Articles by T Sundararaman

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Building on an earlier publication using the same data set plus case studies of three facilities, the reasons for the low utilisation of public health facilities in Uttar Pradesh despite the prohibitively high costs of care in the private sector are explored. The likelihood of choosing a public provider for hospitalisation care was 4.8 times higher in the poorest quintile and 3.4 times as high for women. Where access to public sector services is an issue, many go without any treatment and this could appear in the data to be a higher proportion of private sector utilisation. Inadequate facility density is one barrier to access. Facilities, which are by policy designed to offer very limited types of services—to collect user fees and prescribe drugs and diagnostics to be bought outside, and with no continuity of care between primary and secondary levels—lead to the diminishing of credibility of the public healthcare services. When services are available and there are incentives that facilitate access, like for childbirth, the choice shifts in favour of public services. Market-defined perceptions of what is good healthcare and an understaffed and demoralised workforce also contribute to poor utilisation.

Health allocations in Budget 2016-17, which show a modest increase in nominal terms, must be viewed against the virtual stagnation of allocations since 2010-11, and the major cuts of 2015-16. Meanwhile, state governments' investments in health grew steadily. The centre has only prioritised initiatives that stimulate private health sector growth. This approach will have immediate adverse effects on availability and quality of public health services and will cause impoverishment due to healthcare costs, compromising economic growth in the long run.

The decennial National Sample Survey on health and education provides useful information on the health and education of the population. The summary report on health from the 71st round conducted in 2014 allows us to make an initial assessment of three sets of issues. One, the trends in morbidity rates and patterns of morbidity, two, the effectiveness of the public sector in ensuring access to healthcare, and three, the cost of healthcare across public and private sectors.