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Delivering Effective Health Care for All Monday 29 th  March, 2010
Objectives of the Study <ul><li>Analyse utilization of health services in public facilities across various socio-economic ...
Data Source and Remarks on Methodology <ul><li>Tamil Nadu economically better off than Orissa </li></ul><ul><li>Used data ...
Finding: Utilisation pattern of Delivery services (by Quintiles)  in Tamil Nadu and Orissa during 1995-96 and 2004 <ul><li...
Concentration Curves  for Delivery Services in  Tamil Nadu (Rural) and Orissa (Rural): 1995-2004 <ul><li>Tamil Nadu  1995-...
Finding: Utilisation pattern of Inpatient days (by Quintiles)  in Tamil Nadu and Orissa during 1995-96 and 2004 <ul><li>52...
Finding: Utilisation pattern of out-patient services (by Quintiles)  in Tamil Nadu and Orissa during 1995-96 and 2004 <ul>...
Factors responsible for the Changing Patters of Public Facilities (1995-2004): Case of Maternity Services in TN and Orissa...
Implications for policy and practice <ul><li>Use of BIA/UIA illustrates the need and the extent to which supply side be st...
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Do the Poor Benefit from Public Spending on Healthcare in India?: Results from Utilization Incidence Analysis in Tamil Nadu and Orissa

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Do the Poor Benefit from Public Spending on Healthcare in India?: Results from Utilization Incidence Analysis in Tamil Nadu and Orissa

  1. 1. Delivering Effective Health Care for All Monday 29 th March, 2010
  2. 2. Objectives of the Study <ul><li>Analyse utilization of health services in public facilities across various socio-economic groups in Tamil Nadu and Orissa (Utilization Incidence Analysis) over the period 1995-96 and 2004, and </li></ul><ul><li>Explain the factors influencing utilization pattern (decomposition analysis) over the same period. </li></ul>
  3. 3. Data Source and Remarks on Methodology <ul><li>Tamil Nadu economically better off than Orissa </li></ul><ul><li>Used data base of two rounds of National Sample Survey (NSS) 52 nd Round (1995-96) and 60 th Round (2004). Contain representative data for Tamil Nadu and Orissa States. </li></ul><ul><li>BIA methodology adopted (O’Donnell et al 2007) to carry out Utilization Incidence Analysis, due to lack of cost data at various facility levels. </li></ul><ul><li>UIA for three services: Inpatient care, maternity (delivery) and ambulatory (outpatient) care across Rural and Urban areas </li></ul><ul><li>Supplemented the analysis of the distribution of expenditure with the computation of concentration index </li></ul><ul><li>Decomposition Analysis (Gasperini 2006) </li></ul>
  4. 4. Finding: Utilisation pattern of Delivery services (by Quintiles) in Tamil Nadu and Orissa during 1995-96 and 2004 <ul><li>52 nd Round: 1995-96; 60 th Round: 2004 </li></ul><ul><li>1: Lowest Quintile; 5: Highest Quintile </li></ul>
  5. 5. Concentration Curves for Delivery Services in Tamil Nadu (Rural) and Orissa (Rural): 1995-2004 <ul><li>Tamil Nadu 1995-96 Tamil Nadu 2004 </li></ul><ul><li>Orissa 1995-96 Orissa 2004 </li></ul>
  6. 6. Finding: Utilisation pattern of Inpatient days (by Quintiles) in Tamil Nadu and Orissa during 1995-96 and 2004 <ul><li>52 nd Round: 1995-96; 60 th Round: 2004 </li></ul><ul><li>1: Lowest Quintile; 5: Highest Quintile </li></ul>
  7. 7. Finding: Utilisation pattern of out-patient services (by Quintiles) in Tamil Nadu and Orissa during 1995-96 and 2004 <ul><li>52 nd Round: 1995-96; 60 th Round: 2004 </li></ul><ul><li>1: Lowest Quintile; 5: Highest Quintile </li></ul>
  8. 8. Factors responsible for the Changing Patters of Public Facilities (1995-2004): Case of Maternity Services in TN and Orissa <ul><li>  TN : The second lowest quintile showed highest increase in the use of public institutions. The primary reasons for the increase are: </li></ul><ul><ul><li>(a) substantial increase in the proportion of women (in 2 nd quintile) delivering </li></ul></ul><ul><ul><li>(b) a substantial proportion of them preferring institutional delivery, and </li></ul></ul><ul><ul><li>(c) an increase (though marginal) in the preference of women in this quintile for delivering in public institutions. </li></ul></ul><ul><li>  </li></ul><ul><li>Those in Fifth quintile showed a preference for private facilities, resulting a fall in public facilities </li></ul><ul><li>Orissa : The top two quintiles continue to use public facilities to a greater extent than the poor. The use of public institutions by lowest two quintiles actually fell during the period 1995-2004. The richer are perhaps “crowding out” the poor, in view of the low presence of private institutions, despite the “perceived poor quality” of care in public institutions. </li></ul><ul><li>  </li></ul>
  9. 9. Implications for policy and practice <ul><li>Use of BIA/UIA illustrates the need and the extent to which supply side be strengthened. </li></ul><ul><ul><li>Financial burden due to delivery services in rural Orissa greater on poorer quintiles; </li></ul></ul><ul><ul><li>IP services in TN (Rural) and Orissa (Rural and Orissa) continue to be pro-rich: </li></ul></ul><ul><li>Greater policy attention is required to improve access to public institutions in in rural areas for IP and Delivery services. </li></ul><ul><li>BIA also shows naturally where services have improved: </li></ul><ul><ul><li>OP services becoming pro-poor in both states (rural and urban) </li></ul></ul>

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