Household Survey of Health Care Utilisation and Expenditure
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NATIONAL COUNCIL OF APPLIED ECONOMIC RESEARCH
i
Working Paper No. 53
Household Survey
of
Health Care Utilisation
and
Expenditure
Ramamani Sundar
NCAER
National Council of Applied Economic Research
Parisila Bhawan, 11-Indraprastha Estate, New Delhi-110002 (India)
Fax : (91-11) 3327164
Tel: (91-11) 3317860-68
Working Paper No. 53
Household Survey of Health Care
Utilisation and Expenditure
5
r
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March 1995
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iv
Preface
The National Council of Applied Economic Research has
conducted several surveys since 1986 to study the markets
for a variety of consumer goods. As part of the fourth study
in the series Market Information Survey of Households (MISH),
a Household Survey of Medical Care was conducted in 1990,
to elicit information on the nature of illnesses suffered, source
of medical treatment and the cost of medical care. The results
of the survey, published in 1992, evoked considerable interest
among researchers and policy makers.
Based on this experience, the Council took up a more detailed
Household Survey of Health Care Utilisation and Expenditure
in the summer months of 1993, covering most of the States
and Union Territories of India. The results of this survey are
presented in this report.
The earlier survey of the NCAER had referred only to the
treated illnesses, while the present one covered both treated
and untreated illness episodes. An attempt was also made to
separate the hospitalised from the non-hospitalised illness
episodes. The survey collected detailed information on prevalence
of illnesses, utilisation of health care services including type
of provider, system of medicine, distance travelled to seek
treatment and breakdown of expenditures relating to illnesses.
The data is presented separately for the rural and urban areas,
state-wise, by the socio-economic characteristics of the households
and by gender.
The results of the survey revealed an overwhelming
dependence of the population on the allopathic system of
medicine. It also revealed that dependence on private health
facilities is more than that on public facilities for out-patient
treatment. However, for hospitalisation the dependence on
public hospitals is much higher. There is a noticeable differential
in the household expenditure on the treatment of illnesses,
especially for hospitalisation of males and females. This sex
differential is even more pronounced in the case of children.
V
Economics of Health is now recognised as a discipline that
can address some of the important issues in planning for the
health sector. The findings of this survey will be useful for
formulation of policies for this important sector.
We are grateful to the Ministry of Health and Family Welfare
Government of India and the World Health Organisation for
their support for this study.
I appreciate the work done by the project leader, Ms.
Kamamam Sundar and her study team. Thanks are also due
to Dr. S.P. Pal and Dr. Abusaleh Shariff for their comments
and suggestions.
New Delhi
March 15, 1995
S.L. Rao
Director-General
vi
Contents
Page No.
Preface
Summary & Findings
Chapter 1 - Introduction
Chapter 2 - Sample Design and Methodology
Chapter 3 - Prevalence of Illness and Pattern
of Morbidity
Chapter 4 - Utilisation of Health Care
Services
Chapter 5 - Household Expenditure on
Health Care
Tables
Annexure
References
v
xi
1
5
11
23
37
51
92
95
List of Tables
Page No.
1.
2.
State-wise Prevalence
rrevaience Rate
Kate of
of Illness
Illness by
by Sex
Sex —
— Rural
State-wise Prevalence Rate of Illness by Sex — Urban
3.
Prevalence Rate of Illness by Age and Sex
‘I*
Ratp of lllnocc
Prevalence Rate
Illness kit
by nt
Nature of Illness for
Adults and Children — Rural
5. Prevalence Rate of Illness by Nature of Illness for
Adults and Children — Urban
6. State-wise Prevalence Rate of Illness by Type of Illness
7. H^iHence Rate of Illness by Socio-Economic Characteristics
or the Household
8. State-wise Reported Number of Hospitalisation Cases by Sex
9. State-wise Average Duration of Illness (Communicable
and Acute Illnesses Only)
10. pZTSe ^iS(triKUtiOn Of Untreated I1Iness by Duration of Illness
11. for No Trea^embUtlOn L’ntreated ,linesses by Reasons
51
52
53
54
55
56
57
58
59
60
60
12. Percentage Distribution of Untreated Illnesses by SocioEconomic Characteristics of the Household
61
13. Distribution of Non-Hospitalised Illness Episodes by Type
of Treatment
7
14' ^vnt^T Distribub°n of Non-Hosp.talised Illness Episodes by
Type of Treatment for Male and Female — Rural
7
15. Tvne'7'T D,5tribu‘ion of Non-Hospitalised Illness Episodes by
'’ypc ‘-’fTreatmentfor Male and Female — Urban
istnbution of Non-Hospitalised Illness Episodes by Type of
Treatment and by Nature of Illness
V
17. Distribution of Non-Hospitalised Illness Episodes by Type of
Treatment and Socio-Economic Characteristics of the Household
18. Non HS r5 LCm’f Treatment hy Type of Treatment for
Non-Hospitahsed Illness Episodes
19.
20.
21.
DIstribuHon of Hospilali^hcn Cases by Type o( Treabnen,
22.
62
63
64
65
66
67
68
69
70
by Type O( H..1* C a,a
8 SSS “I
bystem of Medical Treatment — Rural
26. State-wise Distribution of Non-Hospitalised Illi
7
Iness Episodes by
System of Medical Treatment — Urban
27. State-wise Average Expenditure Per Illness Epi
Episode for Adults and
Children by Sex for Non-Hospitalised Illnesses
28. State-wise Average Expenditure T.. .'IL.c —J — Rural
Per Illness Episode for Adults and
Children by Sex for Non-Hospitalised Illi
—Inesses — Urban
viii
71
72
72
73
74
75
76
List of Tables (Contd.)
Page No.
29.
State-wise Average Expenditure Per Illness Episode by Type
of Treatment for Non-Hospitalised Illnesses — Rural
30. State-wise Average Expenditure Per Illness Episode by Type
of Treatment for Non-Hospitalised Illness — Urban
31. State-wise Average Expenditure Per Illness Episode by Duration
of Illness for Non-Hospitalised Illnesses — Rural
32. State-wise Average Expenditure Per Illness Episode by Duration
of Illness for Non-Hospitalised Illnesses — Urban
33. Average Expenditure Per Illness Episode by Nature of Iliness for
Non-Hospitalised Illnesses
34. Average Expenditure Per Illness Episode by Annual Household
Income and Nature of Illness for Non-Hospitalised Illnesses
35. Average Expenditure Per Illness Episode by Highest Level of
Education in the Household for Non-Hospitalised Ilinesses
36. Average Expenditure Per Illness Episode by Occupation of the
Household Head for Non-Hospitalised Illnesses
37. State-wise Breakup of Average Expenditure Per Illness Episode
for Non-Hospitalised Illnesses — Rural
38. State-wise Breakup of Average Expenditure Per Illness Episode
for Non-Hospitalised Illnesses — Urban
39. State-wise Average Expenditure Per Illness Episode for
Hospitalisation Cases by Type of Treatment
40. Average Expenditure Per Illness Episode for Hospitalisation Cases
by Type of Treatment and Nature of Illness
41. Breakup of Average Expenditure Per Illness Episode for
Hospitalisation Cases
42. Average Expenditure Per Immunisation by Type of Health Care
43. Average Expenditure Per Delivery/Abortion by Type of Health Care
44. Average Expenditure Per Illness Episode by Nature of
Illness and System of Treatment
77
78
79
80
81
82
83
84
85
86
87
88
89
90
90
91
Annexure
Results of NCAER’s 1990 and 1993 Surveys : A Comparison
92
t
Study Tfeam
Director-General
Prof. S.L. Rao
Project Leader
Ms. Ramamani Sundar
System Analyst
Mr. K.N. Kool
Research Team
Mr. B.S. Danu
Mr. G.K. Sinha
Secretarial Support
Mr. R.N. Verma
X
Summary and Findings
structures for a variety of consumer goods. Along with the
fourth study in the series. Market Information Survey of
Households (MISH), a household survey of medical care was
conducted in May-July 1990. The results of this national survey
evoked considerable interest among researchers and policy
makers. Drawing on the experience gained from the first survey,
the NCAER launched a second round of the survey in 1993
along with the fifth Market Information Survey of Households
(MISH 1993).
The second survey had several new features and is as such
an improvement over the earlier one in many respects. It collected
data on morbidity, health care utilisation and health expenditure
in greater detail. The earlier survey1 referred only to the treated
illnesses, while the present one covered both treated and
untreated illness episodes. In this study an attempt has also
been made to separate the hospitalised from the non-hospitalised
illness episodes. The results of this second round of Household
Survey of Health Care Utilisation and Expenditure are presented
in this report.
The survey collected information on the prevalence of illness,
utilisation and source of health services,- type of providers,
system of medicine used and the distance travelled to seek
treatment. A detailed break-down of expenditure associated
with each illness episode was also collected. Data on illness
episodes requiring hospitalisation were collected separately.
The survey also gathered data on socio-economic characteristics
of the households and all its members.
*
NCAER, Household Survey of Medical Care, 1992.
xi
Prevalence Rate of Illness for the Reference Month
by Age and Sex
(Per '000 Population)
Rural
250
214.6
■I 92.2
200 150 -
131 4125.0
105.5
110.4
108.1
^.Srrrrrnrn
86.5
100 -
■■172.9
50
0
15-5$ Yr»
6-14 Yrt
£60 Yrw
All Ages
Female
Male
Urban
250
219«7216-0
200
150 - 143.5
■B’22.7
110.6
®8.2
90.2IJW
100 -
108.4
I
50
0
$ 5 Yr»
6-14 Yrt
15-59 Yrt
Male
Female
xii
60 Yrt
All Aflfift
The Household Survey of Health Care Utilisation and
Expenditure was carried out in the summer months of May-
detailed questionnaire and the reference period was one month
preceding the date of interview.
Morbidity Profile
prevalence rate
For the country as a whole, the reported
.
’ } out to be
of illness for the one month reference period works
the rural and
106.7 and 103.0 per thousand population ffor
-------urban areas respectively.
The prevalence rate of treated illness works out to be 94
per thousand population for both rural and urban areas of
the country. These rates are substantially higher ‘han the
prevalence rate of treated illnesses reported in the NCAER s
earlier survey of 1990 which was 79.1 for the rural and 6Z7
for the urban areas. The differences in the rates between the
two surveys could be partly due to the increase in the reference
period from two weeks to one month which could have resulted
in an increase in the reporting of acute illnesses.
The survey results do not indicate any significant sex
differentials in the overall prevalence of illnesses at the all
India level, although some states have reported different rates
for males and females.
The prevalence rate of illness by different age groups reveals
a very high morbidity rate for the 60+age groupfor both
rural and urban areas. In the rural areas, Ithe morbidity rate
(per thousand population) works out to be 215 and 192 for
the male and female elderly persons. In ‘he case of the urban
60+ age group, the rates are as high as 220 and 216 per thousand
population for the male and female population respective y.
The high prevalence of illness among the elderly population
has a very significant policy implication. It indicates that with
an ageing population, the disease burden on the society and
state is going to increase in the coming years.
There are wide variations in the reported prevalence rate
xiii
j
of illness across different states. Among the various states,
erala has reported the highest rate of morbidity (194.8 for
the rural and 183.9 for the urban areas).
Nature of Illness
Fever seems to be the most common illness among both
adults and children, accounting for 30% of the reported illnesses
in the rural areas and about one-fourth of the reported illnesses
in the urban areas. Next in importance comes the respiratory
infection which includes common cold, cough, nose and throat
discomfort and bronchitis.
The prevalence rate of cardio vascular diseases like
hypertension, heart ailments, paralysis is much higher for the
urban adults as compared to their counterparts living in the
rura! areas In the rural areas, the prevalence rate of
M respectively^o^th 65 ^Yt th°J1Sand P°Pulation) is 4.5 and
areas it is 9.0 for adult males and 7^7 foJTduit femYles^Thi
igher prevalence of cardio vascular diseases in the urban
S^bably refleCtS 1116 stresses and strains of the urban
illnlhe dlTtlaSe pattern of the country is dominated by acute
ilInesses. This category accounted for 73% of the reported
illnesses m the rural areas and 68.5% of the illnesses in the
urban areas. The serious communicable diseases, which include
ypooicb malaria, cholera, acute gastero enteritis, jaundice,
uw
?\easles' mumps and tuberculosis account for
14.5 /o and 13.3/o of all reported illnesses respectively in the
rural and urban areas.
In the advanced countries, the chronic and degenerative
diseases have replaced the infectious diseases over a period
Y
^Cute lnfectious ailments which occur most often in
childhood have also declined considerably. In India the
communicable diseases and acute illnesses which include diseases
ike respiratory mfection or diarrhoea account for a high
proportion of reported illnesses even now.
The overall morbidity level comes down with the rise in
the annual household income, suggesting that with improvement
!?. economic status, the health status of the people also improves.
With the increase in the income status of the households, the
xiv
I
Percentage Distribution of Non-Hospitalised Illness
Episodes by Type of Treatment
Rural
Public 43.3
Public 40.2
Med.shop
i
2.6
Med.Shop
.3-6
Other
23
Others
2.7
Private 54.5
Private 50.8
Female
Male
Urban
^^^^^^^^Public 34.7
Med; Shop^^^^^^^^Public 33.2
Meeb Shop 5.5
......
1
Private 60.9
Private 58.9
Female
Male
Cthery- Forth Heoler ond
Feme Remedy
XV
prevalence rate of serious communicable diseases and acute
illnesses also comes down, and the prevalence of chronic illnesses
increases. In other words, with the rise in the economic status,
the diseases of poverty and malnutrition are replaced by the
diseases normally prevalent among the affluent in the Western
World.
Hospitalisation
The reported number of hospitalisation cases (per thousand
population) are 7.1 for the rural areas and 9.7 for the urban
areas. The higher rates for the urban areas perhaps indicates
better access to hospital facilities in the cities.
Unlike in respect of overall reporting of illness, sex
differentials are very significant in the number of hospitalisation
cases. In most of the states, the number of hospitalisation
cases per thousand population has worked out to be lower
for the females.
Untreated Illnesses
For nearly 12% of the illness episodes in the rural areas
and about 8% of the illness episodes in the urban areas, no
treatment has been sought. The higher percentage of untreated
illnesses in the rural areas probably reflects the poor physical
and financial access to heath care in the rural parts of the
country.
The most important reason for not seeking any treatment
turns out to be "illness not considered serious enough".
Utilisation of Out Patient Health Care Services
The survey reveals a high dependence on the private health
providers for the treatment of non-hospitalised illness episodes.
The percentage of illness episodes for which treatment has
been sought from the private health providers works out to
be 52 for the rural areas and 59 for the urban areas.
For 42% of the illness episodes in the rural areas, treatment
has been sought from the public hospitals, community health
centres, primary health centres and sub-centres. In the urban
areas the utilisation of public health facilities like the Government
hospitals and the dispensaries run by the Government and
xvi
I
the local bodies accounted for 34% of the illness episodes for
which treatment was sought.
The percentage of illness episodes for which medicines
have been directly purchased from the Medical Shops (without
consulting a doctor) works out to be 3.1 for the rural and 5.2
for the urban areas. Seeking treatment from religious persons
or faith healers and the dependence on home remedies seem
to be generally very low, though the percentages are marginally
higher for the rural areas.
Though for most of the states, the utilisation of private
health facilities has worked out to be higher, states like Himachal
Pradesh, Rajasthan and the rural parts of Assam, Karnataka
and Orissa seem to rely more on the public health facilities.
In both rural and urban areas, the utilisation of private
health facilities is highest for the acute illnesses. Since the
acute illnesses are generally of short duration and the treatment
is comparatively less expensive, people may find the private
treatment within reach and would consult any doctor who is
easily accessible. The percentage of illness episodes for which
self-medication has been resorted to, is also the highest for
the acute ailments.
Both in rural and urban areas, with an improvement in
the income status of the households, the utilisation of private
health facilities went up. For example, in households with
annual income over Rs. 54,000, the utilisation of private health
facilities works out to be 69% and 75% respectively for the
rural and urban areas. The respective percentages for those
households with annual incomes below Rs. 18,000 are only 51
and 52 and for those with annual incomes ranging from Rs.
18,000 to Rs. 54,000, the percentages are 55 and 63.
Positive association has also been found between levels of
education of the household and private health care utilisation.
Interestingly, the dependence on Medical Shops is comparatively
higher among the well educated people (Graduate and above)
of the urban areas as well as among the uneducated rural
people.
The dependence on private health facilities is fairly high
for the business class, the salary earners/professonals of the
urban areas, and for the cultivators in rural areas.
The dominance of the allopathic system of treatment over
xvii
Percentage Distribution of Hospitalisation Cases
by Type of Treatment
Rural
Public
55.3
Public 65.8
I
Private 34.2
Private
44.7
Male
Female
Urban
Public
59.6
Public 60.4
Private 39.5
Private
40.4
Male
Female
xviii
1
At the all-India level, for more than 90% of the illness episodes,
the allopathic system of treatment has been sought. The
homeopathic treatment was sought by only 2% and ayurvedic
treatment by only 3.8% in the rural areas. The corresponding
percentages for urban areas were 2.9 and 2.2.
I
5
'i
I
On an average people have travelled longer distances in
the rural areas as compared to the urban areas for seeking
treatment. The average distance travelled works out to 5.9
kms. for the rural areas and 2.2 kms. for the urban areas.
Both in the rural and urban areas, the average distance travelled
has worked out to be marginally lower for the female adults
and female children as compared to their male counterparts.
It is important to note that neither the private hospitals nor
the private practitioners seem to have any locational advantage
over the public health facilities both in the rural and urban
areas.
Utilisation of Hospitalisation Facilities
In contrast to the non-hospitalised illness episodes, the
dependence on public health facilities is much higher in the
case of illnesses requiring hospitalisation. For 62% of the cases
in rural areas and 60% of the cases in urban areas, in-patient
treatment has been sought in the public hospitals.
In some of the states like Himachal Pradesh, Madhya Pradesh,
Orissa and Rajasthan, the utilisation of public hospitals is very
high.
On an average people have travelled a longer distance for
hospitalisation as compared to treatment of non-hospitalised
illnesses. The average distance travelled has worked out to
be considerably higher for the rural householdsjndicating that
the hospitals are concentrated in the urban areas and the rural
people have to travel a long distance to reach them.
Utilisation of Health Facilities for Preventive
and Promotive Health Care
The survey results show that the people's dependence on
public health facilities is higher for natal, intra-natal and
preventive health care. More than 60% of the deliveries in
both rural and urban areas have taken place in the Government
xix
Average Expenditure Per Illness Episode
by Type of Treatment
(Non-Hospitalisation)
(In Rupees)
Rural
Public
HH 88
!
35.28
t
130.71
131.47
J
[
Private
14.5
Medical Shop
M ««.25
48.45
Faith Healer
115.27
5.04
S 10.27
Home Remedy
■i 95.54
85.1
All
0
60
40
20
80
I Male
Public
100
120
160
KO Female
Urban
■ 66.16
IMMMBI159.47
■ 165.83
I 14883
Private
Medical Shop
140
■ 28-37
IhW 17.11
65.31
1 87.63
Faith Healer
[
Home Remedy
All
■ 18.95
kw111.47
I 11®-41
1111.44
|
0
20
40
60
80
100
120
Female
Male
XX
140
160
180
health facilities. The immunisation being done in the public
health facilities account for nearly 90% of the reported number
of immunisations.
Household Expenditure on Health Care
I
Based on the expenditure incurred by the households during
the one month reference period for the treatment of illnesses,
the per capita annual household expenditure on curative health
care has been estimated. For the country as a whole, the per
capita annual household expenditure on curative health care
works out to be Rs. 204. The urban dwellers are spending
more on curative health care when compared to their rural
counter parts. The per capita household expenditure on curative
health care works out to be Rs. 184 and Rs. 258 for the rural
and urban households respectively.
The results of the survey indicate that on an average the
households spend nearly 5% of their income on curative health
care. The household expenditure on curative health care comes
down with an increase in the income status of the households.
The poor households with annual income of less than Rs. 18,000
spend more than 7% of their income on the treatment of ailments,
while the rich households (with annual income exceeding Rs.
54,000) spend much less (about 3%).
Household Expenditure on Non-Hospitalised Illnesses
The average household expenditure per illness episode has
worked out to be Rs. 90 for the rural areas and Rs. 114 for the
urban areas. There are substantial rural-urban differentials in
the average household expenditure (per illness episode) for
both adults and children.
