The elderly population in India is a growing percentage with increasing needs for health and support. The issue of the choice of health care services is an important one and largely depends on their socio-economic and demographic characteristics.
The utilisation of the health care services depends on the morbidity condition, health-seeking behaviour, accessibility and their affordability for services and quality of care. The utilization of health services is a complex behavioural phenomenon corresponding to the availability, quality, cost, comprehensiveness of services, and the users’ socio-cultural structure, health beliefs, and personal characteristics (Oladipo,2014). It is the choice of health care services that decides the magnitude of out-of-pocket health spending.
In India, private healthcare providers dominate the healthcare facilities. In the early 1950s, the share of the private sector was merely 8 % of the total healthcare market (Katyal & Singh et al.2015), which has now risen to 70% of all the hospitals and 40% of total hospital beds (Bhat 1996).
According to WHO In India, private expenditures constitute up to 70% of total health expenditures and more than 40% in Russia and China (World Health Organization 2020). As the health sector grew, it became less reliant on out-of-pocket spending. Total out-of-pocket expenditures more than doubled in low and middle-income countries from 2000 to 2017 and increased by 46% in high-income countries. However, it grew slower than public spending in all income groups (World Health Organization 2019). In India, private health care services are almost four times costlier than public ones. Still, more than 61% of the elderly seek health services from private hospitals. For the oldest-old group (80 years and above), private hospitalization is close to two-thirds of the total (Alam & Karan 2010). A cross‐country study reveals that the private inpatient health care utilization among the older Indians is the highest among countries like China, Ghana, Russia, and South Africa (Peltzer, Williams et al.2014).
Longitudinal Ageing Study in India tries to collect information on the inpatient care utilisation from the elderly respondents. The data indicate that in India 59.1% elderly received inpatient care form a private facility and 37.6 % from a public facility. India’s public healthcare is largely a state matter, and some states are reticent to sign up to Modicare, saying they have existing, funded, public health schemes in place already. A government-sponsored health insurance scheme’s utilization data indicates that 70% of India’s hospitalization occurs in the private sector (La Forgia and Nagpal 2012).
The elderly inpatients in rural and urban centres preferred private hospitals over public hospitals. The data shows 61% of elderly in urban areas chose the private sector over the public. In rural areas, nearly 58% put their faith in the private sector.
Given that the cost of public health care is way cheaper than the private centres, it is a little necessary to understand the reason behind people going to private centres. Long waiting periods, unavailability of medicines and doctors, and bad infrastructure are reasons behind this occurrence.
Although India has made considerable progress in health infrastructure under NRHM, the improvement has been quite uneven across regions with large-scale inter-state variations (Kumar, 2013; Hazarika, 2013; Baru et al., 2010). The utilization of general inpatient services is higher than private facilities in the north-eastern region except in Assam. The use of inpatient care from private health facility is high in Karnataka, Jharkhand, Haryana, Telangana, Maharashtra, and low in Andaman Nicobar, Arunachal Pradesh, Tripura, and Jammu Kashmir.
The growth of private health care providers in the hilly north-eastern region of India has not grown as much as in India’s central and southern states due to lack of funding supporting the finding of Kumar and Prakash, 2011. The level of urbanisation in the north-eastern areas is also low, which is the reason behind the slow development of private health services.
It is significant to understand the Indian geriatric population’s preference pattern towards the health services and the consequent financial implications of them. Each region bears different characteristics of healthcare provisions. Hence the healthcare policy needs to be sensitive to the specific regional requirements. Special attention and funding need to be provided to the backward regions of the country in order to have better and affordable services for the elderly to look forward to.
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Jhumki Kundu, MPhil in Population Studies, International Institute for Population Sciences
Deepak, MPhil in Population Studies, International Institute for Population Sciences
Hashita Chari, MPhil in Population Studies, International Institute for Population Sciences
Gaurav Suresh Gunnal, MSc in Biostatistics and Demography, International Institute for Population Science