementation of the program of National Rural Health Mission in 2005. Thus, expenditure through treasury routes in the form of aid grants in the state has decreased since 2005.
HEALTH INDICATORS AND METHODOLOGY USED FOR DISTRICT RANKING
These specific data sources were used for analysis because they were the most recent and updated database during the course of the study. Since the present study focuses on the rural households of Assam, the rural database has been used for district ranking.
DISTRICT LEVEL DISPARITY IN ASSAM
It is below the median, as it is located to the right of the median (the middle line in the field). The ranking of districts on the basis of health coverage indicators shows that Sibsagar ranks first and Dhubri ranks lowest (Table 3.3). Block classifications are based on available data from the 2001 census.
Household schedule for the sample survey: include information on basic health amenities, details of household income, food and non-food household expenditure, acute
Schedule of House List for Census Type Survey: Includes information such as name of household head, place of birth, caste/tribe, religion, sex, age, marital status, head of household, place of birth, caste/tribe, religion, sex, age, marital residence, occupation and level of education of households. Data on land ownership and information on basic health rights such as immunization card, antenatal care card, RSBY card, ASHA and 108 rescue services were also collected during the house list survey. Household schedule for the sample survey: includes information on basic health services, details of household income, household expenditure on food and non-food items, acute.
Healthcare delivery schedule included
- PROFILE OF BALAGAON REVENUE VILLAGE Geographical location
- HEALTH ENTITLEMENTS AND HEALTH FACILITIES IN THE STUDY VILLAGES
The majority of households in the village have a maximum of 5 to 6 members (43 percent) and less than or equal to 4 members (40 percent). The majority of households in the village have less than or equal to 4 members (57 percent). 97 percent and 98 percent of households in the village respectively are aware of ASHA and 108 ambulance services.
Maps of India and Assam
Map of Nagaon district
Map of Nalbari district
MORBIDITY IN INDIA AND ASSAM: AN OVERVIEW
The 60th round, entitled Morbidity and Condition of the Aged, collected information on the overall health care system, the use of health care services offered by the public and private sectors, and expenditure on medical treatment by households. The variations in the morbidity estimates between different rounds can be attributed to changes in some concepts and definitions compared to the earlier rounds. The estimates from the 71st round are therefore not strictly comparable to the earlier rounds.
MORBIDITY PREVALENCE IN THE STUYDY VILLAGES
30 Krishaswami (2004), Sundar and Sarma (2002), Dilip (2002) found that the prevalence rate of morbidity is higher among Scheduled Caste and Scheduled Tribe categories. Similarly in Balagaon village untreated cases are observed more in working age group (6 percent). The caste-wise categorization of the village respondents shows the shortage of untreated cases among the OBCs was 4 percent among the general caste and 6 percent among the scheduled caste population (Table 5.7).
DISEASE SPECIFIC PREVALENCE RATE OF ACUTE MORBIDITY To assess the overall morbidity condition of the study villages’ information on disease
Untreated cases are observed in fever of unknown origin (8 percent) and other diseases (4 percent) (Table 5.10). The general psychology of the residents of both villages is biased against access to institutional facilities for treatment (Table 5.11). Disease specific chronic morbidity among ordinary residents, Balagaon village, Nalbari district, in number and percent Type of disease All persons. in number).
DIFFERENTIALS IN UTILIZATION OF HEALTH CARE SERVICES BY PLACE OF TREATMENT
Thus, the dependence on government health facilities is high in cases of both acute and chronic morbidity in the study town. This implies that higher the education level of the respondent lower the probability of visiting a government health facility for treatment. Higher the monthly income of the household, lower is the probability of visiting a public health facility.
FACTORS INFLUENCING MORBIDITY IN THE STUDY VILLAGES: A POOLED REGRESSION ANALYSIS
The operational retention of the respondent is another important factor taken into account in the model. The variable availability of the toilet facility is indicated in the model by ATF. Please note: ® refers to the reference category. The analysis takes into account the education level of the head of the household.