In both rural and urban areas, the average household
expenditure (per illness episode) has worked out to be lower
for the female adults and the female children as compared to
their male counterparts. This sex differential in the household
expenditure is visible not only at the all-India level but also
in most of the states and the gender difference is more
pronounced in the case of children. The rural households have
spent Rs.114 and Rs.101 per illness episode respectively for
treating the adult male and female, and the urban households
have spent Rs. 134 and Rs. 126 for the same purpose. Similarly,
in the case of children, the average household expenditure
xxi
Average Expenditure Per Illness Episode
by Type of Treatment
(Hospitalisation)
(In Rupees)
Rural
578.88
Public
441.02
2116.62
Private
1545.IQ
AH
■■■I
L___
o
1105.09
934.66
Male
2000
1500
1000
500
2500
RSSSI Female
Urban
| 499.74
Public
382.64
2623.14
Private
1883.51
1339.34
All
980.71
0
500
1500
1000
Male
2000
KM Female
xxii
2500
3000
-■
per illness episode has worked out to be lower for the female
children as compared to their male counterparts. On an average
the rural households have spent Rs. 60 and Rs. 45 respectively
for the male and female children while the urban households
have spent Rs. 77 and Rs. 61 for the same purpose.
The average expenditure on treating an illness episode is
lower when the treatment was sought from the public health
facilities. In the rural areas, for example, the average amount
spent for treating an illness episode is Rs. 49 and Rs. 131
respectively for the public and private health facilities. The
respective amounts for urban areas are Rs. 63 and Rs. 152.
Household Expenditure on Hospitalised Illnesses
The average expenditure incurred by the households for
seeking treatment from the private hospitals/nursing homes
is much higher as compared to the public hospitals. This could
be the most important reason for the higher utilisation of public
health in-patient facilities.
In the urban areas, the average household expenditure per
hospitalised case works out to Rs. 453 for the public hospitals
and Rs. 2319 for the private hospitals, while in the rural areas,
the averages are Rs. 535 for the public hospitals and Rs. 1877
for the private hospitals/nursing homes.
There is a significant sex differential in the average
expenditure incurred by the households for hospitalisation
both in the urban and rural areas, irrespective of the type of
health facility utilised. In the rural areas, the average amount
spent per hospitalisation case turns out to be Rs.1105 for the
males and Rs. 935 for the females. In the urban areas, it is
Rs. 1339 for the males and Rs. 989 for the females.
xxiii
'A'-L. -
Chapter 1
Introduction
INDIA is currently engaged in the structural adjustment of its
economic system and is moving towards increased privatisation
and a market oriented economy. Health and Education however,
are two sectors where the state will continue to play an important
role. Over the years the private health care sector has expanded
widely in both rural and urban areas. Nearly 80% of the country's
registered doctors work in the private sector. In addition to
these practitioners of various systems of medicine, there are a
large number of unqualified 'doctors' whose exact number is not
known. In the big cities, the private corporate sector has entered
the business of health care delivery and has opened a number of
hospitals.
All these phenomena raise some crucial policy issues. What
should be the right mix of private and public health care services?
What are the ways and means by which the state can control
and/or regulate the private health sector? What should be the
role of the state as a provider of health care? Should the state
concentrate mainly on the preventive and promotive aspects of
health care? Should the state play a greater role at the primary
level or at the tertiary level of health care? To answer any of these
questions, information on the utilisation pattern of health care
services in a society is necessary.
Similarly, in order to set priorities for the allocation of scarce
resources for the various health programmes, it is useful to
understand the pattern of morbidity across states and the
morbidity burden on different sections of the society. Information
on household expenditure on health care would also be a useful
guide for the policy makers in assessing the possibilities of cost
recovery or charging user fees from the people.
Unfortunately in India there is a dearth of information on
such health issues which could help the Government in planning
health programmes. Official statistics on cause of death or the
data collected from the hospital in-patient and out-patient records
serve only a limited purpose. Household health surveys can
bridge this information gap by collecting useful data on
1
2
Household Survey of Health Care Utilisatuion and Expenditure
morbidity, utilisation of health care services and expenditure
incurred on health related matters. Comprehensive health
surveys covering various characteristics of the household and
its members can throw light on socio-economic, demographic
and other factors that influence the health status of the people
heakh SClentlS‘S can Play a crucial role by undertaking such
ealth research, as it has become clear from recent research that
andl h°m med11C.al intervention and income, social, cultural
and behavioural determinants also play an important role in
bringing about health transition.
P
m
can^ddre?^5 °f b6;11? *S n°W recoSnised as a discipline that
hpdii?d !
tT6 °f the lmPortar,t issues in planning for the
heaith sector. Economic tools and concepts can be applied to
achieve efficient management of available resources, elimination
of waste, a more rational spending pattern, raising productivity
resou7cesOri1snsfeinnOVhtiVe
tO
additl°"al financial
need for health
35 !qUity' P°11Cy °Ptions and demand/
of htahh rare
taken UP by economists in the planning
of health care and formulation of health care policies
S
In India, only a few morbidity/health survevs which can
row ig ton the health status of the people are available There
5peClfiC
“ Code. s„„eys "
ssEEFr1?"
ST'
for the State of Kerala, Foundation fwReswrch11^
thesSSof
b(FRCH) StUd'eS °n health ^Penditure for
the States of Maharashtra and Madhya Pradesh, and the stud v of
Nationald*Stricts of \,adhya Pradesh, Rajasthan and U.P. bythe
National Council of Applied Economic Research (NCAER).
The Kerala Sastra Sahitya Parishad (KSSP), a voluntary
bn'C°ndUCteda SUrVey °f 10,000househ°lds (covering
1001 panchayats of Kerala) in the year 1987 "to provide I
comprehensive base line data on health status in rural Kerala"
i J thett3 '
The f°CUS °f thC FRCH'S Household Survey
m the Jalgaon district of Maharashtra was on the household
e*pen iture on health care (Duggal and Amin, 1989). There is
inMhih Stupdy ?y FRCH °n the Household Health Expenditures
of 7he NCAFR
(iGmrge; A 'et31'1993)' ThePrimary objective
the NCAER s study of the six rural districts of Madhya
I
Introduction
3
Pradesh, Rajasthan and U.P. was to assess the health needs of the
people and to analyse the utilisation pattern of the existing
health facilities. This survey was conducted in three rounds to
capture the seasonal variations in morbidity (NCAER, 1992 b).
At the national level, the National Sample Survey
Organisation (NSSO) has been the only source of data on health
problems based on a large sample. So far, the NSSO has carried
out three sample surveys on morbidity, i.e., the 17th round, 28th
round and the 42nd round. The 42nd round is the latest and the
data collected during this survey pertains to the year 1986-87.
This survey provides both all-India and state level data on
utilisation of medical services for hospitalised and non
hospitalised illness cases and details about the average
expenditure per hospitalised case by type of hospital.
The NCAER has been conducting several, national surveys
since 1986 to establish market structures for a variety of consumer
goods. Along With the fourth survey in the series, the Market
Information Survey of Households (MISH), a household survey
of medical care was conducted in May-July 1990, to elicit detailed
information on the nature of illnesses suffered by the household
members, source of treatment and the cost of medical care
(NCAER, 1992a). The results of this national survey evoked
considerable interest among researchers and policy makers.
This survey was a pioneering one and the NCAER had very
little earlier experience to bank upon. It covered only the treated
illnesses and no attempt was made to distinguish between the
hospitalised and non-hospitalised illness episodes. Drawing on
the experiences gained from the first survey, the NCAER planned
and carried out the second round of the survey along with the
fifth Market Information Survey of Households (MISH, 1993).
The second survey had several new features and is as such an
improvement over the earlier one in many respects. The results
of this second round of Household Survey of Health Care
Utilisation and Expenditure are presented in this report.
The Household Survey of Health Care Utilisation and
Expenditure (1993) was carried out in the summer months of
May-June 1993 and covered almost all the States and Union
Territories of India. The sample consisted of 18,693 households
spread over the rural and urban areas of the country. The data
collected were based on household interviews carried out with
a detailed questionnaire and the reference period for the study
was one month preceding the date of interview.
4
Household Survey of Health Care Utilisation and Expenditure
utilisation of health services including type of provider, system
of medicine, the distance travelled to seek treatment and a
detailed break down of expenditure associated with each illness
episode. Data on illness episodes requiring hospitalisation was
collected separately. Besides collecting detailed health
information, the survey gathered data on socio-economic
characteristics of the households and on each and every member,
of the households.
The details about the sample design and the sample selection
piocedures are presented in Chapter 2 along with explanations
of concepts and definitions used for the survey. In Chapter 3 the
variations in prevalence rate of illness and the pattern of
morbidity across states and among different sections of the
society are discussed. Chapter 4, deals with the utilisation pattern
of health care services for the non-hospitalised and hospitalised
illness episodes and Chapter 5 with the expenditure incurred by
the households for the treatment of various types of illness
episodes.
!
i
Chapter 2
Sample Design and Methodology
THE Household Survey of Health Care Utilisation and
Expenditure covered all the States and Union Territories of
India except Manipur, Nagaland, Sikkim, Tripura, Andaman
& Nicobar Islands, Arunachal Pradesh, Dadra & Nagar Haveli,
Lakshadweep, Mizoram, and Jammu & Kashmir. A sample of
18,693 households was selected spread over the rural and urban
areas of the country. In this chapter, the details the sample
design and the sample selection procedure are presented in
the first section. This is followed by an explanation of the
concepts and definitions used for the survey along with their
limitations. Some of the methodological issues arising out of
these concepts and definitions are also discussed.
Sample Design and Sample Selection
A multistage stratified sample design is used for the present
study, with village/town as first stage unit and household as
second stage unit. The Universe for the study comprised both
rural and urban areas of the country.
Rural Sample
All the districts in the states/union territories are covered
in the survey and each of these districts is selected with
probability one. From each district two villages are selected
with probability proportion to the population of the village.
In all 718 villages were selected for the survey.
Urban Sample
According to the 1991 Census, there were 3591 cities/towns
in the states and the union territories covered by the survey.
The population of these cities/towns varies from 5000 to over
10 million. There are 53 cities with population exceeding 5
lakhs. All these big cities with the population exceeding 5
lakhs were included in the sample. The r.maining towns were
grouped in five strata, on the basis of their population size.
5
6
Household Survey of Health Care Utilisation and Expenditure
From each stratum, a sample of towns was selected
independently. A progressively increasing sampling fraction
with increasing size class of the stratum was used for allocating
sample towns in each stratum. Thus 515 cities/towns were
selected as first stage unit of sample for the urban areas.
The Census operation has divided each town into a number
of small blocks with a well defined boundary, having nearly
equal population in each block. From each sample town/city,
a sample of census blocks were selected; the number varying
between 2 and 30, depending upon the size of the town. The
total number of blocks selected was 1509. These blocks were
selected independently in each town with equal probability.
Household Selection
All the households in the selected villages and blocks were
listed through a specially designed proforma. If the number
of households in a selected block or a village exceeded 150,
the appropriate sampling fraction was used and the listing
was limited to a maximum of 150 households only. This proforma
sought information, among other things, on the household
size, income, occupation of the head of the household, highest
level of education in the household, religion, caste, etc.
The listed households from each village/block were classified
in five income categories and after stratification, using the
inverse of probability of selection of village or town and blocks,
the number of households in the rural and urban areas were
estimated for each state. Sample households were selected
with equal probability from each stratum of income, using
random number table. In all 18,693 households were selected,
of which 12,339 were from the urban areas and the remaining
6354 from the rural areas. State-wise distribution of sample
towns, village and households are presented in table
(page 7).
Concepts, Definitions and Survey Methodology
The data for this study were collected by canvassing a
precoded survey instrument. The interviewers were non-medical
Sample Design and Methodology
7
State-Wise Distribution Of Sample Towns,
Villages and the Households
States
No. of
Towns
Selected
No.of
Blocks
Selected
No. of
Villages
Selected
Urban
Rural
Total
Delhi
44
9
33
4
34
16
5
35
21
46
45
4
15
19
28
44
80
30
1
1
1
133
22
87
8
101
41
11
104
59
121
153
9
35
53
73
145
213
104
3
4
30
46
46
84
4
38
32
24
40
28
90
60
10
26
24
54
42
126
32
8
2
2
1090
182
717
64
841
320
83
867
490
1010
1287
74
282
233
584
1217
1802
870
24
32
270
351
369
672
32
304
263
120
325
241
720
466
84
205
116
431
323
1012
257
32
15
16
1441
551
1389
96
1145
583
203
1192
731
1730
1753
158
487
349
1015
1540
2814
1127
56
47
286
ALL-INDIA
515
1509
718
12339
6354
18693
Andhra Pradesh
Assam
Bihar
Goa
Gujarat
Haryana
Himachal Pradesh
Karnataka
Kerala
Madhya Pradesh
Maharashtra
Meghalaya
Orissa
Punjab
Rajasthan
Tamil Nadu
Uttar Pradesh
West Bengal
Pondicherry
Chandigarh
No. of Households
persons but concepts and definitions used were explained to
them and they were trained in the application of the interview
technique. The respondents were mostly the heads of households.
Wherever the head of the household was not available, any
other responsible adult member of the household was contacted.
Period of the Survey
The survey was conducted during the summer months of
May-June 1993. It is a one time survey and as such cannot
reflect the seasonal variations in the morbidity pattern.
8
Household Survey of Health Care Utilisation and Expenditure
Reference Period
The length of the recall period is one of the factors influencing
the reliability of illness reporting. Though two-weeks recall
period is considered an ideal, many health surveys in the
past have adopted the one month recall period. For example,
in the FRCH Household Survey of Jalgaon district, the reference
period was one month. Similarly, the NSSO's 42nd round had
adopted the 30 days reference period for calculating the
proportion of persons with ailments. The NCAER's Household
Survey of Medical Care ( NCAER, 1992a) was based on a two
weeks recall period. In the present survey, the reference period
was one month.
Morbidity
The survey includes both prevalence and incidence of illness
during the reference month. In other words it includes all
illness episodes that started during the reference month and
all episodes (including chronic) that existed during the month,
even if the illness episode had started before the reference
period.
The survey includes the following categories of illness
episodes:
(i)
Episodes starting before the reference period and
terminating within the reference period.
(ii)
Episodes starting and terminating within the
reference period.
(iii)
Episodes starting within the reference month and
continuing at the time of the interview.
(iv)
Episodes starting before the first day of the
reference period and continuing on the date of
survey.
Reporting of Illness
After getting the details about the individual characteristics
of all the household members, the interviewers were asked to
read out the names of each and every member of the household
Sample Design and Methodology
9
to find out whether he or she had suffered from any illness
durmg the month-prior to the date of the interview If any
person had suffered from more than one illness during the
reference period whether simultaneously or at different points
of time within the one month reference period, these illnesses
were entered as separate illness episodes.
Ii
a clScal^m
!>ased on laY reporting of illness and not on
here hat the S°ni
nOt be inaPProPria‘e to mention
ere that the medical diagnosis itself is based on people's
description of the symptoms of illness and hence it maynot
tO group the various symptoms under different
categories/names of illnesses based on lay reporting.
In the present survey the interviewers were asked to note
down the symptoms, as described by the households in detail
(wherever the patient had been to a 'doctor' and the doctor
had diagnosed the disease, the name of the illness was noted
ercmnecl 1 d16
Stage' the symPtoms were classified/
grouped under different illness names using the World Health
(WHO 1978? tJ43™31 OI\Lay Reporting of Health Information
fWn?'19?8These were further grouped under the following
four broad categories of illnesses for the purpose of analysis;5
(i)
(ii)
(iii)
(iv)
Serious Communicable Diseases: Typhoid, malaria,
cholera/acute gasteroenterites, jaundice, mumps'
measles, chicken-pox and tuberculosis.
Acute Illnesses: Diarrhoeal diseases, respiratory
infections, non-specific fever, skin diseases, eye/
ear problems, headache/bodyache/backache,
stomach problems - indigestion, gas acidity and
constipation.
Chronic Illnesses: Aches and pains
pains (arthritis
(arthritis and
and
rheumatism). Cardio- Vascular
diseases
—‘ diseases (heart
(heart
ailments, hypertension),diabetes, kidney problems,
breathing problems/asthma, cancer, weakness/
dizziness/anemia, mental and psychological
disorder and others.
Accidents/Inj uries.
Treatment
The survey included both treated and untreated illnesses,
In the case of untreated illnesses, the reason for not seeking
r
I
— Jl
10
MJ
Household Survey of Health Care Utilisation and Expenditure
treatment was also ascertained from the respondents.The survey
had scope for including combinations of different systems of
medicines and multiple treatment for an illness episode.
Chapter 3
Prevalence of Illness and Pattern of
Morbidity
MOST of the world's developing countries are currently at
various stages of epidemiologic transition. Epidemiologic theory
postulates that as mortality declines, there will be a marked
shift in the distribution of major causes of death, i.e., a shift
from infectious diseases to non-communicable diseases. India
is in the midst of an epidemiologic transition and has an
epidemiological profile of a poor as well as an affluent country
(Dasgupta, et al, 1992). The country is simultaneously facing
the double burden of pre-transitional and post-transitional
diseases. The diseases of underdevelopment and poverty, such
as, infectious diseases, nutritional deficiencies and reproductive
health problems still persist and cause a substantial share of
deaths. At the same time, with increase in life expectancy and
urbanisation, chronic and degenerative diseases are adding
to the disease burden. Over and above these diseases, the
country is facing new health threats in the form of AIDS
environmental pollution and behavioural problems like violence
and drug abuse.
This chapter deals with some of these issues on the basis
of the results of the survey on the prevalence of illness and
the pattern of morbidity among different age groups of people
and among the individuals belonging to different socio-economic
categories. Variations in the prevalence rate of illness among
different states, and between the rural and urban areas of the
country are analysed to understand the disease burden on
society and the people.
Prevalence Rate of Illness
State-wise reported prevalence rate of illness (per thousand
population) are presented in Tables 1 and 2. For the country
as a whole the reported prevalence rate of illness for the one
month reference period works out to be 106.7 and 103.0
respectively for the rural and urban areas. The prevalence
11
12
Household Survey of Health Care Utilisation and Expenditure
rate of treated illnesses works out to be 94.1 for the rural and
94.4 for the urban areas of the country.
These rates are substantially higher (especially in the case
of urban areas) than the prevalence rate of treated illnesses
reported in the NCAER's earlier survey (79.06 for the rural
and 67.71 for the urban areas for the year 1990). As mentioned
in the previous chapter, the NCAER's first survey of Medical
Care (NCAER, 1992a) had adopted a two-week reference period.
In the present survey the reference period has been increased
to one month. The differences in the prevalence rate of illness
between the two surveys could be partly due to the increase
in the reference period, which could have resulted in an increase
in the reporting of acute illnesses. It is also difficult to assess
to what extent the increase in the prevalence rate of treated
or to increase in utilisation of health care services.
Sex-Differentials in Morbidity
The survey results do not indicate any significant sex
differentials in the overall prevalence of illness at the all
India level, although some of the states have reported different
rates for male and female populations. The all-India prevalence
rates of illness are 105.5 for the males and 108.1 for the females
of rural areas. In the case of urban population the rates are
98.2 for the males and 108.4 for the females. However, the
prevalence rate of illness by sex and age group of people
shows a slightly different picture (Table 3) Except for the 1559 age group, the reported morbidity rates are much lower
for the females as compared to their male counterparts, both
in the case of rural and urban areas. In fact, among the children,
the sex differentials are substantial.
A number of nutritional studies in India, especially the
micro level studies, have found higher rates of malnutrition
among women and girls than among men and boys (Sen and
Sengupta, 1983; Dasgupta, 1987). One should therefore, expect
the prevalence of morbidity, especially the prevalence of
infectious diseases, to be higher among the females. However,
there is a considerable difference in the perception of illness
by males and females. In the case of women even if they are
suffering from illness, they do not consider themselves ill as
they cannot afford to take time off their domestic chores. As
Prevalence of Illness and Pattern of Morbidity
13
a result the perception of illness is low for women. In the
case of girl children also, especially in the rural areas, the
need, ability and the permission to seek medical aid is severely
restricted. Due to this perception effect, the reporting of morbidity
can be much lower than the actual morbidity burden in the
case of females. As a result many surveys on morbidity do
not show higher prevalence of illness among the females. For
example, the NSSO Survey (42nd round) did not find any sex
difference in the proportion of persons who had fallen ill during
the 30-day reference period. The morbidity rates were the
same for both the sexes in the rural and urban areas. The
results of the present survey, thus are on expected lines. However
the findings of the present survey, are in contrast to the earlier
survey of the NCAER which had reported substantial sex
differentials in the prevalence rate of treated illnesses for both
adults and children. In the earlier survey, the low reporting
of illness by women and the female children was attributed
to the differences in the perception of illness between the
sexes. In the case of the present survey, due to improvement
in the interview technique (the interviewers were asked to
read out the names of each and every family member and ask
whether he or she suffered from any illness), the reporting
error might have come down considerably, resulting in a better
reporting of diseases of the females.
