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• W71292981 abstract "Rationale: One of the major reform initiatives underway is the Secondary Health System Strengthening Project funded by the World Bank in seven States in India. The reform process also coincided with the introduction of user-charges in 1995 and farmers' health insurance scheme in 2003 in one of the States. However, there is insufficient, inadequate systematic documentation and analysis of the various dimensions and impact of the health sector reform at State levels in India. Objectives: The main objective of this paper is to evaluate the health sector reform process and its impacts on access to healthcare of rural households and suggest policy options and strategies for user-charges and health insurance scheme in Karnataka State in India. Methodology: Individual number of visits to a doctor as an outcome indicator for access to healthcare. The paper uses the data of longitudinal household survey in health, which has four waves of panel from 1993-93 to 2003-04. The paper uses various models of Poisson distribution (here number of doctor visits) and reports the results of a robust model (especially Probit-Poisson-Log-Normal Model). Results and Discussion: The estimates indicate that there is a general improvement in health status in correlating with various socio-economic characteristics and preference of healthcare providers of the population in the State. Results of basic Poisson model with gamma distributed individual specific random effects indicate that the health indicators like prevalence rate of short-term and long-term morbidities have the largest effect among all variables. However, the improvements in perceived health provide evidence against the possibility of reform effect. The effects of health sector reform, measured by the percentage increase or decrease in the expected number of doctor visits, show that the average number of doctor visits for hospitalization per annum increased from 2.65 to 4.70 (or 77.33 per cent) between 1993-94 and 2003-04 and in the case of outpatient visits per month increased from 1.02 to 2.5 (or 145 per cent) in the same period. However, the number of doctor visits of lower income groups or social hierarchy (caste groups) has significantly reduced to 20 per cent in the reform period, which worsened the general health status of lower stratum of the population. Policy implications: The imposition of user charges and the introduction of farmers' health insurance scheme in the State alienated the lower income groups from the effective access of healthcare services in the State. It calls for social and financial protection of these groups in accessing the healthcare services and suggests an alternative method of social health insurance scheme and advocates a case for hospital funding program at State level in India." @default.
• W71292981 created "2016-06-24" @default.
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• W71292981 date "2007-06-01" @default.
• W71292981 modified "2023-09-24" @default.
• W71292981 title "Health Sector Reform and Access to Healthcare at a State Level in India: Challenges and Options" @default.
• W71292981 hasPublicationYear "2007" @default.
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