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Does open defecation practise increase healthcare utilisation and expose households to catastrophic healthcare expenditure?: – The case for expanding the coverage of State Health Insurance policy(RGJAY) in Maharashtra-INDIA.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
2017 (English)Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
Abstract [en]

Background: This study will address the link between open defecation and diarrhoeal disease likewise the percentage of amount spent to avail the healthcare facility for diarrhoeal disease adding to Catastrophic Healthcare Expenditure(Cata) among the poor in rural Maharashtra. It further outlines the Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY) which is a State Health Insurance scheme in which ailments that can be treated in primary health centre are not covered including the outpatient care for diarrhoeal disease. Thus the focus of this sudy is to expand RGJAY to cover the outpatient care atleast to the ailments which is the leading cause of death but preventable.

Aim: 

  • To assess the prevalence and care-seeking for diarrhoeal disease by household sanitation practices (open defecation) and to investigate associations between by social and demographic factors and the likelihood of diarrhoeal disease in this study sample.
  • To see any systematic differences in the Healthcare Expenditure on Diarrhoeal diseases vs. other reasons for care-seeking and to estimate the health care share of household budget and to examine proportions of households in Latur and Nanded district of Maharashtra incurring Catastrophic Healthcare Expenditure and to analyze if it is a case for expansion of RGJAY to incorporate outpatient care.

Method: This study builds upon cross-sectional baseline data(N=3595) collected for “Understanding the Links and Interactions between Low Sanitation and Health Insurance in India”. The self-reported ‘Diarrhoeal disease’ was used as the dependent variable. Multivariable logistic regression analysis was used to determine the association between diarrheal disease and predictors of interest. This paper considered a household to have incurred a catastrophic health expenditure if out of pocket on health is 40% or more of its capacity to pay.

Result: The prevalence of diarrhoeal disease: by households who practice open defecation is 3%(N=102). In Multivariable logistic regression, we find no noteworthy significant differences in key variables across diarrhoeal disease except for the primary education with odds higher than one (OR 1.8; 95% CI 1.1-2.9). It is worth pointing out 24% of the households incurred catastrophic healthcare expenditure in a month in the context of outpatient care.

Conclusion: The findings strengthen the need for expansion of the state health insurance scheme(RGJAY) to cover the outpatient care since 24% of the households experienced expenditure at a catastrophic level in the context of outpatient care and also the inadequate sanitation in India and the need for prioritizing sanitation investment.

Place, publisher, year, edition, pages
2017. , p. 21
Series
Centre for Public Health Report Series, ISSN 1651-341X ; 2017:28
Keyword [en]
Diarrhoeal disease and associated factors, Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY) and Catastrophic healthcare expenditure (cata)
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-142198OAI: oai:DiVA.org:umu-142198DiVA, id: diva2:1160143
External cooperation
Institute for Fiscal Studies, London, United Kingdom
Educational program
Master's Programme in Public Health
Presentation
2017-05-23, Room N210, Natural Sciences Building, Umeå University, Umeå, 09:00 (English)
Supervisors
Examiners
Available from: 2017-12-19 Created: 2017-11-24 Last updated: 2017-12-19Bibliographically approved

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CiteExportLink to record
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Citation style
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