CONCLUSION
This chapter examines the extent, nature and effects of out-of-pocket expenses (OOP) on health among households in the study area. Out-of-pocket expenses above catastrophic levels lead to impoverishment of the rural poor. Components of out-of-pocket health care costs and costs for hospitalization and non-hospitalization cases are discussed in detail in this section.
OUT OF POCKET EXPENDITURE IN INDIA
A study on out-of-pocket expenditure is worthwhile as it can provide policy makers with insight into the financial burden households bear as a result of their own work. The estimate of out-of-pocket costs, which combines expenditures for inpatient and outpatient care, is estimated for the reference period of the last 365 days. rounds 2009-10)47 were used to compare the costs of self-implementation across countries.48. According to the latest Consumer Expenditure Survey (2009-2010), states with out-of-pocket costs higher than the national average are Andhra Pradesh, Kerala, Maharashtra, Punjab, Tamil Nadu, Uttar Pradesh and West Bengal50.
OUT OF POCKET EXPENSES ON HEALTH IN THE STUDY VILLAGES To assess the share of out of pocket expenses on health of the households, we have categorized
The share of expenditure on doctor's fees is 8 percent of the total OOP expenditure in Balagaon. The share of expenses for the purchase of drugs and medicines is the highest in the total average OOP expenses. The table shows that the share of expenditures for physician fees is 1 percent of total average OOP expenditures.
CATASTROPHIC HEALTH EXPENSES AMONG RURAL HOUSEHOLDS The concept of catastrophic expenditure emerged in the 1980’s. According to Berki (1986)
Catastrophic overshoot (O) estimates the intensity as an average degree by which payments exceed the threshold (Q). Caste-wise classification shows that the catastrophic excess is higher for OBCs at the threshold level of 5 percent. Similarly, the catastrophic exceedance of the 10 percent threshold level is 1.5 percent, meaning that average health care costs are 1.5 percent higher than the 10 percent threshold level.
IMPOVERISHMENT DUE TO CATASTROPHIC HEALTH EXPENSES
At nominal prices 49 percent of households were in extreme poverty in Bamuni Pathar village. At normalized prices 71 percent of households were in extreme poverty in Bamuni Pathar village. The dependent variable used in the model is "whether an individual makes a catastrophic expenditure that exceeds 10 percent of the total household consumption expenditure or not" if "yes" the variable takes the value 1, or 0 otherwise56.
SOURCE OF FINANCING HEALTH EXPENDITURE AMONG HOUSEHOLDS Out of pocket expenses also have an impact on the economic condition of the households. The
Dependence on loans is greater and financing of health care costs through contributions from friends, family and friends is minimal. Since the literate population of the village is large, they seek loans instead of other sources or contributions from friends and relatives. 11 percent of households have to bear healthcare costs through the sale of household assets in Balagaon.
CONCLUSION
The study shows that a large portion of OOP expenditure is related to hospital admissions, especially in Bamuni Pathar village. Households depend on private health care facilities due to lack of quality care in nearby government health facilities. A better healthcare system is essential to have an impact in the form of reduced morbidity or mortality for the rural population.
ORGANIZATIONAL STRUCTURE OF HEALTHCARE DELIVERY SYSTEM IN RURAL AREAS OF ASSAM
The primary tasks of KHO are care mainly in the fields of medicine, surgery, pediatrics and gynecology. One of the main responsibilities of the PHC is to refer cases to the PHC and other higher levels of public health institutions in the hierarchy. According to the norms, a sub center should be established for every 5,000 population in plain areas, while it should be established for every 3,000 population in hilly areas.
HEALTH INFRASTRUCTURE IN THE STUDY VILLAGES IN REFERENCE TO INDIAN PUBLIC HEALTH STANDARDS (IPHS)
The health assistant informed me that there is a drug crisis at the health center. Provision of statistical data on births and deaths in villages in the sub-centre, KSHP or QSQ. They expressed that they find it difficult to keep all the official work in the sub-centre.