Prevalence of Illness by Age Group
The reported prevalence rates of illness by different age
groups of the population reveals a very high morbidity rate
for the 60+ age group, for both rural and urban areas. The
rates are 214.6 for the males and 192.2 for the females in
rural areas for the one month reference period. In the case of
urban elderly population, the rates are 219.7 for the males
and 215.9 for the females. The high prevalence of illness among
the elderly population has a very important policy implication.
With an increase in life expectancy and a reduction in birth
and death rates, the proportion of 60+ population to the total
population is bound to increase over the years. The proportion
of 60+ population has increased steadily from 5.6% in 1961 to
6.5% in 1991 and it is estimated to go up to 7.5% by the end
of the century. Since India's population itself is very large, in
terms of numbers this will be very significant. The high
prevalence of morbidity among the old people indicates that
Mfim &
14
Household Survey of Health Care Utilisation and Expenditure
with an ageing population, the disease burden on the state
and society is going to increase in the coming years. Also,
since old people suffer more from chronic illnesses which require
prolonged and/or expensive treatment, the financial implication
of the disease burden would be significant.
The morbidity rate for both male and female children up
to 5 years of age is higher than the rates for the older children
and for the adults belonging to the 15-59 age group. In the
rural areas, the prevalence rate of illness for the children upto
5 years of age works out to be 131.4 for the male and 125.0
for the female per thousand population. For the older children,
i.e., 6-14 years of age, the morbidity rates are much lower at
86.5 for the male and 72.9 for the female. Similarly in the case
of urban areas, the prevalence rate of illness for the younger
children works out to be 143.5 for the male and 122.7 for the
female, and for the children belonging to the 6-14 years age
group the rates are lower at 76.0 for the male and 67.2 for the
female. This is understandable since young children are more
susceptible to infectious diseases.
It is interesting to note that the percentage of treated illness
to total reported illness decreases marginally with increase in
age (especially in the case of rural old women) indicating
that with limited access to health care (both physical and
financial) old people's illnesses are likely to get neglected.
State Level Variations
There are wide variations in the reported prevalence rate
of illness across different states/regions of the country. Among
the various states, Kerala has reported the highest rate of
morbidity. The rates are 194.8 for the rural areas and 183.9
for the urban areas for the reference month. This is in line
with the findings of a number of studies reporting higher
morbidity for the state of Kerala (Panikar and Soman, 1984;
Kannan, et al, 1991). The state of Kerala, that has made major
strides in mortality reduction, reporting high level of morbidity
has remained a puzzle for the researchers. Many explanations
have been put forward to understand this 'paradox' of the
co-existense of low mortality with high morbidity. The high
perception of illness of the people of Kerala, is considered an
important factor responsible for the reporting of high morbidity.
The high literacy rate has made the people of Kerala highly
Prevalence of Illness and Pattern of Morbidity
15
health conscious and this has led to greater utilisation of health
care services. However it has been argued that high self
perception of illness by itself cannot fully explain the higher
reporting of illness in Kerala. Based on official data and other
studies relating to Kerala, it has been concluded by researchers
that the real illness burden is quite high in Kerala and that
higher perception, and the recall factor are important only to
the extent that they exaggerate this phenomenon (Kumar, 1993;
Irudaya Rajan, 1993).
Besides Kerala other states reporting morbidity higher than
the all-India average are, Andhra Pradesh, Himachal Pradesh,
Karnataka, Madhya Pradesh, Orissa, Punjab, Rajasthan, Uttar
Pradesh and Delhi. Some of the states like Assam, Bihar,
Maharashtra and Tamil Nadu have reported very low morbidity.
A number of factors can be considered while trying to
explain these variations. The variations across states in the
reporting of illnesses can be due to differences in the ability
of the respondents as well as the interviewers to report morbidity.
Besides, in a country where economic, social and cuItura
conditions vary widely, the definition of morbidity is likely
to be different for different people, since morbidity is to a
large extent a matter of perception. However, the ^porting
error or the perception factor cannot fully explain the large
differences in morbidity across regions/states. It could actua y
imply the real differences in the illness burden on the society
and state.
In order to understand the real illness burden on the different
states, one could look at the state-wise prevalence rate of illnesses
by type of illnesses (Table 6). Though the co-efficient of variation
(CV) has worked out to be high for all, the variation in the
reported illnesses is much higher for the chronic illnesses^
Both Kerala and Himachal Pradesh have reported a very high
overall morbidity as well as a high prevalence of chronic illnesses.
In both these states, the proportion of 60+ population is quite
high. As we have already seen, the prevalence rate of illness
is very high for the old people and for children below 5 years
of age. The state of Himachal Pradesh has reported a high
prevalence of chronic diseases like arthritis and rheumatism
in the rural areas and cardio vascular diseases, asthma and
weakness, dizziness and anemia in the urban areas. Kera
has reported a high prevalence of cardio vascular diseases
breathing problems and asthma. Most of these diseases are
I
!
I
16
Household Survey of Health Care Utilisation and Expenditure
associated with old age and the climatic conditions of these
states.
Delhi is another state which has reported a higher prevalence
of chronic diseases. Among the various chronic diseases, Delhi
has a fairly high prevalence of cardio vascular diseases, a
sign of affluence in the capital city. One of the reasons for
Punjab reporting a higher prevalence of illness again could
be the high proportion of old people in the state's population.
The state of Andhra Pradesh has also reported a high overall
morbidity as well as a high prevalence of chronic illnesses. In
this state also the proportion of 60+ population is fairly high.
Among the various chronic diseases the state has reported
higher prevalence of weakness/dizziness and anaemia.
Among the backward states, Orissa has reported very high
morbidity. The morbidity profile of the state is dominated by
diseases of poverty and underdevelopment. The state has
reported the highest level of serious communicable diseases
as well as of acute illnesses.
Other backward states which have reported fairly high
morbidity are Madhya Pradesh and Rajasthan. In both, the
proportion of children below 5 years of age is fairly high and
both have reported a high prevalence of acute illnesses. The
state of Rajasthan has also reported a high prevalence of serious
communicable diseases. The other two poor states like Bihar
and U.P. have very low morbidity and these states have very
low prevalence of chronic illnesses also.
Some of the better off states like Maharashtra, Tamil Nadu,
Haryana, and Gujarat have reported a lower prevalence of
morbidity, probably indicating a better health status of the
people in these states. The state of Assam has reported very
low morbidity but the percentage of treated illnesses and the
average duration of acute illness (Table 9) are fairly high for
this state. It is quite likely that in this state due to reporting
error or poor enumeration of illnesses, only illnesses of longer
duration have been reported resulting in lower morbidity rate
with a high average duration of illness.
In the following section, a more detailed analysis of the
nature of illnesses suffered by the people and the state-wise
prevalence of different types of illnesses are presented.
r
Prevalence of Illness and Pattern of Morbidity
17
Nature of Illness
This study, as mentioned earlier was based on self-reporting
of illness and the households were asked to describe the
symptoms of the illnesses in great detail. At the editing stage,
based on the nature of the problem, these symptoms were
grouped under 19 illness groups based on the WHO's Manual
on Lay Reporting of Health Information.
The distribution of reported illnesses by nature of illness
is presented for the rural and urban areas in Tables 4 and 5
respectively. Among the various types of reported illnesses,
'Fever', which includes viral fever, flu and other non-specific
fevers, seems to be the most common illness among both adults
and children. Fever accounted for 30% of the reported illnesses
in the rural areas and about one-fourth of the reported illnesses
in the urban areas. Next in importance come, the respiratory
infection which includes common cold, cough, nose and throat
discomfort and bronchitis. The reporting of this infection is
higher for the children than for the adults.
The data indicate that communicable diseases account for
a high proportion of reported illnesses. The serious communicable
diseases, which include typhoid, malaria, cholera, acute gasteroenteritis, jaundice and tuberculosis, account for 14.5% of all
reported illness episodes in the rural areas and 13.3% in the
urban areas.
The increase in the number of tuberculosis cases is a matter
of great concern in the country. It is estimated that currently
there are 12 million T.B. patients in the country. The NCAER
survey shows that the prevalence rate of tuberculosis (per
thousand population) is 2.9 and 1.9 respectively for the rural
and urban areas. It is more prevalent among adults and in
the case of adult males belonging to rural areas it is as high
as 5.1 per thousand population.
The prevalence rate of cardio vascular diseases like
hypertension, heart ailments, paralysis is much higher for the
urban adults as compared to their counterparts living in the
rural areas. This probably reflects the stresses and strains of
the urban life style. It is also interesting to note that the prevalence
of the cardio vascular diseases is more among men than women.
The reason for this could be that the addiction to tobacco and
alcohol which is associated with cardio vascular diseases is
18
Household Survey of Health Care Utilisation and Expenditure
more among men.
The state-wise prevalence rate of illness by type of illness,
i.e., serious communicable, acute and chronic illnesses for the
rural and urban areas is presented in Table 6. According to
this categorisation the disease pattern of the country is dominated
by acute illnesses. This category accounted for 73% of the
reported illnesses in rural areas and 68.5% of illnesses in the
urban areas. The proportion of serious communicable diseases
was marginally higher in rural areas than in urban areas (14.6%
and 13.6% respectively). The proportion of chronic illnesses
to total reported illnesses is much higher in urban areas indicating
that these diseases (especially degenerative disorders) are more
an urban phenomenon.
In the advanced industrial countries, the chronic and
degenerative diseases have replaced the infectious diseases
and the acute infectious ailments which occur most often in
childhood have declined considerably in incidence and potency.
The diseases of poverty have been substituted by diseases of
affluence. In India, the communicable diseases and acute illnesses
which include diseases like respiratory infection or diarrhoea
account for a high proportion of reported illnesses, indicating
that the country has a long way to go in the epidemiological
transition.
Pattern of Morbidity by Socio-Economic
Characteristics of the Households
The level and the pattern of morbidity by various socio
economic characteristics of the household are presented in
Table 7.
The relationship between the income status of the people
and the level of morbidity is very complex, since there are a
number, of intermediate factors which influence the nature of
the relationship. One should normally expect the prevalence
of morbidity to be related negatively to income and expect a
positive association between poverty and morbidity. However,
as the income level of the people rises, the perception of illness
might increase since the definition of illness depends to a
large extent on whether they can purchase medical attention.
The results of the survey (Table 7) show that the overall
morbidity level comes down with the rise in the annual household
Prevalence of Illness and Pattern of Morbidity
19
income, indicating that with improvement of the economic
status the health status of the people also unproves^ This
corroborates the findings of the NCAER's earlier survey (NCAER
1992a) which also showed a fall in the prevalence rate of illness
with a rise in the income level of the household.
• * -J of the household,
With the increase in the income status
of
serious
communicable
diseases and the
the prevalence rate <----------acute illnesses come down; while the prevalence• of chronic
level. Two
illnesses increases with the increase in
i- income
------Firstly,
with
the
important factors can explain
maln rise in the
jvertv and malnutrition are
economic status, the dir
replaced by the diseases of affluence. Secondly, due to mortality
differentials among different income groups, the Prev^e"^
of chronic illnesses (which are generally associated with^o
age) may be more among the higher income households as
compared to lower income households. In the hig er i
households, the prevalence of chronic illnesses is more because
these households may have a higher
and in the poor or low income households those suYeri“S
from or likely to suffer from chronic illnesses may be already
dead.
A similar pattern emerges, when the level of mortndity is
analysed by the highest level of education in the househokL
Generally speaking, the increase in the educational level o
the people should ifad to greater awareness and better utilisation
of health care services, and this should bring about: a
relationship between morbidity
XratS
»n '.bo change,
leading to a higher reporting of illnesses.
In the urban areas the pattern is very similar to the one
found in the case of prevalence of illness by
the morbidity levels of serious communicable diseases ana
the acute illnesses falling with the rise in the educational statu
and the chronic illnesses increasing with the increase in tne
illnesses.
20
Household Survey of Health Care Utilisation and Expenditure
Among the various occupational categories, people belonging
to the wage earner category have reported the highest level
of serious communicable diseases. The prevalence of chronic
illnesses is very high for the salary eamer/professional category
and for the 'others' category which comprises an assorted
group of people including the households headed by retired
people.
Hospitalisation
The state-wise number of hospitalisation cases reported
during the reference month (per thousand population) are
given in Table 8. The prevalence rates of hospitalisation are
7.1 for the rural and 9.7 for the urban areas. The higher rates
for the urban areas, perhaps indicates a better access to hospital
facilities in the cities.
In the overall reporting of illness there was no significant
sex differentials but in respect of hospitalisation cases, this is
not the case. In most of the states, the number of hospitalisation
cases per thousand population has worked out to be lower
for the females. At the all-India level the rates are 8.4 for the
males and 5.5 for the females in rural areas, and 10.9 for the
males and 8.4 for the females in urban areas. In some of the
states like U.P. and Rajasthan, the sex differentials are substantial
for both rural and urban areas. Since hospitalisation involves
high expenditure and a complete disturbance of family routine,
generally, women avoid getting admitted in hospitals until
3nd unless it is absolutely essential. Studies based on hospital
records also show such sex differentials in the in-patient data.
The NSS Survey (42nd round) found that the male-female ratio
among the hospitalised persons was about 56 : 44.
Average Duration of Illness Episode
The duration of an illness episode can be considered as an
indicator of the seriousness of an illness, i.e., the longer the
duration, the greater its severity. However, a prompt curative
intervention can moderate the duration of illness. Therefore,
the availability of a well developed health infrastructure and
the accessibility can reduce the severity as well as the length
of an illness episode. Moreover, individual perceptions can
also influence the length of an illness episode. This perception;
in turn, depends on various socio-economic factors. For example.
Prevalence of Illness and Pattern of Morbidity
21
in a society where the medical insurance schemes are functioning
efficiently, workers can afford to take time off from their work
for a longer period and hence their perception of illness would
be high. On the other hand, if they are solely dependent on
their daily wages, they can hardly afford to be away from
their work.
Table 9 gives the state-wise average duration of the reported
illnesses for the rural and urban areas. These averages have
been calculated only for the illnesses belonging to the serious
communicable diseases and acute illnesses categories. The data
does not show any significant sex differential or rural and
urban differences in the average duration of illnesses. The
average duration of illnesses for the country as a whole has
worked out to be 10.8 days for the rural areas and 10.1 days
for the urban areas.
The average duration of illnesses is 11.4 days for the males
and 10.1 for the females in the rural areas. In the urban areas
the averages are 10.4 days for the males and 9.8 days for the
females. Thus the average duration of illnesses is marginally
lower for the females both in the case of rural and urban
areas.
Among the various states, the average duration of illness
is the highest for rural Kerala. Even in the case of urban Kerala,
the figure is higher than the all-India average. As we have
already seen, the reported level of morbidity is also the highest
for Kerala. The reporting of high morbidity along with the
long duration of illnesses, inspite of a fairly well developed
health infrastructure implies, a high morbidity burden as well
as a high self perception of illness among the people of Kerala.
Another state for which the average duration of illness
has worked out to be fairly high is Himachal Pradesh and as
we have already seen, this state has also reported a very high
prevalence of morbidity.
The states like Assam and West Bengal had reported a
very low prevalence of morbidity but the duration of illness
has worked out to be very high, probably indicating that only
serious illnesses have been reported and the minor illnesses
have been left out. On the other hand, the states like Andhra
Pradesh and Orissa had reported a high prevalence of morbidity
but the duration of illness is quite low, indicating a better
reporting of illnesses. The backward state of U.P. reporting a
[I
■i
22
Household Survey of Health Care Utilisation and Expenditure
low prevalence of morbidity as well as a low average duration
of illness, perhaps reflects a low perception of illness among
the people of U.P.
1
4
Chapter 4
Utilisation of Health Care Services
I
THE utilisation of health care services depends on the availability
of quality health care services at a reasonable distance and on
the ability of the people to utilise the health services effectively.
Thus, the provision of appropriate health infrastructure is a
necessary but, not a sufficient condition for health care utilisation.
A number of factors such as economic status, caste, occupation,
education and gender have a great influence on the "perceived
need" for medical care and affect the access to health care
facilities. In this survey an attempt was made to study the
pattern of utilisation of health care services for various types
of diseases by socio-economic characteristics of the households,
and the analysis was made across all states and for the rural
and urban areas.
First, the types of illnesses for which no treatment has been
sought was taken up to understand the reasons for not seeking
any medical help. This was followed by an analysis of the
pattern of utilisation of health care services for the treated
illnesses. The non-hospitalised illnesses and the illnesses which
required hospitalisation were studied separately, since the pattern
of utilisation is very different in both cases. An attempt has
also been made to understand the use of health services for
promotive and preventive health care by analysing the utilisation
of health facilities for deliveries, abortion/miscarriages and
immunisation.
Untreated Illness
i
As already stated, all the reported illness episodes were
not treated. For nearly 12% of the illness episodes in the rural
areas and about 8% of the illness episodes in the urban areas,
no treatment was sought. The higher percentage of untreated
illnesses in the rural areas probably reflects the lack of physical
access to health care and the financial constraints that prevail
in the rural parts of the country.
23
24
Household Survey of Health Care Utilisation and Expenditure
Duration of Illness
More than 50% of the untreated illness episodes had lasted
for less than or equal to 3 days indicating that they were minor
illnesses (Table 10). However, in the case of rural areas, onefourth of the untreated illnesses lasted for more than a week,
though in the urban areas only about 18% of the untreated
illness episodes exceeded the duration of a week.
Reasons for 'No Treatment'
The most important reason for not seeking treatment, turns
out to be "illness not considered serious enough". This is the
respondents' perception of seriousness of the illness and it
need not really indicate whether these illnesses were serious
or not. For nearly two-thirds of the untreated illness episodes
in rural and 80% of the untreated illness in the urban areas
"illness not considered serious enough" is given as the reason
for not seeking any treatment (Table 11). The lack of financial
resources available for seeking health care has also come out
as an important reason. Lack of medical facilities in close
proximity was given as the reason by about 13% of the rural
households which did not seek treatment.
Untreated Illness by Socio-Economic
Characteristics of the Households
The distribution of untreated illnesses by various socio
economic characteristics of the households are presented in
Table 12. The percentage of untreated illness comes down, with
an increase in the income status of the households indicating
that economic reasons do play an important role in the decision
to seek treatment. The perceived need for treatment depends
largely on the ability of the person to seek treatment.
The distribution of untreated illnesses by the educational
level of the household also reveals more or less a similar pattern.
However, the differences in the percentages of untreated illness
are more marked in the rural areas than in the urban areas.
Education enhances health consciousness as well as creates
greater awareness about the availability of health care facilities.
Since the general level of awareness and the availability of
facilities are poorer in rural areas, the percentage of untreated
illness is very high for the lower educational categories, i.e..
Utilisation of Health Care Services
25
4
'No formal'education' and 'Primary' level education.
The distribution of untreated illness by the occupation of
rhe hfead of the households, does not show a very clear pattern.
The percentage of untreated illness is the highest for the wage
earner category. The rural-urban differentials in the percentage
of untreated illness are quite significant for the cultivator and
the wage earner categories. For the salary earner/professional
category, there is hardly any difference in the percentage of
untreated illness between the rural and urban areas of the
country.
Non-Hospitalised Illness Episodes
This section deals with the pattern of utilisation of health
care services by the type of health care providers and the
nature of illnesses across all states and for the rural and urban
areas of the country, for the non-hospitalised illness episodes.
