INVESTIGATING OUT-OF-POCKET EXPENDITURE WITH REFERENCE TO INFORMATION DIFFERENTIALS AND LEMONS IN HEALTH CARE: CASE OF SELECT REGIONS OF ASSAM

Abstract

‘Health for All’ is the target of the World Health Organization since 1977 (WHO, 1981), which aims at securing the health and well-being of people around the world. The National Rural Health Mission (NRHM) in India in 2005, aimed at the betterment of the quality of public health care services, especially for the rural poor. But still, we are struggling with quality health care. Some of the challenges of our healthcare system are lack of awareness, lack of access, workforce shortages, and lack of affordability and accountability. In this study, we focus on the various factors affecting health care expenditure with reference to information differentials, social networks, and the existence of Quacks in the health care sector. The work is stratified into six chapters: Chapter 1 deals with the background of the study, its contributions, and some facts from National Health Account (NHA) reports and NSS 75th round have been incorporated. This chapter also includes objectives of the thesis and the conceptual framework. Chapter 2 deals with the factors affecting OOPE on health care. It further takes into consideration the special cases of Empowered Action Group (EAG) states. The study is an attempt to find out the relevant covariates of OOPE with a special focus on EAG states. This study has considered some important covariates like waiting time, treatment location along with other variables and their changes over five years duration. The work uses India Human Development Survey (IHDS) database. Log-linear regression analysis (four models) by incorporating both IHDS I and IHDS II. After analyzing various factors affecting OOPE on health care, we find the importance of information dissemination along with other variables. Various health schemes and their facilities must reach the underprivileged section of the society. Therefore, the next chapter deals with information dissemination about health care facilities and possible effect on OOPE on health care. Chapter 3 conceptualizes the role of Information and Communication Technology (ICT) with health care expenditure. The nexus between mass media and the expenditure on health care is the gist of this chapter. Data is extracted from the India Human Development Survey II (2011-12). Two models are specified. In model 1, the log-linear regression method is applied. In model 2, multinomial logit regression is applied to find out the OOPE on the health care of those who are using ICT devices differently. The findings in this paper confirm the nexus between use of mass media and expenditure on health care of the Indian households. But access to ICT devices has a cost involved both in the production and transmission. However, Social network do not incurprovide them with information. Therefore, the next chapter deals with social network and the possible implication on OOPE on health care. Chapter 4 deals with the role of social network on OOPE in health care. It further bifurcates social network into direct social network and indirect social network. The paper follows India Human Development Survey II (IHDS-II), 2011-12. Propensity Score Matching (PSM) approach is used to find out their individual effect on OOPE on health care. Further, application of PSM for impact analysis shows that direct social network reduces OOPE on health care by ₹1,417. But the problem lies as the recommendation of peers might lead to less than qualified doctors, particularly in the rural areas. It is impossible to think about the Indian medical system without the existence of quacks. Therefore, the next chapter investigates the role of quacks on OOPE on health care. Chapter 5 discusses the role of Quacks (lemons) in health care sector and the possible consequences on the health expenditure. Quacks are individuals who pretend to have the potential to be able to diagnose or treat patients with health problems. National surveys do not give information about quacks. But in the NSS 75th round, ‘informal health care provider’ is included as an option. Therefore, secondary data has been taken from NSS 75th round. Apart from that, this chapter also incorporates field survey data from Assam. The study identifies the situation of health care in Assam and their dependence on Quacks for medical treatment. We use logit regression method to find out percentage of population accessing Quacks in Assam. We have used Focus Group Discussion (FGD) to find out both the patient’s and doctor’s perspectives regarding health care in Assam. The findings suggest the existence of a huge number of Quacks in Assam and it impacts OOPE on health care. Chapter 6 focuses on brief Summary of the work, Conclusion and Policy Recommendations, Limitations and Scope for further research. expenditure, unlike ICT devices. Poor people have social network which connects them and