Since there was only one ANM each in both sub-centres, they have a heavy workload.
Centre
State
District
Block
PROBLEMS ASSOCIATED WITH HEALTH CARE DELIVERY SYSTEM IN THE STUDY VILLAGES
The lack of qualified medical personnel in medical institutions in both villages was already emphasized in the previous chapter. Another serious problem was the lack of medicines in the health centers of both villages. Another problem in state medical institutions is insufficient seating capacity and overcrowding.
PATTERN OF UTILIZATION OF MATERNAL AND CHILD HEALTH CARE SERVICES IN THE SAMPLE VILLAGES
Similarly, the percentage of women receiving PNC was 60 percent in Bamuni Pathar and 79 percent in Balagaon. The low birth weight in Bamuni Pathar is mainly due to a lack of nutritious food among the pregnant mothers. As for vaccination, of all children aged 0 to 6 years, 92 percent were vaccinated in Bamuni Pathar and 97 percent in Balagaon.
DELIVERY FACTORS INFLUENCING MATERNAL AND CHILD HEALTH CARE
Data from the Child Health Services Utilization Survey shows that 92 percent of children in Bamuni Pathar village were weighed at birth, compared to 98 percent in Balagaon. The test results show that there is a significant relationship between institutional implementation and all explanatory variables (see Table 7.3). Similarly, among child health indicators, it can be observed that the percentage of low birth weight infants is lower among those who are beneficiaries of JSY and Mamoni.
CONCLUSION
Government flow of funds is also insufficient to maintain the normal functioning of the health care facilities. Assam is identified as one of the states with 'poor health outcome indicator' in the flagship program of National Health Mission introduced in 2005. A large difference in terms of performance of health outcome indicators across rural and urban areas of the state was also observed.
PUBLIC HEALTH EXPENDITURE IN ASSAM: 1990-91 TO 2011-12
Government expenditure in the state consists of expenditure on medical and public health and family welfare. In 2010-2011, medical and public health expenditures accounted for 89 percent of the state's total healthcare expenditures. On the contrary, the share of spending on family welfare as a percentage of total state health care spending has declined.
DISTRICT LEVEL ANALYSIS OF HEALTH INDICATORS
MORBIDITY AND HEALTH STATUS OF THE RURAL HOUSEHOLDS On the basis of the household survey, the study examines the status of health among the
Caste-wise classification in both the villages indicates a higher percentage of untreated morbidity cases among the Scheduled Tribes in Bamuni Pathar and Scheduled Caste respondents in Balagaon. Cases of untreated morbidity are also higher for waterborne diseases and communicable diseases in both the towns. However, the dependence on private health facilities is found to be higher for chronic diseases in both the towns.
CATASTROPHIC HEALTH EXPENSES IN THE SAMPLE VILLAGES The present study found a high level of catastrophic expenditure in both the villages (10
The study also identifies some factors that have an effect on morbidity in the study villages. 15 percent of total out-of-pocket expenditure is spent on diagnostic tests in government health care facilities, while 14 percent is spent in private health care facilities. The study identifies some of the crucial factors that have a significant impact on catastrophic household expenditure.
HEALTH CARE DELIVERY IN BAMUNI PATHAR AND BALAGAON VILLAGES
The study also found a positive relationship between the health care delivery system and maternal and child health indicators in the sample villages. One of the successes of the government's health programs is felt in the indicators of reproductive health and child health. Many households in the survey believed that only services related to maternal and child health care were easily accessible in nearby village health centers.
LIMITATIONS AND SCOPE FOR FUTURE RESEARCH
Since basic health problems such as communicable diseases have a long-term effect on the community, this should be taken into account by the government. Needless to say, government spending on infrastructure and quality services needs to improve, given the affordability of such services by the common man.