Type of Treatment
I
i
The percentage distribution of reported illness episodes
(not requiring hospitalisation) by types of treatment are presented
in Table 13 for the rural and urban areas of the country
respectively. The table shows a high dependence on the private
health providers among the health seekers. The percentage of
illness episodes for which treatment has been sought from
the private health providers works out to be 51.8 for the rural
areas and 58.8 for the urban areas. Thus the dependence on
the private sector is marginally higher among the urban people
and the dependence on the public health care facilities is
marginally higher in the rural areas. However, as much as
41.6% of the illness episodes in the rural areas have sought
treatment from the public institutions such as public hospitals,
community health centres, primary health centres and the sub
centres. The utilisation of PHCs/CHCs accounted for 20% of
the illness episodes. In the urban areas the utilisation of public
health facilities like the Government hospitals and the
dispensaries run by the Government and the local bodies
accounted for 33.8% of the illness episodes seeking treatment.
In India, it is not uncommon to find people buying medicines
directly from the chemist shops without consulting a doctor.
This kind of self-medication is found to be marginally higher
in the urban areas, though the percentages are very low. The
I
I
26
Household Survey of Health Care Utilisation and Expenditure
percentage of illness episodes for which medicines have been
directly purchased from the medical shops works out to be
3.1 for the rural and 5.2 for the urban areas. Seeking treatment
from religious persons or faith healers and the dependence on
home remedies seem very low, though the percentages are
marginally higher for the rural areas.
Thus in spite of a well developed public infrastructure, the
public health care system is far from being the only instrument
for providing health care. The private sector seems to play an
important role in providing curative health care. A number of
surveys on the utilisation pattern have indicated the high
dependence on the private sector. For example the NSSO's
(42nd round) survey found that the dependence on private
health providers for the non-hospitalised cases was as high as
69% for the country as a whole.
Inter-State Variations in Health Care Utilisation Pattern
The state-wise variations in the pattern of utilisation are
given in Tables 14 and 15. Though for most of the states the
utilisation of private health facilities has worked out to be
high, the states like Himachal Pradesh, Rajasthan and the rural
parts of Assam, Karnataka and Orissa seem to rely more on
the public health facilities. The higher utilisation of public
health services by Himachal Pradesh was brought out in the
NCAER's earlier survey as well. (NCAER,1992a). Himachal
Pradesh bemg a hilly region, and a difficult terrain, the availability
of private health facilities may be poor and hence people rely
more on the public health facilities. This must be true of rural
Assam also where the utilisation of public health services is
quite high. In the case of rural Orissa treatment has been sought
from the public health facilities for nearly 70% of the illness
episodes. This high dependence on the public services in this
backward state of Orissa could be because of the poor economic
status of the people who cannot afford private treatment. The
non-availability of any other alternative facility could be an
additional factor. It is interesting to note that the dependence
on home remedies is the highest for rural Orissa. For nearly
9% of the illness episodes only home remedies have been resorted
to. The tribal population of Orissa are known for their indigenous
medicines. In fact, rural Orissa has reported the highest
dependence on indigenous systems of medicine (Table 25) for
the treatment of illnesses.
Utilisation of Health Care Services
27
The utilisation of public facilities seem higher wherever
the private sector is not well developed and the public facilities
are the only services within the reach of the people. The states
where the public health system is functioning efficiently, may
also register higher utilisation of public health care services.
For example, a survey conducted by the NCAER (NCAER,
1992b) found the utilisation of public services provided at the
level of PHC to be very high in the rural parts of Tonk district
of Rajasthan and this was attributed mainly to the better services
in public facilities as reflected by low population coverage
per PHC. In this district 83% of the patients visiting the PHCs
had expressed full satisfaction with the available services.
Although Kerala has a well developed public health
infrastructure, there is greater reliance on the private sector
in the state. In Kerala, though the share of the health sector
over time, the Government facilities are not able to cope up
with the growing demand for health care; in fact the private
expenditure on health in Kerala is reported to be one of the
highest in the country (Panikar, 1992). Kerala has a large number
of hospitals and dispensaries in the private sector. The high
dependence on the private health services in Kerala has also
been brought out by the KSSP's study and by the Kerala Fertility
Survey. According to the KSSP's study, utilisation of private
hospitals is high even among the poor people.
Type of Treatment by Nature of Illness
In both rural and urban areas the utilisation of private
health facilities is highest for the acute illnesses (Table 16). In
the urban areas for nearly 60% of the acute illness episodes
treatment has been sought from the private health care providers.
Since the acute illnesses are generally of short duration and
the treatment is comparatively less expensive (Table 33) people
may find the private treatment within reach and would consult
any doctor who is easily accessible. The percentage of illness
episodes for which self-medication has been resorted to, is
also the highest for the acute ailments.
In the rural areas, the utilisation of public health facilities
is very high for accidents and injuries, i.e., 60% and 70%
respectively for the male and female population. This is
understandable since in the rural areas, the public hospitals
J
i
28
Household Survey of Health Care Utilisation and Expenditure
may be the only facility available for this category of illnesses.
Also in the case of major accidents (especially medico legal
cases), the Government hospitals are the only choice. Since
only out-patient cases are analysed in this section, the accidents
and injuries category includes minor injuries also. In the urban
areas, both the private and the public health facilities are being
utilised for the treatment of accidents and injury cases. In
fact, for 11.4% of the cases, the females living in the urban
areas have taken only home treatment. This probably indicates
that these were minor injuries.
As compared to the rural areas, the utilisation of private
facilities is much higher in the urban areas for all the four
categories of illnesses for both the sexes. In other words,
irrespective of the type of illnesses, the urban people seem to
rely more on the private health care services compared to the
rural.
Type of Treatment by Socio-Economic
Characteristics of the Household
In both rural and urban areas, with an improvement in
the income status of the household, the utilisation of public
health facilities comes down and the utilisation of private
health facilities goes up (Table 17). For the highest income
category, i.e., the households with annual incomes over Rs.
54,000 the utilisation of private facilities is fairly high; the
percentages being 69.3 and 74.6 respectively for rural and
urban areas. Though the ability to pay for the private treatment
could be the main reason for the high income people going in
for private health care services, social prestige also affects
the decision. The people belonging to higher income brackets
may think that it is beneath their dignity to go in for free
treatment.
The utilisation of health services by the highest level of
education in the household also reveals more or less a similar
pattern, especially for the urban areas. With an increase in
the level of education, the utilisation of private health facilities
goes up and the utilisation of public health facilities comes
down. Interestingly self medication in the form of purchasing
the medicines directly from the chemist shops without consulting
any doctor is comparatively high among the well educated
people (Graduates and above) of the urban areas as well as
Utilisation of Health Care Services
29
among the uneducated rural people. The well educated people
indulging in this kind of self medication, show their 'confidence'
in dealing with their ailments. One of the reasons for the higher
utilisation by medical shops by the educated urban people
could be lack of time to visit a health provider and the easy
accessibility of the chemist shops in the cities. On the whole,
the dependence on 'non-professional' treatment is as high as
11.3% for the uneducated people belonging to the rural areas.
The utilisation of health facilities by the occupation of the
head of the household shows that the dependence on private
health facilities works out to be fairly high for the business,
and the salary earner/professional categories of the urban
areas. Here again, apart from affordability, time constraint
must also be influencing the people's decision to go in for the
private health care provider. In the rural areas, the utilisation
of private health facilities is the highest for the cultivator class.
For the wage-earner category, it is more or less the same as
in the urban areas. On the whole, for all the occupational
categories the utilisation of private facilities has worked out
to be higher.
Reasons for Choice of Treatment
In Table 18 the reasons for the choice of treatment are
presented for the rural and urban areas. Most of the people
who have sought treatment from the public health facilities
have done so, because in these facilities, the services are available
free. As expected, both in the rural and urban areas, "free/
inexpensive" has turned out to be the most important reason
for utilising the public health facilities.
In the rural areas, for nearly three-fourths of the illness
episodes seeking treatment from the Government hospitals
"free/inexpensive" has been given as a reason for the choice.
In the case of PHCs/CHCs, "free/inexpensive" was the reason
for choice for 68.7% of the illness episodes and in the case of
treatment from ANM/MPHW/Anganwadis, free/inexpensive
has been cited as a reason for choice for 63.3% of the illness
episodes. In addition to this reason, nearness/being close by
has also come out as an important reason for people seeking
medical help from the PHCs/CHCs or from the ANM/MPHW/
Anganwadis.
Both in the urban and rural areas, 'good reputation' has
‘Mfr1
30
Household Survey of Health Care Utilisation and Expenditure
come out as an important reason for seeking treatment from
the private health facilities. The percentage of illness episodes
for which "good reputation' has been given as a reason for
choice is 35.0 and 46.5 respectively in the rural and urban
areas. In addition to this 'close by' has also come out as an
important reason for opting for treatment from the private
providers; the percentages are 35.5 and 33.9 respectively for
the rural and urban areas.
Thus, it is clear that free/inexpensive is the predominant
reason for seeking treatment from public health facilities. In
the case of private health facilities 'good reputation' and 'close
by' have turned out to be two important reasons for the choice
of treatment. However, it is necessary to point out that when
people choose a private provider because of his/her reputation,
it is the user's judgment. It need not be the correct judgment
of the quality of health care. Generally, it is a human tendency
to devalue what is available free and people may even choose
to go to unqualified private practitioners, since they consider
them to be superior to the 'qualified' doctors at the Government
health facilities.
Both in the rural and urban areas, people buy medicines
directly from the medical shops because they are available
close by and the timings are suitable. Those who have gone
to faith healers or religious persons have done so because of
their belief that it is the only possible cure for the ailment.
For example for jaundice, measles or chicken pox people generally
go to faith healers or religious persons, because they feel that
there is no medical treatment available for such diseases. In
the case of illness episodes for which only home remedies
have been resorted to, the reasons are either because the home
remedies are inexpensive or because the illness episodes were
not considered serious enough to seek outside treatment. In
the rural areas, for some illness episodes (27.3%) only home
treatment has been given because no other facility is available
nearby.
Average Distance Travelled for Seeking Treatment
Table 19 shows the average distance travelled for seeking
treatment from various types of health facilities for the rural
and urban areas. On an average people have travelled longer
distances in the rural areas as compared to the urban areas.
Utilisation of Health Care Services
31
The average distance travelled for seeking treatment works
out to be 5.9 kms. for the rural and 2.2 kms. for the urban
areas.
Both in the rural and urban areas the average distance
travelled has worked out to be marginally lower for the female
adults and the female children as compared to their male
counterparts.
It is interesting to note that neither the private hospitals
nor the private practitioners seem to have any locational
advantage over the public health facilities both in the rural
and urban areas. In the rural areas the average distance travelled
(per illness episode) for seeking treatment has worked out to
be 12.6 kms. for the private hospitals and 10.0 kms. for the
public hospitals. Similarly, the average distance has worked
out to be higher for seeking treatment from the private
practitioners as compared to the PHCs/CHCs. In the urban
areas, both the private and the public facilities seem to be
available at more or less the same distance. Inspite of this
and the free treatment available at the public health facilities,
there is a higher utilisation of private health services. This
indicates that people have preferred to go to the private providers
because they consider them to be superior to the public providers
and are not satisfied with the available services at the public
health facilities.
The average distance travelled for purchasing the medicines
directly from the medical shops has worked out to be very
small. This must be one of the reasons why people indulge in
self medication of this sort.
Hospitalisation Cases
The state-wise percentage distribution of hospitalisation
cases by type of treatment are presented in Table 20. In contrast
to the non-hospitalised illness episodes the dependence on
public health facilities is much higher in the case of illnesses
requiring hospitalisation. For 62% of the cases in rural areas
and for 60% of the cases in urban areas, treatment has been
sought in the public hospitals. The NSSO's 42nd round also
found more or less the same pattern of treatment of indoor
cases in public Institutions i.e. 59.74% of cases in rural areas
and 60.26% in urban areas.
32
Household Survey of Health Care Utilisation and Expenditure
What could be the reason for the people's preference for
public institutions in case of hospitalisation? The most important
reason could be the large expenditure involved in seeking
treatment in a private hospital as an indoor patient (Table
39). The difference in expenditure between the public and
private hospitals is very high and hence people find the public
services more affordable. Moreover, in many rural areas the
public hospitals could be the only available service nearby.
This is probably the reason for the near total dependence on
public services in the case of rural Assam, Himachal Pradesh
and Orissa.
According to the figures published in the Health Information
of India, 1992, though nearly 57% of the hospitals are privately
owned, these private nursing homes account for only 32% of
the beds available in the country. Most of these private nursing
homes are small in size. Moreover, some of the states like
Himachal Pradesh, Madhya Pradesh, Orissa and Rajasthan have
very few hospitals/nursing homes in the private sector. Since
in these states, the public hospitals are the only facility available
the utilisation of public hospitals is also high. On the other
hand in the states like Gujarat, Maharashtra and Kerala, the
private nursing homes are comparatively more in number,
and the percentage of illness episodes being treated at the
private institutions has worked out to be higher for these
states.
Reasons for Choice of Treatment
As indicated by the reasons for choice of treatment (Table
21), people opt for the public hospitals because they find them
less expensive. Both in the case of rural and urban areas,
inexpensive/free seems to be the most important reason for
preferring treatment in the Government hospitals. However,
this reason seems less important in rural areas as compared
to the urban areas since as many as 29% of the users of public
hospitals in the rural areas have mentioned 'good reputation'
as a reason for their choice. The non-availability of any other
facility nearby accounted for another 10.9% of the cases. Thus
in the rural areas, apart from economic considerations, people
seem to go in for the public hospitals since these are the only
facility of good reputation available nearby, whereas in urban
areas, as many as 77.7% had gone in for the public hospitals
because they are inexpensive or free. This is understandable
Utilisation of Health Care Services
33
since some of the "private hospitals" in the urban areas are
very expensive. Only 10% have given "good reputation" as a
reason for opting for the public hospitals.
In the case of private hospitals/nursing homes "good
reputation" has turned out to be the most important reason
for the preference for more than 50% of the cases. This again
is the user's perception and need not reflect the reality. In
addition to this reason, closeness and non-availability of any
other facility nearby have also been considered while opting
for treatment in a private hospital.
Average Distance Travelled for Seeking Treatment
The state-wise, average distance travelled for hospitalisation
are presented for the rural and urban areas in Table 22. On
an average people have travelled a longer distance for
hospitalisation as compared to treatment of non-hospitalised
illnesses. The average distance is considerably higher in rural
areas indicating that the hospitals are concentrated in the urban
areas and the rural people have to travel a long distance.
This could be one of the reasons for lower prevalence of
hospitalisation cases as well as lower percentage of reported
illnesses being hospitalised, in the rural areas. For some of
the states like Rajasthan and Himachal Pradesh, the average
distance travelled has worked out to be very high for the
rural areas. For the country as a whole, there is not much
difference in the average distance between private and public
hospitals for both rural and urban areas, though for some of
the states the average worked out to be very different for the
public and private hospitals.
Utilization of Health Facilities for Deliveries and Immunisation
The survey results show that for preventive and promotive
health care, people depend more on public health facilities.
Table 23 shows the distribution of reported number of delivery
and abortion/miscarriage cases during the reference month
by the type of health facility utilised. More than 60% of the
deliveries in both rural and urban areas have taken place in
the Government health facilities which include the Government
hospitals, maternity centres, CHCs and the PHCs. The financial
consideration could be an important reason for people opting
for the Government facility. The difference in per delivery
34
Household Survey of Health Care Utilisation and Expenditure
expenditure between the public and private hospital is quite
significant (Table 43). Another 26% of the delivery cases in
the urban areas has taken place in the private nursing homes/
hospitals. In the rural areas only 15% of the deliveries took
place at the private health facilities.
i
A high percentage of deliveries especially in the rural areas,
has taken place in homes. The home deliveries account for
23.4% and 11.2% respectively of the deliveries in the rural
and urban areas of the country. One of the reasons for high
neo-natal mortality in the country is the unhygienic conditions
in which deliveries take place. The home deliveries without
any assistance from trained birth attendants can prove to be
very dangerous for both the mother and child.
In the case of abortions and miscarriages, the pattern of
utlisation is slightly different The dependence on private sector
’V/air,y high in the urban areas- Even in the rural areas nearly
va/u° °f the CaSeS Were handled bY the private nursing homes.
What could be the reason for this? In the case of abortion,
since it is intentional (as against miscarriage which is accidental),
women may like to keep it a secret and hence may refer to go
to a private clinic where they may have personal contacts. In
rural areas, no treatment outside the home has been sought
in the case of about 18% of miscarriages/abortions. This
percentage is only 1.7 in the urban areas.
The total dependence on the public health facilities for
preventive health care is clear from Table 24. Since the launching
o the Universal Immunisation Programme in the Year 1985
the public health facilities, both in the rural and urban areas
have taken a number of steps to improve the access to
immunisation. The immunisation done in the public health
facilities account for nearly 90% of the reported number of
immunisation cases. In the rural areas, the PHCs and the subcentres account for more than 80% of the immunisation cases,
this indicates that the sub-centres and the PHCs/CHCs play
an important role in the immunisation programme. Even in
the urban areas, people seem to depend on the Government
Xltar and on Government or Municipal dispensaries; only
12.3 /o of the cases were handled in the private sector.
i
Utilisation of Health Care Services
35
System of Medicine
India hds a number of indigenous systems of medicine. In
the pre-colonial period, the ayurveda system was the most
prominent system of medicine. During the colonial period,
there was a transition from the traditional to the modern
imported systems of medicine. This transition was originally
confined to the urban areas and the rural population continued
to depend on the traditional systems of medicine which included
tribal and folk medicine, unani and ayurveda. Over the years,
the allopathy system of medicine has turned out to be the
most dominant among the various systems. However, in recent
years, there has been a revival of interest among the people
not only in siddha/ayurveda and in homeopathy but also in
other systems like naturopathy, and acupuncture. The trend
is towards a holistic approach to health care.
The present survey had also collected information on the
system of treatment sought by people for treating their ailments.
The state-wise distribution of non-hospitalised illness episodes
by the system of treatment sought are presented for the rural
and urban areas respectively in Tables 25 and 26.
The dominance of the allopathic treatment over other systems
of medicine is very well depicted by the results of the survey.
At the all-India level, for more than 90% of the illness episodes,
the allopathic system of treatment has been sought and this
percentage is marginally higher for the urban areas. The illness
episodes for which homeopathic treatment has been resorted
to worked out to be 2.0% and 2.9% respectively in the rural
and urban areas. Ayurvedic/siddha, the traditional Indian
systems of medicine seem slightly more popular in the rural
areas as compared to the urban parts of the country. The
percentages are 3.8 and 2.2 respectively in the rural and urban
areas.
It is important to note here that a number of private
practitioners in the unorganised sector practice allopathic
medicine, even though they are qualified in other systems of
medicine. In other words, treatment of illness under allopathic
system of medicine does not necessarily mean that they are
being treated by 'allopathic doctors’. It is not uncommon to
see some of the doctors combining more than one system of
medicine. The survey results showed that for 2.0% and h2/o
of the illness episodes respectively in the rural and urban
i
36
Household Survey of Health Care Utilisation and Expenditure
areas, a combination of two systems (mostly in addition to
allopathy, either homeopathy or ayurveda or even rituals)
has been used for treatment of ailments. The combination need
not be prescribed by the 'doctor', sometimes people themselves
resort to more than one system of medicine.
The strong preference for the allopathic system of medicine
among the people has been well established by a number of
surveys. The NSSO's survey (42nd round) found that the
allopathic system was used in respect of nearly 96% of non
hospitalised cases both in the rural and urban areas. A recent
NCAER survey of rural districts of Madhya Pradesh, U.P. and
Rajasthan (NCAER, 1992b) also revealed the popularity of
allopathic medicines. More than 90% of illness episodes were
treated under this system of medicine.
Though for the country as a whole the percentage of illness
episodes seeking homeopathic or ayurvedic systems of treatment
has worked out to be very low, the pattern is slightly different
for some of the states especially in the rural parts (Tables 25
and 26). For example, in the case of rural Assam, for nearly
10% of the illness episodes homeopathic treatment has been
sought. In fact, homeopathic treatment seems popular in urban
West Bengal where 11.3% of the illness episodes have been
treated under this system. The ayurveda system seems fairly
popular in the rural parts of Maharashtra, Orissa, Haryana,
Bihar and Kerala.
