Health seeking behaviour and its determinants in urban areas of developing countries: A primary survey in Kolkata city, India.

The aim of universal access to health care for most of the developing countries seems more challenging nowadays with rapid urbanization. We analyzed the health seeking behavior, as an indicator of the health access situation, its determinants and equitability among slum vs non-slum population in Kolkata. Public hospitals, found to be preferred by less-educated and uninsured people and provided cheaper service, although struggled with high indirect-costs and access barriers. People with high opportunity cost and higher social background were found to be more serious about treatment. However, the slum and non-slum people did not differ significantly in their health-seeking behaviour. A strengthened public health system with reduced access barrier is recommended.

Policy intervention for access to medicine: Does it work similarly for poor and non-poor?

Many federal states in India have recently taken steps to improve distribution and affordability of medicines across public hospitals for reducing high out-of-pocket (OOP) expenditure. West Bengal has introduced a Public-Private Partnership (PPP) scheme, Fair Price Medicine Shops (FPMS) within government hospitals in 2012, which offers high discounts on maximum retail price of the drugs. This model introduces the state as a facilitator, rather than provider or financer, of health care. This paper attempts to measure its impact on OOP expenditure (OOPE) of patients using propensity-score-matching technique on the data collected from primary survey among patients. The study finds that although for non-poor patients, the average OOPE has reduced significantly, the impact has been counter-productive for the poor patients, hinting that PPP intervention seems to work only for relatively better-off people, as the best alternative for the poorest remains to be free provision of drugs from the government. The difference in outcome lay in the fact that the nature of control groups differed between poor and non-poor patients. Those poor patients who did not visit FPMS received most of the medicines free (hence OOPE nearly zero), while for the non-poor patients not visiting FPMS bought the drugs from outside retail shops.

Challenges of Rasthryia Swasthya Bima Yojana (RSBY) in West Bengal, India: An exploratory study.

This study reviews the economic viability of the Rashtriya Swasthya Bima Yojana (RSBY), India's landmark health insurance program for below poverty line (BPL) populations in West Bengal state of India. It addresses the issue through in-depth analysis of literature, national and state level data, and a number of key stakeholder interviews. The study argues that the market failure conditions of this insurance model will continue to perpetuate losses for not only the state, but also for insurance companies, unless they adjust on a continuous basis for profit by raising the premium rate. This will further deplete state budgets for health care affecting the viability of the scheme in the long run.