I
Chapter 5
Household Expenditure on Health Care
IN India, the public outlay on health care has not kept pace with
the health needs of the people. There has been a progressive
reduction in the proportion of budgetary allocation of resources
to the health sector in the successive Five Year Plans, with a
marginal improvement in the Seventh Plan (Health Information
of India, 1992). Government spending on the health sector
works out to be less than 2% of the country's GDP (Tulasidhar,
V B., 1992). The WHO has recommended that governments
must spend atleast 5% of their GDP on health care. The per
capita public sector expenditure on health (including water
supply) was a meagre amount of Rs. 64 for the year 1990-91
(Duggal, R., 1992). As against this, the household expenditure
on health care is considerably higher. According to the present
survey the per capita annual household expenditure on curative
health care works out to be about Rs. 204.
The results of the survey indicate that on an average the
households spend nearly 5% of their income on curative health
care and this percentage is marginally higher for the rural
households as compared to the urban households as presented
in the table (page 38). The household expenditure on curative
health care as a proportion of their income comes down with an
increase in the income status of the households-. The poor
households seem to spend more than 7% of their income on the
treatment of ailments while the rich households spend only
2.7%.
As mentioned earlier the per capita annual household
expenditure on curative health care works out to be Rs. 204 and
the per capita expenditure increases with the increase in the
household's income status. This indicates that though the
prevalence of illness is lower for the rich households they spend
more on the treatment of ailments. The per capita expenditure
on health care is generally higher for the urban households and
the rural-urban differential in the per capita household
expenditure is substantial for the rich households.
37
J
38
Household Survey of Health Care Utilisation and Expenditure
Household Expenditure on Curative Health Care*
(In Rs.)
Household
Income
Group
A verage
Annual
Household
Income
A verage
Annual
Household
Health
Expenditure
Rural
10946
Expenditure Per Capita
as Percentage Annual
of Income
Expenditure
<18,000
18001-54000
354000
29033
76039
855.84
1195.44
1722.33
7.82
4.12
2.27
167.81
206.36
246.10
TOTAL
18716
988.40
5.28
183.87
Urban
£18,000
18001-54000
>54,000
12832
32147
78504
908.18
1352.33
2313.20
7.08
4.21
2.95
194.58
262.66
406.81
TOTAL
30184
1294.09
4.29
257.64
7.66
4.15
2.66
172.53
226.51
328.53
Total
< 18,000
18001-54000
>54,000
11303
30233
77431
865.75
1255.93
2055.84
TOTAL
21931
1074.10
4.90
________________
203.56
Estimates are based on the expenditure incurred by the households
during the one month reference period for the treatment of illnesses.
The following sections deal with the expenditure incurred
by the households for the treatment of various types of ailments
by the type of health care facilities utilised. The household
expenditure on treatment of hospitalised and non-hospitalised
illness episodes are analysed separately. This chapter also throws
some light on the amount spent by the households on other
health care services such as, deliveries, abortions, miscarriages
and immunisation of children.
Non-Hospitalised Illness Episodes
The state-wise average household expenditure per illness
episode for adults and children are presented in Tables 27 and
28 respectively for rural and urban areas. For the country as a
I
Household Expenditure on Health Care
39
whole, the average household expenditure per illness episode
has worked out to be Rs. 90 for the rural areas and Rs.114 for the
urban areas.The expenditure incurred by the households for
the treatment of ailments includes the fees paid to the doctors,
the cost of medicine, cost of diagnostic tests and the transport
costs to commute to the health facilities. In addition to these
expenses, the households have to provide special diet to the sick
persons and incur certain incidental expenses such as paying
bribes and tips to get better attention at the health facilities. In
some households rituals are performed to pray for the speedy
recovery of the sick persons. While calculating the average
household expenditure for the treatment of illnesses, all these
costs have been taken into account.
Rural- Urban Differentials
There is a substantial rural-urban differential in the average
household expenditure (per illness episode) for both adults and
children. The rural households have spent Rs. 114 and Rs. 101
(per illness episode) for treating the adult male and female
while the urban households have incurred an expenditure of
Rs. 134 and Rs. 126 for the treatment of the adult male and
female. Similarly, in the case of children, the average household
expenditure per illness episode has worked out to be Rs. 60 and
Rs. 45 for the rural male and female children. These averages
are much lower than the average expenditure incurred by the
urban households for the treatment of children. The urban
households have spent Rs. 77 and Rs. 61 respectively for the
treatment of the male and female children. These figures indicate
that like other expenditures, the medical expenses are also
higher in the urban areas and on an average the urbanites spend
more on the treatment of illnesses. As we have already seen,
even the per capita expenditure on health care has worked out
to be higher for the urban households.
Children
vs Adults
It is clear from Tables 27 and 28 that the expenditure per
illness episode has worked out to be much lower for the children
up to 14 years of age, when compared to the adults. This is in
line with the findings of NCAER's earlier survey of Medical
Care (NCAER, 1992a). Even the FRCH's study of the Jalgaon
district of Maharashtra found the average household
expenditure for the children to be lower. Children generally
i
40
Household Survey of Health Care Utilisation and Expenditure
suffer more from acute illnesses which are of shorter duration
while the chronic illnesses are more prevalent among the adults
(Tables 4 and 5). The chronic illnesses are of longer duration
and the treatment of most of these ailments are expensive
(Table 33). Hence the average expenditure per illness episode
has worked out to be lower for the children.
S ex-Differen tials
In both rural and urban areas the average household
expenditure tper illness) has worked out to be lower for the
female adults and the female children as compared to their
male counterparts. This sex differential in the household
expenditure is visible not only at the all India level but also in
most of the states and the gender difference is more pronounced
in the case of children. It is interesting to recall that the survey
results did not show any gender difference in the reporting o
illnesses (Chapter 2). In contrast to this, the earlier NCAER
survey found a substantial sex difference in the reporting o
illness and little bias against women in the amount spent per
. illness (though in the case of children, the average expenditure
per illness episode was marginally higher for the male children).
An important reason for this could be that in the earlier
report since the reporting of illness was poor for women and the
female children, only serious illnesses would have got reported
and hence the amount spent per illness episode would have
been greater. While in the present survey since the reporting of
illness for women has improved, even the non-serious illnesses
would have been reported. Hence the average expenditure per
illness episode has worked out to be lower as compared to that
for their male counterparts.
The present survey results show discrimination against
both the female children and adults in the form of lower
expenditure for treating an illness episode. In spite of not
having any gender difference in the type of health care services
utilised (public vs private), the amount spent per illness episode
has worked out to be lower for the female children and the
female adults. This probably indicates discrimination against
women in the intra-household allocation of resources for medical
care.
been found by a number of studies. The study of the Health
Household Expenditure on Health Care
41
Impact of the Indira Gandhi Nahar Project (Sundar, R., 1994)
found a vast difference in the average cost of treatment for boys
and girls. The average cost of treatment per illness episode
worked out to be Rs. 174 for boys and only Rs. 100 for girls. Such
gender differences in the expenditure on medical care, were
also brought out by a study of Punjab villages where about two
and a half times more expenditure was incurred on medicine for
boys than for girls during infancy and during 0-4 years the ratio
of expenditures on medicine for boys to that of girls was 1.2 : 1
(Das Gupta, 1987). The FRCH's household survey of cost of
health care in Jalgaon district has also revealed a vast difference
in the cost of health care between men and women (Duggal and
Amin, 1989).
State-level Variations
Both in the rural and urban areas, there are wide variations
across states in the amount spent per illness episode for treating
ailments. In the rural areas the average household expenditure
(per illness episode) works out to be the highest for the state of
Kerala; (the amount spent is as high as Rs. 172 per illness episode)
closely followed by Andhra Pradesh. For some of the poor
states like Rajasthan, U.P. and Madhya Pradesh the amount
spent per illness episode has worked out to be quite low; the
respective averages are Rs. 60, Rs. 62 and Rs. 64. However, in the
case of urban households, there is not so much variation across
states in the amount spent per illness episode. Delhi households
have spent the highest amount (Rs. 161 per illness episode),
closely followed by Haryana. The poor states like U.P., Rajasthan
and Madhya Pradesh have spent comparatively lesser amounts
per illness episode.
However even for the better off states like Tamil Nadu,
Maharashtra or Punjab the average household expenditure per
illness episode has worked out to be quite low.
These variations across states in the average amount spent
per illness episode could be partly explained by the differences
in the type of health facilities utilised (Tables 14 and 15). In the
state, where the dependence on private health provider is
higher, the amount spent per illness episode has worked out to
be fairly high. For example, in the rural areas, the average
household expenditure (per illness episode) has worked out to
be high for the states of Kerala, Andhra Pradesh and Gujarat
j
42
Household Survey of Health Care Utilisation and Expenditure
and in these states, the utilisation of private health facilities is
fairly high. Similarly, in the urban areas, the household
expenditure per illness episode has worked out to be very high
for Delhi, Haryana, Bihar, Maharashtra and West Bengal and m
these states the dependence on private health facilities is also
higher as compared to other states. On the other hand, some of
the states like Tamil Nadu and Rajasthan and the rural areas of
Assam, Orissa and Punjab have relied more on the public health
facilities and hence the amount spent per illness episode has
turned out to be fairly low. In the case of U.P., though the
utilisation of private facility is high the average expenditure
per illness episode has worked out to be low indicating the poor
paying capacity of the people.
Household Expenditure by Type of Treatment
In Tables 29 and 30, the state-wise details about the
household expenditure per illness episode are presented for the
rural and urban areas, by types of health care services utilised.
It is clear from the tables that on an average the urban households
have spent a larger amount (per illness episode) for all categories
of treatment.
The average expenditure per illness episode works out to be
the lowest for home remedies-the averages are Rs. 8.00 and
Rs. 15 respectively for the rural and urban areas. The expenditure
per illness has worked out to be considerably low even for the
illness for which medicines have been purchased directly from
the medical shops. The average amount spent works out to be
Rs. 21 for the rural and Rs. 23 for the urban areas. Since generally
self-medication is resorted to only for the minor ailments, the
amount spent has turned out to be quite low. There are very few
illness episodes for which the households have relied solely on
the faith healers or religious persons. Though for the country as
a whole the average amount spent per illness episode for getting
'treatment' from religious persons/faith healers has worked
out to be moderate at Rs. 66 for the rural areas and Rs. 77 for the
urban areas, in some cases the households have spent a huge
amount especially in the rural areas.
Both in the rural and the urban areas, as expected the
average expenditure (per illness episode) has worked out to be
much lower for the illnesses for which treatment has been
sought from the public health facilities when compared to the
Household Expenditure on Health Care
43
expenditure incurred for treatment from the private health
services. In the rural areas, the average expenditure per illness
episode works out to be Rs. 49 and Rs. 131 respectively for
In the urban areas, these averages turned out to be Rs. 63 and Rs.
152 respectively. This is understandable, since in the public
health facilities, generally no consultation fee is charged and
even the medicines and the clinical tests are 'supposed' to be
available free of cost. However, in reality people have to
invariably buy medicines from outside since the public facilities
do not have enough stock of all the medicines (ICMR, 1991). The
NCAER's recent survey of Primary Health Care Services
(NCAER, 1994) revealed that the Government's expenditure on
drugs and supplies is less than Rs. 5 per capita for the sample
rural districts of West Bengal, U.P., Tamil Nadu and Gujarat.
This amount is hardly adequate to meet the requirements.
Hence even when people seek treatment from the public health
facilities, they may have to purchase the medicines from outside.
In addition to this, the households have to spend on transport,
special diet, etc.
In the rural areas, the average expenditure per illness episode
for seeking treatment from the public health facilities has worked
out to be the highest for Himachal Pradesh i.e., Rs. 125. Himachal
Pradesh being a hilly region, the transport cost has worked out
to be fairly high (Table 37) for the rural areas of the state.
It is interesting to note that the variations in expenditure
(per illness episode) across states is much lower in the urban
areas as compared to the rural areas for treatment by both
public and private facilities.
f
Average Expenditure by Duration of Illness
As already mentioned the duration of an illness episode can
be considered as an indicator of the seriousness of an illness.
The longer the duration, the greater is its severity. As a result
the amount spent on the treatment of ailments should also go up
with an increase in the length of the illness episodes. In Tables
31 and 32, the state-wise average household expenditures per
illness episode are presented by duration of illness, respectively
for the rural and urban areas. It is clear from the tables that the
average amount spent increases systematically as the duration
of illness episodes increases from less than or equal to 5 days to
r
44
Household Survey of Health Care Utilisation and Expenditure
more than 30 days. In the rural areas, the average expenditure
(per illness episode) works out to be as low as Rs. 33 tor the
illness episodes which lasted for less than/equal to 5 days^n
the expenditure goes up to Rs. 347 for the illness episodes w ic
continued for more than 30 days. Similarly in the urban areas
the households have spent on an average Rs. 45 for the treatment
of illness episodes which lasted for less than or equal to 5 days
and have spent Rs. 355 for the major illnesses which continued
for more than a month. The same pattern of increase in the
expenditure by the duration of illness episodes is noticeable for
all the states.
Average Household Expenditure by Nature of Illnesses
The amount spent for the treatment of illnesses would depend
on the nature of ailments as well as on the type of treatment
sought. In Table 33 details about the expenditure incurred by
the households for the four categories of illnesses, i.e., serious
communicable diseases, acute illnesses, chronic illnesses and
accidents/injuries are presented.
For all the four categories of illnesses, the amount spent per
case works out to be more for the urban areas as compared to
the rural areas with the exception of chronic illnesses, where the
amount spent is marginally higher for the rural areas.
Among the various categories of illnesses, the amount spent
on the treatment of acute illnesses turned out to be the lowest.
For the treatment of acute illnesses, on an average the households
have incurred an expenditure of Rs. 56 and Rs. 72 per illness
episode, in the rural and urban areas. There is a substantial
and other types of illnesses.
The average household expenditure per illness episode
works out to be the highest for the accidents/injury cases in the
urban areas and for serious communicable diseases in the rural
areas. In the case of serious communicable diseases, the average
household expenditure per illness episode works out to be Rs.
172 and Rs. 198 respectively for the rural and urban areas.
In the case of chronic illnesses, only the amount spent
during the one month reference period has been included and
the amount works out to be Rs. 208 and Rs. 201 respectively for
the rural and urban areas.
I
Household Expenditure on Health Care
45
While there is no significant sex difference in the amount
spent (per illness episode) by the households for the treatment
of acute illnesses, in the case of chronic illnesses and the serious
communicable diseases, there is a substantial gender difference
in the household expenditure, especially among the children.
On an average the households have spent a much lower amount
on the treatment of women and the female children. This
probably shows that when the amount involved is more, the
households do discriminate against females in the allocation of
resources.
Household Expenditure by Socio-economic Characteristics
Table 34 shows the average amount spent by the households,
belonging to different income classes on the treatment of various
types of illnesses. The amount spent per illness episode increases
systematically with an increase in the income status of the
households, for all the four categories of illnesses i.e. serious
communicable diseases, acute illnesses, chronic illnesses and
accidents/injury cases. These differences in the expenditure
among the different income classes, are more pronounced in the
urban areas as compared to the rural areas. This probably
indicates that where facilities are available, households with
money are able to purchase better quality health care. In the
case of urban households there is a substantial difference in the
amount spent per illness episode between the lowest (< Rs.
18,000) and the highest income (> Rs. 54,000) category One of
the reasons for this difference in the amount spent is the higher
utilisation of private health facilities by the households
belonging to the upper income categories.
In Table 35, the average expenditure incurred by the
households for the treatment of illnesses are presented by the
highest level of education in the household and by the type of
illnesses. For all the educational categories, the amount spent
per illness episode has worked out to be higher for the urban
households as compared to the rural households.
For all the four categories of illnesses, with an increase in the
educational level of the households, the amount spent per
illness episode also shows an increasing trend, but the rise in
expenditure is not as directly related as was the case in respect
of income, especially for the rural areas. On the whole, the
households belonging to the lower educational level seem to
46
Household Survey of Health Care Utilisation and Expenditure
pent lesser amount on the treatment of iHncsses compared
to the households with higher educational status. !n the^urba
areas the households belonging to the highest educational
category (i.e. graduates and above) have spent a much higher
amount for the treatment of all the four types o i nes
compared to households with lower educational status.
The average expenditure incurred by the households by
occupation oHhe head of the household
’J^io^ki
expeiXu*™^^
occupational categones except in
the case of accidents/injuries. In the urban areas the averag
amount spent per illness episode works out to be lowest for the
wage earner category. The households belonging to the salary
Tarner/'rofessioL/category and the business category have
spent more or less the same amount per illness episode. In t
urban areas, the cultivator category includes the households
where the head of the household is a land owner and other
family members are engaged in other occupations. For these
households, the amount spent per household has worked out to
be the highest, while in the rural areas, the average exPend**^
per illnefs episode has worked out to be more or less the, same
for the households headed by cultivators, wage earners and the
salary earners. For the business households and the household
belonging to 'others' category, the average expenditure has
worked out to be higher.
Break-up of Expenditure
In Tables 37 and 38, the item-wise break-up of average
expenditure incurred per illness episode by tl'e1ho“s^°1r^‘S1
presented for the rural and urban areas separately. In the rural
areas, the Tees and medicine' component accounted for 71.3 o
of the total amount spent per illness episode. Fees paid to the
health provider and the medicine costs are clubbed together
since in many cases, the “doctors' also dispense the medicine
and the households are unable to separate the medicine cost
and the fees from the total amount paid to the doctors . In^
case of urban households, the 'fees and medicine co’Hp
accounts for a higher proportion of the total expenditure re
77.6% of the expenditure incurred by the household goes in for
this item.
As already mentioned, in the rural areas longer distances
....
Household Expenditure on Health Care
47
have to be travelled for seeking treatment than in the urban
areas. Hence, the transport cost forms a much h^er proportion
of the total expenditure in the rural areas. Out of the tota
amount spent by the households, as much as 14.5 /□ has gone■ i
for the transport cost, while in the case of urban households the
transport cost accounted for only 6.5% of the tota exPe"*
incurred per illness episode. In the case of rural Himachal
Pradesh, the transport cost formed nearly one-fourth ol the
total expenditure. Some of the other states for which.the ranspor
cost formed a higher proportion are. rural. parts of Cupra
(21.0%), Karnataka (21.8%), Maharashtra (21.5/o) and Tamil
Nadu (22.6%).
As against this, the urban households seem to have spent
proportionately more on the clinical tests when compared to
rhePrural households. In the urban areas, the expenditure o
clinical tests formed 6.9% of the amount spent per illness eP,s«^
while in the case of rural households, this Perce"ta^(7XSds
at 4.4. As compared to the rural areas, the urban h^sehc d
have spent proportionately lesser amounts on rituals and o
bribes/tips.
Household Expenditure on Hospitalised Illnesses
For seeking treatment as in-patients people seem to prefer
the public health facilities and the most important reason for
the higher utilisation of public hospitals turned out to be that
they are less expensive than the private facilities. This is obvl^
from Table 39 which shows that the average expenditure
incurred by the households for seeking treatment from he
private hospitals/nursing homes is much higherthan.the
expenditure incurred for seeking treatment frorr the publ c
hospitals. The difference between the public and private
hospitals is much more pronounced in the urban than in the
rural areas.
In the urban areas, the average household expenditure per
hospitalised case works out to be Rs. 453 and Rs. 2319 respectively
for seeking treatment from the public and the pnva e hospital^
In the rura^ areas, the averages are Rs.535 for the public hospita
and Rs. 1877 for the private hospitals.
of illnesses, there is a substantial difference in the expenditure
48
Household Survey of Health Care Utilisation and Expenditure
between the public and the private health facilities.
There is a significant sex differential in the average
expenditure incurred by the households for hospitalisation
both in the rural and urban areas, irrespective of the type of
health facility utilised. In the rural areas, the average amount
spent per hospitalisation case has worked out to be Rs. 1105 for
the males and Rs. 935 for the females; in the urban areas, it was
Rs. 1339 and Rs. 989 respectively for the males and females.
The average expenditure incurred by the households by
type of illnesses shows that in the urban areas for all the four
categories of illnesses the average expenditure was lower for
the females than for the males. In the rural areas the sex
differentials are obvious only for the chronic illnesses and for
accidents and injuries. Thus in the case of hospitalisation there
is a gender discrimination not only in the form of fewer females
reporting hospitalisation but also in the form of lesser
expenditure for the treatment of hospitalised cases for females
than for males.
The break-up of expenditure incurred by the households for
hospitalisation (Table 41) shows that nearly half the amount is
spent in the form of fees and medicines. As expected the
households in the rural areas have spent a higher proportion of
the total expenditure (per hospitalisation case) on transport
when compared to their counterparts in the urban areas. For the
rural households the transport costs accounted for 12.1% of the
total amount spent per hospitalisation case, while for the urban
households this percentage was much lower at 4.8. Both the
urban and rural households have spent nearly 9% of the total
expenditure for clinical tests. The actual amount as well as the
proportion of expenditure on hospitalisation charges are much
higher for the urban households. The hospitalisation charges
formed 21 % of the total expenses in the case of urban households,
whereas the rural households spent only 14.6% of the total
expenditure on hospitalisation charges.
Household Expenditure on Other Health Care
It has already been seen that for preventive health care,
there is a near total dependence on the public health facilities.
Only a very small percentage of children have gone to the
private health provider for immunisation. Under the Universal
Immunisation Programme, since immunisation facilities are
Household Expenditure on Health Care
49
easily available at the public health facilities, the households
have incurred hardly any expenditure for immunising their
children against preventable diseases (Table 42). The average
expenditure incurred by the households (per immunisation)
works out to be around Rs. 4 for utilising the public health
services. This small amount is spent mostly on transport to
commute to the health facilities. In the case of households
utilising the services of private health providers, the average
amount spent (per immunisation) works out to be Rs. 48 and Rs.
37 respectively for the rural and urban areas. In the rural areas,
the average amount spent is more because of higher transport
cost.
In Table 43, the average expenditure incurred by the
households for deliveries and abortion/miscarriage cases are
presented by the type of health care facilities utilised. In the
case of home deliveries, the households have spent only a
nominal amount and this could be one of the reasons for not
utilising any health facility. The amount spent works out to be
Rs. 76 and Rs. 52 respectively, for the rural and the urban
households. This amount is usually spent on special diet, rituals
and payment to birth attendants, if any.
There is a substantial difference in the average amount
spent for deliveries between the public and private health
services On an average the rural households have spent (per
delivery) Rs. 257 and Rs. 1497 respectively for utilising the
public and private health facilities. For the urban households,
these averages work out to be Rs. 231 and Rs. 1858.
Household Expenditure by System of Treatment
Among the various systems of medicine, the allopathic
system has turned out to be the most popular system of medicine.
It is interesting to note that inspite of the allopathic system of
medicine being more expensive than the other systems of
medicine (Table 44), for nearly 90% of the illness episodes the
households have relied on this system of medicine.
The average amount spent per illness episode works out to
be Rs. 92 and Rs. 114 respectively in the rural and urban areas,
for utilising the allopathic system of medicine. As against this,
the households utilising the homeopathic system of medicine
have incurred an average expenditure of Rs. 70 and Rs. 83
respectively in the rural and urban areas.
|
50
Household Survey of Health Care Utilisation and Expenditure
The indigenous systems of medicine, ayurveda/siddha seem
to be comparatively very inexpensive in the rural areas. The
rural households that have relied on these indigenous systems
of medicine, have spent on an average Rs. 38 while the urban
'households have paid Rs. 97 per illness episode.
The amount spent (per illness episode) works out to be very
high for utilising a combination of more than one system of
medicine. As mentioned earlier, only for a small percentage of
illness episodes have the households utilised a combination of
systems and for these illness episodes the average expenditure
works out to be Rs. 130 and Rs. 165 respectively for the rural and
urban areas.
■JI
Table 1 : State-wise Prevalence Rate* of Illness by Sex — Rural
( Per 'OOP Population )
Preva
lence
Rate of
Illness
Preva
lence
Rate of
Treated
Illness
Treated
Illness as
Percentage
of Total
Illness
Preva
lence
Rate of
Illness
Preva
lence
Rate of
Treated
Illness
Treated
Illness as
Percentage
of Total
Illness
Preva
lence
Rate of
Illness
Preva
lence
Rate of
Treated
Illness
Treated
Illness as
Percentage
of Total
Illness
Andhra Pradesh
Assam
Bihar
Gujarat
Haryana
Himachal Pradesh
Karnataka
Kerala
Madhya Pradesh
Maharashtra
Orissa
Punjab
Rajasthan
Tamil Nadu
Uttar Pradesh
West Bengal
135.9
90.2
98.3
71.6
78.9
127.2
123.0
201.6
114.7
65.4
159.4
155.8
109.0
78.0
109.6
77.8
121.9
86.0
81.4
67.2
71.4
124.0
100.0
196.3
106.2
60.0
129.2
155.8
95.5
71.8
95.3
59.4
89.7
95.3
82.8
93.7
90.6
97.3
81.4
97.4
92.6
91.7
81.0
100.0
87.6
92.2
86.9
76.3
115.5
80.8
97.7
80.8
70.7
167.2
110.1
187.8
116.3
68.4
229.2
106.4
119.6
79.0
110.6
87.2
107.9
72.7
87.5
72.7
64.6
157.2
95.6
182.1
101.6
54.5
183.2
104.5
110.2
68.7
93.8
86.2
93.5
90.0
89.8
90.0
91.3
94.0
86.8
96.9
87.3
79.6
80.0
98.2
92.2
87.0
84.8
99.0
126.6
86.0
98.0
75.8
75.4
146.3
116.6
194.8
115.4
66.8
191.4
132.0
113.7
78.3
110.0
82.0
115.5
80.2
84.2
69.7
68.6
139.7
97.8
189.3
104.1
57.3
154.0
131.0
102.2
70.4
94.6
71.6
91.3
93.2
85.7
92.0
91.1
95.5
83.9
97.2
90.2
85.8
80.4
99.3
89.7
89.7
86.0
87.3
ALL-INDIA
Coefficient of
Variation %
105.5
92.9
88.1
108.1
95.6
88.4
106.7
94.1
88.2
33.35
32.77
39.18
38.30
34.29
35.29
State
T
tn
<= c>
o
All
Female
Male
* Prevalence rates have been worked out for the one month reference period in all the tables.
r- <.
34
Note: AlUndia figures include the States/Union Territories of Goa, Meghalaya, Pondicherry, Chandigarh and Delhi.
v>
U1
NJ
Table 2 : State-wise Prevalence Rate of Illness by Sex—Urban
(Per '000 Population)
Stale
Preva
lence
Rate of
Illness
Andhra Pradesh
Assam
Bihar
Gujarat
Haryana
Himachal Pradesh
Karnataka
Kerala
Madhya Pradesh
Maharashtra
Orissa
Punjab
Rajasthan
Tamil Nadu
Uttar Pradesh
West Bengal
Delhi
Preva
lence
Rate of
Treated
Illness
Treated
Illness as
Percentage
of Total
Illness
135.0
118.2
87.6
64.0
106.2
74.5
63.0
98.5
95.0
77.2
163.9
89.7
191.8
127.0
77.8
163.0
120.6
139.7
76.5
78.1
101.0
71.0
75.3
148.4
75.6
170.0
122.7
74.4
95.3
97.4
90.6
84.3
88.6
96.6
95.7
Preva
lence
Rate of
Illness
146.6
65.3
98.2
95.0
101.2
211.5
106.4
176.1
119.5
79.5
178.6
175.4
74.4
95.2
69.8
70.4
89.2
96.4
95.0
92.3
92.9
89.4
94.6
93.7
98.2
90.7
92.4
108.4
157.2
108.5
All
Female
Male
Preva
lence
Rate of
Treated
Illness
120.3
61.8
89.0
83.8
96.2
188.9
98.5
153.4
113.6
75.8
159.2
165.2
Treated
Illness as
Percentage
of Total
Illness
82.0
94.7
90.7
88.3
95.2
89.3
92.5
87.1
95.1
95.3
89.0
94.2
Preva
lence
Rale of
Illness
Preva
lence
Rale of
Treated
Illness
Treated
Illness as
Percentage
of Total
Illness
140.4
64.5
102.4
84.3
87.9
186.3
119.2
84.9
62.5
95.5
77.2
97.0
93.2
96.2
97.5
84.5
167.5
86.3
183.9
161.6
123.4
78.6
170.4
118.4
87.9
95.9
95.5
175.4
156.2
75.6
80.3
75.2
158.2
165.2
143.2
160.2
67.3
73.2
91.2
82.9
143.0
93.0
97.8
118.3
69.3
71.4
76.4
113.6
98.6
90.9
103.0
94.4
35.88
35.42
36.25
34.22
35.38
Note: All-India figures include the States/Union Territories of Goa, Meghalaya, Pondicherry and Chandigarh.
34.79
ALL-INDIA
Coefficient of
Variation %
129.0
71.2
175.6
74.7
82.9
89.2
146.2
90.2
88.4
81.5
91.5
89.9
88.5
92.7
92.3
I
I
A
S
5
i
91.7
91.5
88.9
937
96.0
91.7
1
3
* I
53
Tables
Table 3 : Prevalence Rate of Illness by Age and Sex
(Per '000 Population)
Female
Male
Age Croup
(Years)
Prevalence Prevalence Treated Prevalence Prevalence Treated
of Treated As % of
of Illness
of Treated As % of of Illness
Illness
Total
Illness
Total
Illness
Illness
RURAL
131.4
116.4
88.6
125.0
113.6
90.9
-
14
86.5
78.3
90.5
72.9
65.9
90.3
15 -
J59
99.5
86.5
86.9
110.4
97.3
88.2
>60
214.6
192.0
89.4
192.2
160.4
83.5
TOTAL
105.5
92.9
88.2
108.1
95.5
88.4
93.6
<S5
6
URBAN
143.5
134.6
93.8
122.7
115.0
-
14
76.0
70.4
92.7
67.2
60.9
90.7
15 -
59
90.2
83.0
92.0
110.5
100.2
90.5
^60
219.7
202.0
91.8
215.9
194.5
90.2
TOTAL
98.2
90.5
92.3
108.4
98.5
90.9
<,5
6
I
Household Survey of Health Care Utilisation and Expenditure
54
Table 4 : Prevalence Rate of Illness by Nature of Illness
for Adults and Children — Rural
(Per '(XX) Population)
Children
Adults
Total
Nature of Illness
Male
Female
Male
Female
Typhoid, Malaria, Cholera, Acute
Gastroenteritis, Jaundice
12.5
10.4
16.3
13.5
12.6
Mumps, Measles, Chickenpox,
T.B.
5.1
2.6
0.9
0.4
2.9
4.9
5.5
12.0
11.8
7.4
Serious Communicable Diseases
Acute Illness
Diarrhoeal diseases
Respiratory infection
9.1
9.3
15.0
16.6
11.3
Non-specific fever
30.0
31.5
39.3
32.8
32.5
Eye/Ear problems
6.8
7.0
3.7
2.2
5.6
Headache/Bodyache/Backache
4.1
9.0
1.6
1.6
4.8
Stomach problems — Indigestion,
Gas, Acidity, Constipation
6.9
11.5
3.1
3.8
7.2
Others
2.6
7.2
1.4
0.9
3.5
Accident and injuries
4.3
1.1
1.7
0.4
2.3
3.7
1.7
3.1
5.0
3.2
Aches and pains — Arthrities,
Rheumatism
2.2
2.0
0.0
0.0
1.4
Cardio vascular diseases — BP/
Heart ailments/Paralysis
4.5
3.1
0.4
0.0
2.6
Diabetes/Kidney problems
1.2
1.3
0.1
0.0
0.9
4.1
0.1
0.0
2.3
0.0
0.7
Skin diseases*
Chronic Illness
Breathing problems/ Asthama
2.8
Cancer
0.8
1.0
0.3
Weakncss/Dizziness/ Anaemia
2.7
5.1
0.6
1.0
2.8
Mental/Psychological disorder
0.8
0.2
0.0
0.1
0.4
Others
3.0
3.0
0.4
0.3
2.1
108.0
116.6
100.3
90.4
106.6
ALL ILLNESS
* Includes some chronic skin diseases also.
55
Tables
Table 5: Prevalence Rate of Illness by Nature of Illness
for Adults and Children — Urban
(Per'000 Population)
Children
Adults
Total
Nature of Illness
Male
Female
Male
Female
Typhoid, Malaria, Cholera, Acute
Gastroenteritis, Jaundice
11.4
11.2
15.7
11.3
11.8
M umps. Measles, Chickenpox,
T.B.
2.7
2.2
0.7
0.6
1.9
Serious Communicable Diseases
Acute Illness
Diarrhoeal diseases
5.0
6.8
11.7
10.3
7.6
Respiratory infection
10.1
12.3
16.6
17.0
12.8
Non-specific fever
21.7
26.1
32.2
29.8
25.9
Eye/Ear problems
4.9
6.1
3.8
3.3
4.9
Headache/Bod yache/Backache
4.3
7.5
1.1
2.4
4.6
Stomach problems — Indigestion,
Gas, Acidity, Constipation
5.7
8.8
2.9
2.3
5.8
Others
2.1
7.6
0.7
0.6
3.7
Accident and injuries
5.0
1.5
2.7
0.8
2.9
Skin diseases*
2.9
3.1
2.9
1.8
2.8
Aches and pains — Arthrities,
Rheumatism
2.3
3.1
0.0
0.0
1.9
Cardio vascular diseases — BP/
Heart ailments/Paralysis
9.0
7.7
0.3
1.0
6.1
0.1
2.2
Chronic Illness
Diabetes/Kidney problems
3.3
2.7
0.0
Breathing problems/Asthama
2.7
3.2
0.7
0.5
2.3
Cancer
0.5
0.7
0.1
0.0
0.4
Weakness/Dizziness/ Anaemia
3.4
4.6
1.3
1.3
3.2
Mental/Psychological disorder
0.8
1.3
0.2
0.0
0.8
Others
1.9
1.5
1.4
0.6
1.5
ALL ILLNESS
99.7
118.0
95.0
83.7
103.1
Includes some chronic skin diseases also.
Household Survey of Health Care Utilisation and Expenditure
56
Table 6: State-wise Prevalence Rate of Illness by Type of Illness
(Per 'OOP Population)
Urban
Rural
State
Serious Acute Chronic Total
Commit- Illness Illness
nicable
Diseases
Serious Acute Chronic Total
Commu- Illness Illness
nicable
Diseases
Andhra Pradesh
14.6
83.4
2&6
126.6
az
105.9
25.8
140.5
Assam
22.5
50.5
13.0
86.0
166
36.3
11.6
64.5
Bihar
18.3
72.0
7.7
98.0
17.3
74.4
11.0
102.6
Gujarat
21.0
49.6
5.2
75.8
1&8
528
127
84.3
Haryana
9.6
52.3
13.6
75.5
10.6
65.9
11.4
87.9
Himachal Pradesh
20.1
91.3
35.0
146.3
11.7
112.2
625
186.3
Karnataka
15.6
82.0
19.0
116.7
15.8
61.2
20.5
97.5
Kerala
18.8
111.4
64.7
194.9
67
125.6
49.6
184.0
Madhya Pradesh
9.6
99.0
6.8
115.4
17.2
89.8
164
123.4
Maharashtra
67
49.8
8.4
66.9
162
45.8
166
78.6
Orissa
30.3
140.7
20.6
191.5
25.9
116.0
265
170.4
Punjab
12.9
111.1
7.9
132.0
18.1
105.6
222
145.8
Rajasthan
21.8
826
9.3
113.8
23.7
115.0
17.4
156.1
Tamil Nadu
9.6
623
6.6
78.5
10.6
48.0
17.1
75.7
Uttar Pradesh
15.4
84.1
10.5
110.0
10.2
60.0
10.1
80.3
West Bengal
15.2
53.8
13.1
82.1
11.4
522
17.9
81.5
9.1
79.1
30.1
1163
Delhi
ALL-INDIA
15.6
77.9
13.2
106.7
14.0
70.6
18.4
103.0
Coefficient of
Variation %
35.69
33.49
90.38
34.29
35.25
36.89
63.19
35.88
* ’ • the States/Union Territories of Goa, Meghalaya,
Note: All-India figures 'include
Pondicherry, Chandigharh and Delhi rural.
I
I
57
Tables
Table 7: Prevalence Rate of Illness by Socio-Economic Characteristics of the
Household
(Per '(XX) Population)
Rural
Urban
Serious
Acute Chronic Total
Commu- Illness Illness
nicable
Diseases
Serious
Acute Chronic Total
Commu- Illness Illness
nicable
Diseases
Annual Household
Income (Rs.)
<18000
16.6
83.4
11.9
111.8
17.3
80.3
17.7
115.3
18001-54000
14.0
69.8
15.5
99.3
125
67.3
18.5
98.4
>54000
123
59.3
16.0
87.6
10.3
56.5
19.7
86.4
No Formal
Education
16.3
97.7
128
126.7
18.3
107.8
18.9
145.0
Primary
19.4
74.4
10.5
1043
18.4
74.9
16.8
1102
Higher Secondary 13.9
73.6
13.5
101.0
148
70.8
172
102.8
Graduate
15.2
78.9
17.3
111.4
104
63.5
208
947
Cultivator
3.9
75.4
11.7
100.9
126
620
13.5
88.1
Wage Earner
19.0
804
129
112.0
163
77.1
15.1
108.5
Salary Earner/
Professionals
141
83.5
16.9
114.4
13.3
69.8
18.8
102.0
Business
13.6
752
11.5
1003
13.4
69.0
17.3
99.7
Others
17.1
81.5
213
119.9
13.4
68.5
25.0
107.0
ALL
15.6
77.9
132
106.7
14.0
70.6
18.4
103.0
Highest Level of
Education in the
Household
Occupation of the
Household Head
58
Household Survey of Health Care Utilisation and Expenditure
Table 8 : State-wise Reported Number of Hospitalisation Cases by Sex
(Per '000 Population)
Rural
Urban
State
Male
Female
Total
Male
Female
Total
Andhra Pradesh
19.9
15.3
17.8
18.8
15.5
17.2
Assam
7.1
4.1
5.7
0.5
2.2
1.2
Bihar
7.2
5.7
6.5
6.1
10.9
8.3
Gujarat
3.4
6.5
4.7
10.4
4.5
7.6
Haryana
9.5
2.1
6.3
9.5
10.5
10.0
Himachal Pradesh
14.3
9.8
12.2
31.6
11.5
22.1
Karnataka
6.1
6.1
6.1
12.4
12.0
12.2
12.7
Kerala
26.4
29.0
27.7
18.4
7.1
Madhya Pradesh
5.7
3.4
4.7
3.0
5.3
4.1
Maharashtra
7.6
3.2
5.5
15.4
12.6
14.1
Orissa
4.0
10.3
6.9
12.2
7.8
10.2
Punjab
22.2
5.7
14.2
12.4
16.6
14.3
Rajasthan
12.3
4.2
8.7
12.6
5.7
9.5
Tamil Nadu
2.4
0.5
1.5
8.6
4.2
6.4
Uttar Pradesh
10.3
3.7
7.4
10.2
3.7
7.3
West Bengal
0.8
0.4
0.6
3.5
3.6
3.5
13.0
18.2
15.4
10.9
8.4
9.7
Delhi
ALL-INDIA
8.4
5.5
7.1
Note : All-India figures include the States/Union Territories of Goa, Meghalaya,
Pondicherry, Chandigarh and Delhi rural.
!
(
59
Tables
Table 9: State-wise Average Duration of Illness
(Communicable and Acute Illnesses Only)
(In Days)
Urban
Rural
State
Male
Female
Total
Male
Female
Total
Andhra Pradesh
10.6
8.6
9.8
8.5
8.1
8.3
Assam
14.6
10.2
12.7
12.5
17.8
14.2
Bihar
11.3
10.7
11.0
10.7
9.9
10.3
Gujarat
11.4
14.2
12.7
8.2
8.7
8.5
Haryana
10.4
8.2
9.5
10.3
7.9
8.9
Himachal Pradesh
15.9
10.7
13.2
11.5
17.0
14.7
Karnataka
17.7
12.5
15.2
10.0
10.9
10.4
11.4
Kerala
19.2
15.0
17.1
12.1
10.8
Madhya Pradesh
11.0
10.4
10.8
9.3
9.6
9.4
Maharashtra
11.0
9.5
10.2
11.8
12.3
12.0
Orissa
6.5
6.6
6.5
11.2
8.2
9.5
Punjab
14.0
12.2
13.2
9.2
9.5
9.3
9.5
11.4
9.4
7.2
8.3
10.3
11.2
Rajasthan
13.0
Tamil Nadu
10.2
9.3
9.8
11.9
Uttar Pradesh
8.6
7.3
8.0
8.9
7.8
8.4
West Bengal
13.0
15.3
14.2
15.3
14.2
14.7
11.8
10.7
11.2
Delhi
10.1
9.8
11.4
10.1
10.8
10.4
ALL-INDIA
Note : All-India figures includes the States/Union Territories of Goaz Meghalaya,
Pondicharry, Chandigarh and Delhi rural.
1
Household Survey of Health Care Utilisation and Expenditure
60
Table 10 : Percentage Distribution of Untreated Illnesses
by Duration of Illness
Urban
Rural
Duration
Male
Female
Total
Male
Female
Total
1 Day
8.0
6.3
7.2
13.2
15.2
14.3
2-3 Days
44.3
43.3
43.8
38.2
39.9
39.1
4-7 Days
23.4
23.2
23.3
31.4
27.0
29.0
> 7 Days
24.4
27.3
25.7
17.1
18.0
17.6
ALL
100.0
100.0
100.0
100.0
100.0
100.0
Table 11: Percentage Distribution of Untreated Illnesses by Reasons
for No Treatment
Urban
Rural
Reasons
4
Illness not consi
dered serious enough
Male
Female
Total
Male
Female
Total
63.3
69.2
66.0
79.5
80.8
80.2
No medical facility
near by
11.5
15.8
13.4
1.6
1.7
1.6
Financial constraints
21.7
11.1
16.8
8.6
11.6
10.2
Time constraints
0.0
0.2
0.1
0.3
1.0
0.7
10.0
4.9
7.3
100.0
100.0
100.0
Others
3.5
3.7
3.7
ALL
100.0
100.0
100.0
I
/.
61
Tables
Table 12 : Percentage Distribution of Untreated Illnesses by
Socio-Economic Characteristics of the Household
Urban
Rural
Male
Female
Total
Male
Female
Total
£18,000
13.2
12.3
12.8
8.4
11.1
9.7
18,001-54,000
9.3
10.3
9.8
7.8
8.0
7.9
>54,000
8.3
8.0
8.2
4.1
6.6
5.3
19.3
18.9
19.1
8.3
14.3
11.4
10.5
10.1
Annual Household
Income (Rs.)
Highest Level of Education
in the Household
No formal
education
Primary
14.6
12.2
13.5
9.9
Higher Secondary
9.4
9.1
9.2
6.7
8.6
7.7
Graduate and above
7.4
9.6
8.4
8.2
8.3
8.3
Cultivators
13.3
12.0
12.7
8.6
9.3
9.2
Wage earner
12.7
14.5
13.2
8.4
11.5
9.9
Occupation of the
Household Head
Salary earner/
Professional
9.8
6.1
7.9
8.4
8.8
8.6
Business
12.1
11.4
11.7
6.4
8.0
7.2
Others
5.3
7.0
6.1
6.3
7.6
6.9
ALL
11.9
11.6
11.8
7.6
9.1
8.4
62
Household Survey of Health Care Utilisation and Expenditure
Table 13 : Distribution of Non-Hospitalised Illness Episodes by
Type of Treatment
(Percentage)
Adults
Children
Type of Treatment
Male Female Male Female
Total
Male Female
Total
RURAL
Government Hospital
20.1
19.8
11.4
12.3
171
17.6
17.4
PHC/CHC
18.9
20.5
21.9
22.0
19.9
21.0
20.4
A NM / M PHW/Anganwadi 2.7
Private Hospital/
Nursing Home
6.3
Private Practitioner
46.1
3.8
4.3
7.0
3.2
4.7
3.9
7.0
3.8
Z7
5.5
5.7
5.6
43.4
51.5
47.3
47.9
44.5
46.3
Charitable Trust
1.0
0.7
1.3
0.0
1.1
0.5
Medical Shop
0.8
2.9
3.1
2.1
5.1
2.6
3.7
3.1
Faith Healer/
Religious Person
0.2
0.1
1.5
0.8
0.7
0.3
0.5
Home Remedy
1.8
1.6
2.2
2.8
Z0
ZO
ZO
100.0 100.0
100.0
100.0
100.0 100.0
100.0
ALL
URBAN
Government Hospital
27.7
26.5
21.0
21.4
25.6
25.3
25.5
Government / Municipal
Dispensaries
8.5
7.3
10.4
9.9
9.1
7.9
8.5
Private Hospital /
Nursing Home
10.9
11.7
7.4
6.9
9.8
10.7
10.2
Private Practitioner
45.5
47.5
54.1
53.9
48.2
49.0
48.6
Charitable Trust
1.0
1.3
0.4
0.9
0.8
1.2
Medical Shop
1.0
5.5
4.6
5.7
6.2
5.5
4.9
Faith Healer /
Religious Persons
5.2
0.3
0.2
0.2
0.3
0.3
0.2
0.2
Home Remedy
0.6
0.9
0.8
0.5
0.7
0.8
0.8
100.0 100.0
100.0
100.0
100.0 100.0
100.0
ALL
Table 14 : State-wise Distribution of Non-Hospitalised Illness Episodes by Type of Treatment for Male and Female - Rural
(Percentages)
Female
Male
Faith
Healer/
Religi
ous
Person
Home
Remedy
Total
Public
Facility
Private
Facility
Medical
Shop
Faith
Healer/
Religi
ous
Person
Home
Remedy
Total
State
Public Private Medical
Facility Facility Shop
Andhra Pradesh
Assam
Bihar
Gujarat
Haryana
Himachal Pradesh
Karnataka
Kerala
Madhya Pradesh
Maharashtra
Orissa
Punjab
Rajasthan
Tamil Nadu
Uttar Pradesh
West Bengal
41.5
66.8
34.8
36.8
36.9
43.6
65.0
25.9
31.1
46.1
68.6
42.2
67.5
41.9
28.2
18.5
57.9
29.3
49.5
62.2
54.2
56.4
35.0
71.7
65.0
51.3
14.4
57.8
30.7
51.7
67.2
80.2
0.6
2.3
9.6
0.0
4.2
0.0
0.0
0.0
1.7
0.0
2.2
0.0
1.6
3.2
4.3
0.0
0.0
0.0
1.4
1.0
0.0
0.0
0.0
0.0
0.0
0.0
5.4
0.0
0.0
0.0
0.3
1.3
0.0
1.6
4.7
0.0
4.7
0.0
0.0
2.4
2.2
2.5
9.3
0.0
0.3
3.2
0.0
0.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
32.6
57.5
39.0
36.7
40.7
56.5
54.6
37.2
37.0
41.6
72.1
42.6
65.2
57.1
33.8
21.2
60.7
42.0
46.0
59.8
58.6
40.0
45.2
61.2
58.4
55.0
11.3
57.4
30.1
35.3
62.9
74.6
6.7
0.6
9.5
1.2
0.0
0.8
0.2
1.6
3.0
0.0
8.1
0.0
2.0
3.5
2.8
4.3
0.0
0.0
0.0
0.0
0.6
0.0
0.0
0.0
0.7
0.0
0.0
0.0
0.0
4.1
0.0
0.0
0.0
0.0
5.7
2.3
0.0
2.7
0.0
0.0
0.9
3.4
8.5
0.0
2.7
0.0
0.5
0.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
_________ 40.2
54.5
2.6
0.7
2.0
100.0
43.3
50.8
3.7
03
2.0
100.0
ALL-IN DI A
S1
£
Note : AU-India figures include the States/Union Territories of Goa, Meghalaya, Pondicherry, Chandigarh and Delhi.
•
’ll
Table 15 : State-wise Distribution of Non-Hospitalised Illness
Episodes by Type of Treatment for Male and Female - Urban
____________ _____________________________
Male
State
Andhra Pradesh
Assam
Bihar
Gujarat
Haryana
Himachal Pradesh
Karnataka
Kerala
Madhya Pradesh
Maharashtra
Orissa
Punjab
Rajasthan
Tamil Nadu
Uttar Pradesh
West Bengal
Delhi
ALL-INDIA
Female
Public Private
Facility Facility
Medical Faith
Home
Total
Shop
Healer/ Remedy
Religi
ous
Person
Public Private
Facility Facility
Medical Faith
Home
Total
Shop
Healer/ Remedy
Religi
ous
Person
37.3
50.0
26.7
38.7
34.7
60.8
43.6
43.5
32.2
30.0
41.1
18.2
57.0
41.2
19.3
33.8
21.5
10.4
3.3
11.8
2.5
4.2
0.0
12.8
4.7
4.3
2.0
16.7
1.5
6.8
3.3
2.6
2.4
2.6
30.1
49.0
25.7
31.6
40.7
63.6
47.7
41.4
35.6
35.1
42.5
28.8
46.5
32.4
16.1
27.3
26.4
5.4
0.0
10.7
2.7
0.0
0.0
2.0
5.6
3.3
1.7
8.9
1.4
14.3
5.9
5.7
3.0
1.6
0.0
0.0
0.0
0.0
0.6
0.0
0.0
0.0
0.0
0.7
0.0
0.0
1.0
0.2
0.7
0.0
0.0
1.7
0.0
0.0
2.5
0.0
0.0
0.0
0.5
0.5
0.0
0.6
0.0
0.0
1.2
1.3
1.1
1.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
5.0
0.2
0.8
100.0
52.1
46.7
60.1
57.7
54.2
39.2
43.6
51.8
61.7
68.0
41.5
78.7
35.1
51.7
78.1
63.7
73.2
£
( Percentage)
0.1
0.0
0.9
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
1.2
0.0
0.0
2.6
0.1
0.0
0.6
1.1
4.7
0.0
0.0
0.0
1.8
0.0
0.7
1.7
1.2
2.5
0.0
0.0
0.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
62.8
51.0
63.6
63.2
58.6
36.5
50.3
52.5
60.6
62.4
48.0
69.8
38.2
60.2
76.2
68.5
71.1
34.7
589
55
0-3
0-7
100.0
33.2
60.9
100.0
Note : All-India figures include die State/Union Territores of Goa, Meghalaya, Pondicherry, Chandigarh.
I
I
tn
£■
a-
P
C
Si
g3
f
w.-
E
*
I
Table 16: Distribution of Non-Hospitalised Illness Episodes by Type of Treatment and by Nature of Illness
(Percentages)
Male
Nature of
Illness
Female
Public
Private Medical Faith
Facility Facility Shop
Healer/
Religious
Person
Home
Total
Remedy
Public
Private
Facility Facility
Medical Faith
Shop
Healer/
Religious
Person
Home
Total
Remedy
RURAL
Serious Communicable
Illness
Acute Illness
Chronic Illness
Accident/ Injuries
43.8
38.0
46.2
60.3
49.8
56.8
51.0
31.6
3.5
0.9
ALL ILLNESS
40.2
54.5
2.6
3.7
0.1
2.7
1.7
1.9
8.1
100.0
100.0
100.0
100.0
53.8
40.9
45.4
70.1
43.0
52.0
53.1
29.9
4.7
1.0
1.9
0.1
0.5
1.4
2.3
100.0
100.0
100.0
100.0
0.7
2.0
100.0
43.3
50.8
3.6
0.3
2.0
100.0
0.7
0.9
0.6
0.7
100.0
100.0
100.0
100.0
42.3
30.5
37.7
33.9
55.7
62.3
58.8
54.7
0.9
6.6
1.3
0.6
0.1
0.9
0.5
0.5
1.3
11.4
100.00
100.00
100.00
100.00
0.3
0.7
100.0
33.2
60.9
0.5
0.2
0.8
100.00
URBAN
Serious Communicable
Illness
Acute Illness
Chronic Illness
Accident/ Injuries
39.9
32.3
37.4
49.0
56.9
59.7
58.4
50.7
1.4
7.4
2.9
0.3
ALL ILLNESS
34.7
58.8
5.5
1.0
S'
Table 17: Distribution of Non-Hospitalised Illness Episodes by Type of Treatment
and Socio-Economic Characteristics of the Household
(Percentages)
Rural
Urban
Public
Private Medical Others
Facility Facility Shop
Total
Public
Private Medical Others
Facility Facility Shop
£18,000
18,001-54,000
>54,000
43.4
39.8
27.6
50.9
54.5
69.3
2.9
3.8
2.0
2.8
1.9
1.1
100.0
100.0
100.0
41.7
30.5
20.7
52.3
62.8
74.6
5.0
5.7
4.0
1.0
1.0
0.7
100.0
100.0
100.0
Highest Level of Education
in the Household
No Formal Education
Primary
Higher Secondary
Graduate and Above
48.5
48.5
37.8
42.6
40.2
50.8
57.6
52.0
4.9
2.6
2.7
3.3
6.4
1.0
1.9
2.1
100.0
100.0
100.0
100.0
44.5
44.2
35.3
24.9
50.3
48.9
59.2
67.6
2.8
5.8
4.6
6.7
2.4
1.2
0.8
0.8
100.0
100.0
100.0
100.0
Total
Annual Household
Income (Rs.)
Occupation of the
Household Head
II
tn
5*
p
3
C
Cultivator
Wage Earner
Salary Earner/Professional
Business
Others
39.8
43.2
42.3
42.3
45.4
54.5
50.8
52.1
52.3
50.9
3.8
1.9
3.5
4.4
2.1
1.8
4.2
2.2
0.9
1.7
100.0
100.0
100.0
100.0
100.0
34.6
42.5
29.8
28.6
39.6
60.6
51.7
62.7
66.0
55.2
4.0
4.3
6.5
4.9
4.5
1.6
1.6
1.0
0.5
0.7
100.0
100.0
100.0
100.0
100.0
TOTAL —ALL
41.7
52.7
3.1
2.5
100.0
33.9
59.9
5.2
1.0
100.0
I
§.
1
§
67
Tables
Table 18 Reasons for Choice of Treatment by Type of Treatment for
Non-Hospitalised Illness Episodes
(Percentages)
Type of Treatment
Inexpen
sive/
Free
No Other Time
Suit
Facility
Near By able
Close
By
Good
Repu
tation
Others
Total
RURAL
Government Hospital
74.6
5.5
6.5
1.3
10.5
4.1
1.6
1.3
100.0
100.0
68.7
15.3
9.3
1.4
63.3
17.7
6.2
1.0
12.0
0.0
100.0
Anganwadi
Private Doctor/
Nursing Home
4.2
35.5
18.1
5.6
23.0
40.8
3.6
15.7
1.6
15.4
100.0
100.0
Medical Shop
35.0
1.5
Faith Healer/
Religious Person
18.7
0.0
4.8
2.1
39.2
1.3
27.3
7.4
55.0
20.1
100.0
100.0
Home Remedy
19.5
4.8
33.2
24.8
13.5
4.2
21.8
2.5
100.0
ALL
PHC/CHC
anm/mphw/
URBAN
77.0
9.7
3.0
1.1
7.8
1.3
100.0
Government/Municipal
68.1
Dispensaries
15.9
4.2
2.9
7.3
1.7
100.0
Private Doctor/
Nursing Home
5.4
33.9
5.3
7.4
15.4
37.4
2.8
11.7
1.6
24.3
100.0
100.0
Medical Shop
46.5
8.5
Faith Healer/
Religious Person
11.3
0.0
3.2
0.0
46.0
12.7
2.2
1.6
85.6
37.5
100.0
100.0
Home Remedy
0.0
0.0
29.8
26.2
4.5
5.6
30.9
3.2
100.0
ALL
Government Hospital
68
Household Survey of Health Care Utilisation and Expenditure
Table 19 : Average Distance Travelled for Seeking Out-Patient
Treatment by Type of Treatment
(In Kms.)
Adult
Children
Total
Type of Treatment
Male
Female
Male
Female
RURAL
Government Hospital
12.4
8.9
8.4
6.8
10.0
PHC/CHC
4.6
2.8
3.1
4.1
3.6
ANM/MPHW/Anganwadi
3.1
2.1
1.5
0.2
1.7
Private Hospital/
Nursing Home
13.3
15.7
4.0
4.0
12.6
Private Practitioner
5.5
5.8
4.9
4.0
5.3
Medical Shop
0.7
2.7
0.9
2.4
1.8
Faith Healer/Religious Person
1.6
2.7
1.1
4.2
2.0
ALL
7.0
6.2
4.6
4.0
5.9
URBAN
Government Hospital
3.5
3.2
1.6
2.5
3.1
Dispensaries
2.1
1.9
2.1
1.0
1.9
Private Hospital/
Nursing Home
2.8
3.7
1.4
1.5
2.9
Private Practitioner
1.9
2.0
1.7
1.3
1.8
Medical Shop
0.6
0.3
0.2
0.3
0.4
Faitfi Healer/Religious Person
0.0
5.6
0.0
0.0
1.8
ALL
2.4
2.4
1.6
1.5
2.2
Govemment/M unicipal
69
Tables
Table 20 : State-wise Distribution of Hospitalisation
Cases by Type of Treatment
(Percentages)
Urban
Rural
State
Andhra Pradesh
Assam
Public
Private
Total
100.0
56.1
43.9
100.0
100.0
100.0
0.0
100.0
63.1
37.0
100.0
Public
Private
Total
30.$
69.4
100.0
0.0
Bihar
59.3
40.7
100.0
Gujarat
32.2
67.8
100.0
27.2
72.8
100.0
Haryana
73.5
26.5
100.0
65.9
34.1
100.0
Himachal Pradesh
100.0
0.0
100.0
69.7
30.3
100.0
Karnataka
61.1
38.9
100.0
57.8
42.2
100.0
Kerala
64.7
35.3
100.0
64.2
35.8
100.0
Madhya Pradesh
72.2
27.8
100.0
72.7
27.3
100.0
Maharashtra
30.5
69.5
100.0
58.8
41.2
100.0
Orissa
98.1
1.9
100.0
68.7
31.3
100.0
Punjab
95.3
4.7
100.0
67.2
32.8
100.0
Rajasthan
78.1
21.9
100.0
88.8
11.2
100.0
Tamil Nadu
14.6
85.4
100.0
49.6
50.4
100.0
35.1
100.0
59.7
40.3
100.0
76.8
232
100.0
69.8
30.2
100.0
60.1
39.9
100.0
Uttar Pradesh
West Bengal
64.9
100.0
0.0
100.0
62.0
38.0
100.0
Delhi
ALL-INDIA
Note: All - India figures include the States/Union Territories of Goa, Meghalaya, Pondicherry,
Chandigarh and rural Delhi.
MM -
70
Household Survey of Health Care Utilisation and Expenditure
I
Table 21: Reasons for Choice of Treatment by Type of Treatment
for Hospitalisation Cases
Urban
Rural
Reasons
Public
Private
Total
Public
Private
Total
Inexpensive/ Free
53.9
5.0
35.3
77.7
6.1
49.2
Close By
1.7
12.7
5.9
6.3
15.1
10.0
No Other Facility
Near By
10.9
20.0
14.4
3.5
12.3
7.0
Timing Suitable
0.8
4.4
2.2
1.1
9.2
4.3
Good Reputation
29.0
50.8
37.3
10.0
55.4
28.1
Others
3.7
7.1
5.0
1.4
1.9
1.6
TOTAL
100.0
100.0
100.0
100.0
100.0
100.0
I
71
Tables
Table 22 : Average Distance Travelled for Seeking In-Patient
Treatment by Type of Treatment
(Kms.)
Urban
Rural
State
Public
Private Total
Public
Private
Total
Andhra Pradesh
13.9
12.8
13.1
2.3
2.4
2.3
Assam
6.7
0.0
6.7
5.3
0.0
5.3
Bihar
8.7
11.6
9.9
7.1
3.2
5.6
Gujarat
13.6
24.0
19.5
1.8
5.0
4.1
Haryana
15.2
22.2
17.1
2.7
2.2
2.5
Himachal Pradesh
35.0
0.0
35.0
3.3
5.6
4.0
Karnataka
22.5
15.1
19.6
7.1
11.0
8.7
Kerala
26.3
19.5
23.9
8.1
3.4
6.4
Madhya Pradesh
40.3
73.8
50.8
6.4
6.6
6.4
Maharashtra
2.8
10.3
8.4
5.9
6.0
5.9
Orissa
7.8
2.0
7.7
2.5
5.5
3.5
Punjab
9.0
15.0
9.3
3.5
5.4
4.1
Rajasthan
21.6
42.8
26.0
3.6
4.3
3.7
Tamil Nadu
50.0
21.4
25.6
7.9
9.2
8.6
Uttar Pradesh
21.8
13.4
19.0
8.4
6.0
7.5
West Bengal
9.5
0.0
9.5
1.9
4.4
2.5
10.6
15.4
12.0
5.7
6.2
5.9
Delhi
ALUNDIA
18.6
18.7
18.7
Note : All-India figures included the States/Union Territories of Goa, Meghalaya,
Pondicherry, Chandigarh and rural Delhi.
72
Household Survey of Health Care Utilisation and Expenditure
Table 23 : Distribution of Delivery/Abortion Cases by
Type of Health Care
(Percentage)
Delivery
A bort ion/M is carriage
Type of Health Care
Rural
Urban
Rural
Urban
Home Delivery
23.4
11.2
18.0
1.7
Public
61.6
63.0
40.2
30.6
Private
15.0
25.9
41.8
67.7
TOTAL
100.0
100.0
100.0
100.0
Table 24: Distribution of Immunization Cases by
Type of Health Facility
Rural
Urban
Type of Health Facility
\
Boys
Girls
Total
Boys
Girls
Total
Govt Hospital
12.0
13.1
12.5
48.1
47.0
47.6
PHC/CHC
55.5
45.4
50.9
Sub-Centre
25.9
31.2
28.3
38.7
41.8
42.1
Gov t/M unicipal
Dispensary
Private Hospital/
Nursing Home
TOTAL
6.6
10.3
8.3
13.2
11.2
12.3
100.0
100.0
100.0
100.0
100.0
100.0
f
Tables
73
Table 25: State-wiae Distribution of Non-Hospitalised IllneM
Episodes by System of Medical Treatment — Rural
(Percentages)
I
Rituals
Others
0.6
0.0
0.9
100.0
0.9
0.0
0.0
0.0
100.0
6.7
0.0
0.0
0.8
0.0
100.0
5.9
1.6
0.0
0.0
0.6
0.0
100.0
86.2
0.0
8.3
0.0
5.2
0.3
0.0
100.0
Himachal Pradesh 93.5
0.0
3.1
0.0
3.4
0.0
0.0
100.0
Karnataka
95.8
2.0
0.0
0.0
2.1
0.0
0.1
100.0
Kerala
84.7
4.4
5.8
0.0
5.1
0.0
0.0
100.0
Madhya Pradesh
94.5
0.7
2.8
0.4
0.9
0.7
0.0
100.0
Maharashtra
82.7
0.4
11.3
0.0
5.5
0.0
0.0
100.0
Orissa
84.6
03
10.8
0.4
0.1
2.5
1.2
100.0
Punjab
97.3
1.4
0.0
0.0
1.4
0.0
0.0
100.0
0.0
100.0
Unani Any
Combi
nation
State
Allo Homeo- Ayur
pathy pathy
veda/
Siddha
Andhra Pradesh
96.6
0.9
0.0
0.9
Assam
85.7
9.9
3.4
Bihar
90.2
2.4
Gujarat
91.9
Haryana
All
Rajasthan
94.3
1.4
3.7
0.0
0.6
0.0
Tamil Nadu
88.7
2.0
2.0
0.0
2.0
2.0
3.3
100.0
Uttar Pradesh
92.6
2.2
1.5
0.0
3.5
0.2
0.0
100.0
West Bengal
90.0
3.6
0.7
0.0
2.6
0.8
2.4
100.0
ALL-INDIA
90.9
2.0
3.8
03
2.0
0.6
0.5
100.0
Note : All-India figures include the States/Union Territories of Goa, Meghalaya,
Pondicherry, Chandigarh and Delhi.
7\
Household Survey of Health Care Utilisation and Expenditure
Table 26: State-wise Distribution of Non-Hospitalised Illness
Episodes by System of Medical Treatment — Urban
(Percentages)
J
Others
All
0.1
0.5
100.0
0.0
0.0
0.0
100.0
1.0
0.6
0.0
100.0
100.0
Unani Any
Rituals
Combi
nation
State
Allo- Homeo- Ayurvedaf
pathy pathy
Siddha
Andhra Pradesh
96.9
1.0
1.0
0.0
0.5
Assam
90.8
7.3
1.8
0.0
Bihar
90.1
7.8
0.6
0.0
Gujarat
91.2
2.5
5.2
0.0
1.2
0.0
0.0
Haryana
89.9
0.0
4.1
0.0
6.1
0.0
0.0
100.0
Himachal Pradesh 97.2
0.0
2.8
0.0
0.0
0.0
0.0
100.0
Karnataka
95.4
2.0
1.2
0.0
1.4
0.0
0.0
100.0
Kerala
91.0
4.8
2.8
0.0
1.4
0.0
0.0
100.0
Madhya Pradesh
95.8
0.9
2.1
0.8
0.4
0.0
0.0
100.0
Maharashtra
92.6
1.5
2.9
0.0
2.3
0.4
0.4
100.0
Orissa
89.2
5.6
5.2
0.0
0.0
0.0
0.0
100.0
Punjab
94.9
0.7
2.3
0.0
2.1
0.0
0.0
100.0
Rajasthan
97.7
0.1
1.6
0.0
0.1
0.5
0.0
100.0
Tamil Nadu
96.1
0.6
1.3
0.0
0.6
0.7
0.6
100.0
Uttar Pradesh
90.4
4.7
2.1
0.0
2.2
0.3
0.3
100.0
West Bengal
83.5
11.3
1.6
0.0
1.5
0.0
0.2
100.0
Delhi
96.8
0.8
1.2
0.0
0.0
1.1
0.0
100.0
ALL-INDIA
3.2
2.9
2.2
0.1
1.2
0.3
0.2
100.0
Note : All-India figures include the States/Union Territories of Goa, Meghalaya,
Pondicherry, Chandigarh.
75
Tables
Table 27: State-wise Average Expenditure Per Illneae Episode for Adults
and Children by Sex for Non-Hospitalised Illnesses — Rural
(In Rupees)
Adults
Children
Total
State
Male
Female
Male
Female
Andhra Pradesh
166.67
214.40
73.40
7434
171.81
Assam
91.70
60.92
32.01
29.68
66.04
Bihar
160.52
13821
38.71
61.64
114.73
Gujarat
188.42
182.45
47.35
64.59
149.14
Haryana
130.36
135.74
87.52
35.16
109.07
Himachal Pradesh
135.48
103.62
119.42
9732
115.42
Karnataka
134.71
132.91
174.17
39.55
13027
Kerala
21032
153.54
19120
65.48
171.52
Madhya Pradesh
85.56
74.92
42.40
36.65
64.48
Maharashtra
14622
107.61
44.82
2623
90.71
58.43
Orissa
76.92
6536
39.12
29.24
Punjab
79.75
46.91
85.51
7636 |
70.46
Rajasthan
59.92
5731
97.64
4120
59.91
Tamil Nadu
45.86
52.42
41.75
42.78
45.90
Uttar Pradesh
72.98
70.77
43.68
32.11
62.06
West Bengal
7628
90.65
88.11
5833
79.74
ALL-INDIA
113.65
101.43
60.06
44.79
90.48
I
Note : All-India figures include the States/Union Territories of Goa, Meghalaya,
Pondicherry, Chandigarh and Delhi ruraL
I*
v
I
t
76
Household Survey of Health Care Utilisation and Expenditure
Table 28 : State-wise Average Expenditure Per Illness Episode for Adults
and Children by Sex for Non-Hospitalised Illnesses — Urban
(In Rupees)
Children
Adults
State
I
Total
Male
Female
Male
Female
Andhra Pradesh
136.35
138.72
75.48
106.65
12625
Assam
84.70
119.90
130.82
86.99
106.52
Bihar
149.14
196.78
142.91
91.73
157.25
Gujarat
117.01
124.86
85.81
80.29
111.00
Haryana
195.71
168.45
135.34
44.26
154.14
Himachal Pradesh
64.29
116.98
74.99
59.96
90.93
Karnataka
178.14
157.77
65.76
46.87
145.56
Kerala
108.28
78.19
47.44
41.09
80.57
Madhya Pradesh
75.35
75.29
60.45
48.19
68.82
Maharashtra
174.05
152.24
65.30
59.63
136.60
Orissa
154.60
153.40
91.01
107.03
136.75
Punjab
91.11
143.34
116.95
19.74
116.84
Rajasthan
119.97
90.40
45.06
39.72
87.95
Tamil Nadu
118.27
79.08
4125
33.81
8037
Uttar Pradesh
127.68
112.01
82.15
58.43
100.50
West Bengal
159.89
137.68
88.47
61.94
13233
Delhi
179.25
172.32
146.17
68.05
161.15
ALL-INDIA
134.08
126.40
77.18
60.71
113.93
Note : All-India figures include the States/Union Territories of Goa, Meghalaya,
Pondicherry, Chandigarh.
i
1-
Tables
77
Table 29 : State-wise Average Expenditure Per Illness Episode by Type
of Treatment for Non-Hospitalised Illnesses — Rural
(In Rupees)
State
Public
Private
Medical
Shop
Faith
Healer/
Religious
Person
Home
Remedy
Total
Andhra Pradesh
95.04
227.34
85.87
Assam
45.30
106.51
45.78
Bihar
66.74
183.04
14.21
40.00
Gujarat
78.03
196.26
100.00
100.00
149.14
Haryana
49.29
159.31
18.00
101.00
109.07
Himachal Pradesh
124.75
109.96
10.00
115.42
Karnataka
45.48
274.41
20.00
130.27
Kerala
30.19
240.64
175.00
171.52
Madhya Pradesh
36.16
83.68
15.35
Maharashtra
52.84
126.97
Orissa
59.76
115.60
Punjab
62.42
76.37
Rajasthan
30.81
128.76
15.66
Tamil Nadu
33.36
61.87
20.00
91.43
45.90
Uttar Pradesh
26.61
81.82
13.51
20.00
62.06
West Bengal
72.57
82.49
20.00
201.00
79.74
ALL-INDIA
49.08
130.06
21.24
65.82
9.69
171.81
66.04
19.16
191.24
16.00
114.73
64.48
2.27
90.71
7.65
85.43
4.80
5 9.91
70.46
8.00
90.48
Note : All-India figures include the States/Union Territories of Goa, Meghalaya,
Pondicherry, Chandigarh and Delhi rural.
II
i I
H
II
78
Household Survey of Health Care Utilisation and Expenditure
Table 30: State-wise Average Expenditure Per Illness Episode
by Type of Treatment for Non-Hospitalised Illnesses — Urban
(In Rupees)
State
I
Public Private
Medical
Shop
Faith
Healer/
Religious
Person
Home Total
Remedy
15.00
0.80
Andhra Pradesh
49.13
188.43
23.12
Assam
87.62
129.02
3227
Bihar
66.79
22023
34.86
Gujarat
79.93
138.90
25.70
Haryana
52.59
212.25
35.13
154.14
Himachal Pradesh
62.51
140.53
Karnataka
63.63
240.70
29.58
145.56
Kerala
59.15
104.61
17.03
80.57
Madhya Pradesh
4323
87.78
14.91
Maharashtra
74.10
169.85
55.33
Orissa
83.10
219.18
3320
Punjab
9223
12527
89.91
Rajasthan
60.18
150.77
6.60
180.00
Tamil Nadu
26.98
124.12
12.02
22.85
17.00
8037
Uttar Pradesh
76.99
115.15
1835
3820
37.49
100.50
West Bengal
8122
16123
2632
15.00
13233
Delhi
99.18
188.43
15.51
100.00
ALL-INDIA
62.90
152.19
23.02
7721
12625
106.52
50.00
15725
1334
110.00
90.93
132
50.00
68.82
136.60
10.42
136.75
116.84
87.95
161.15
14.95
113.93
Note : All-India figures include the States/Union Territories of Goa, Meghalaya,
Pondicherry and Chandigrah.
K.
X
79
Tables
Table 31: State-wise Average Expenditure Per Illness Episode by
Duration of Illness for Non-Hospitalised Illnesses — Rural
(In Rupees)
^5
Days
6-10
Days
11-20
Days
21-30
Days
>30
Days
Total
Andhra Pradesh
58.76
13036
169.90
255.71
789.35
151.02
Assam
23.80
30.59
89.84
105.46
284.11
64.71
Bihar
48.93
78.07
137.59
201.40
577.73
111.48
Gujarat
46.71
7637
181.00
451.33
420.00
148.56
Haryana
55.15
108.62
223.42
201.88
151.80
107.18
Himachal Pradesh
27.83
45.90
100.66
240.06
150.00
101.93
Karnataka
33.06
41.88
175.95
106.37
411.00
119.48
Kerala
44.92
36.01
52.77
171.32
233.74
90.41
Madhya Pradesh
17.21
'31.00
84.70
169.16
200.55
55.05
Maharashtra
15.26
67.69
107.42
176.45
357.79
7833
Orissa
32.08
72.14
85.60
95.46
396.13
58.12
Punjab
40.01
44.57
86.96
233.59
125.54
64.58
Rajasthan
27.28
41.07
112.94
278.96
103.16
57.83
Tamil Nadu
18.47
40.29
58.43
83.07
154.06
44.86
Uttar Pradesh
28.60
50.36
100.50
192.47
377.59
57.16
West Bengal
25.82
51.97
82.51
100.92
249.47
76.78
ALL-INDIA
32.71
56.59
109.95
176.02
346.93
79.32
State
* J
Note : All-India figures include the State/Union Territories of Goa, Meghalaya,
Pondicherry, Chandigarh and Delhi.
I i
II
Household Survey of Health Care Utilisation and Expenditure
80
Table 32: State-wise Average Expenditure Per Illness Episode by Duration
of Illness for Non-Hospitalised Illnesses - Urban
(In Rupees)
I
State
^5
Days
6-10
Days
11-20
Days
21-30
Days
>30
Days
Total
Andhra Pradesh
53.02
109.49
250.40
280.58
43424
119.37
Assam
44.19
61.34
112.91
181.27
162.50
102.34
Bihar
61.57
147.54
230.57
254.45
716.31
146.43
Gujarat
45.71
101.08
228.84
182.41
Haryana
100.62
122.30
326.28
176.86
1121.90
153.67
Himachal Pradesh
24.88
31.66
141.70
150.95
200.00
92.55
Karnataka
46.21
6527
148.89
301.91
512.44
114.10
Kerala
27.81
40.25
76.14
106.95
92.81
62.77
Madhya Pradesh
2138
38.22
74.43
131.84
280.59
50.43
98.22
Maharashtra
49.26
103.53
186.47
297.53
378.88
126.58
Orissa
56.73
108.58
13723
303.34
32133
115.89
Punjab
43.21
49.98
138.66
416.46
632.96
110.58
Rajasthan
35.00
94.09
152.83
141.60
44937
83.43
Tamil Nadu
28.87
61.89
114.56
165.98
165.31
74.58
Uttar Pradesh
41.08
7821
167.47
302.88
646.51
93.98
West Bengal
35.15
52.48
89.98
18039
438.46
127.99
Delhi
88.19
121.77
27026
244.84
207.79
14821
ALL-INDIA
45.27
81.62
163.18
217.34
385.45
102.51
Note : All-India figures include the States/Union Territories of Goa, Meghalaya,
Pondicherry and Chandigarh.
81
Tables
Table 33 : Average Expenditure Per Illness Episode by Nature of
Illness for Non-Hospitalised Illnesses
Children
Adults
Total
Nature
Male
Female
Total
Male
Female Total
RURAL
Serious Communi
204.18
cable Disease
180.83
194.67
154.36
84.65 126.46
171.56
Acute Illness
67.67
66.05
66.84
36.72
36.13
36.46
56.05
Chronic Illness
220.02
198.56
208.81
250.07 114.46 178.75
207.77
Accident/ Injury
119.16
131.28
122.68
140.40
109.32 13321
124.91
ALL
113.65
101.43
107.61
60.06
44.79
53.45
90.48
198.39
URBAN
Serious Communi
219.17
cable Disease
234.45
226.36
150.56
104.70 133.75
73.33
86.11
80.38
54.91
50.78
Acute Illness
Chronic Illness
212.42
196.60
53.11
71.83
204.49
185.40
108.43 148.62
•201.46
287.59
70.24
113.93
Accident/ Injury
412.40
169.17
330.61
137.79 300.28 146.51
ALL
134.08
126.40
130.04
77.18
60.71
K2
Household Survey of Health Care Utilisation and Expenditure
Table 34 : Average Expenditure Per Illness Episode by Annual Household
Income and Nature of Illness for Non-Hospitalised Illnesses
(In Rupees)
Annual Household
Income
Serious
Communi
cable
Diseases
Acute
Illness
Chronic
Illness
Accident/
Injury
All
Illness
RURAL
< 18,000
162.83
51.33
203.90
104.16
82.02
18,001-54,000
188.74
60.31
211.37
168.11
102.10
>54,000
195.43
109.20
215.95
270.10
142.75
171.56
56.05
207.77
124.91
90.48
ALL
URBAN
18,000
187.13
56.93
169.72
77.52
92.76
18,001-54,000
201.03
76.80
205.84
465.62
120.72
>54,000
237.17
107.41
265.28
557.95
160.89
198.39
71.83
201.46
287.59
113.93
ALL
4
>
K.
11 LJJllI III I
Tables
«3
Table 35 : Average Expenditure Per Illness Episode by Highest Level
of Education in the Household for Non-Hospitalised Illnesses
(In Rupees)
Educational
Level
Serious
CommuniCable
Diseases
Acute
Illness
Chronic
Illness
Accident/
Injury
Total
RURAL
No Formal Education
142.78
41.30
137.17
44.83
64.59
Primary
180.14
49.14
147.79
157.17
84.28
Higher Secondary
184.76
64.11
235.85
131.23
100.84
Graduation & Above
142.25
52.58
220.10
139.75
91.95
ALL
171.56
56.05
207.77
124.91
90.48
URBAN
No Formal Education
163.80
49.86
180.51
21.83
77.21
Primary
161.77
40.55
216.03
91.31
85.16
Higher Secondary
203.24
71.95
170.72
293.05
110.12
Graduation & Above
214.85
89.95
243.18
405.52
140.73
ALL
198.39
71.83
201.46
287.59
113.93
.
84
Household Survey of Health Care Utilisation and Expenditure
Table 36 : Average Expenditure Per Illness Episode by Occupation
of the Household Head for Non-Hospitalised Illnesses
I
(In Rupees)
Occupation
Serious
CommuniCable
Diseases
Acute
Illness
Chronic
Illness
Accident/
Injury
All
Illness
RURAL
Cultivator
174.13
54.50
191.51
112.27
85.62
Wage Earner
146.65
51.77
221.38
115.27
86.37
Salary Earner/Professional 151.52
57.51
172.25
173.75
88.43
Business
216.17
84.78
128.75
87.19
106.99
Others
248.28
54.73
297.89
350.00
118.15
ALL
171.56
56.05
207.77
124.91
90.48
URBAN
Cultivator
155.13
82.05
255.99
546.16
125.23
Wage Earner
206.43
53.99
156.49
111.64
90.11
Salary Earner/Professional 195.77
79.17
212.29
502.82
122.87
Business
210.00
74.57
235.72
247.97
122.36
Others
184.99
74.27
173.46
143.98
111.30
ALL
198.39
71.83
201.46
287.59
113.93
85
Tables
Table 37: State-wise Breakup of Average Expenditure Per
Illness Episode for Non-Hospitalised Illnesses — Rural
(In Rupees)
Clinical Special Rituals Transport Bribes,
Fees &
Diet
Tips &
Medicine Tests
Miscel
laneous
State
Andhra Pradesh
Assam
Bihar
Gujarat
Haryana
Himachal Pradesh
Karnataka
Kerala
Madhya Pradesh
Maharashtra
Orissa
Punjab
Rajasthan
Tamil Nadu
Uttar Pradesh
West Bengal
ALL-INDIA
Notes :
Total
Expen
diture
039
(02)
0.86
(13)
2.10
(1.8)
0.00
1.36
(2.1)
0.41
(0-4)
1.11
(1-9)
1.97
(2.8)
0.18
(03)
1.56
(3.4)
0.19
(03)
1.18
(1.5)
17.85
(10.4)
10.81
(164)
728
(63)
3131
(21.0)
9.89
(9-1)
28.99
(25.2)
28.39
(21.8)
25.97
(15.1)
11.89
(18.4)
19.47
(21.5)
8.16
(14.0)
7.33
(10.4)
10.58
(17.7)
10.36
(22.6)
8.20
(133)
6.57
(82)
(1.1)
0.09
(0.1)
1.07
(1.7)
0.63
(0.7)
0.19
(03)
2.67
(3.8)
0.40
(0-7)
1.68
(3-6)
0.06
(0.1)
0.52
(0.7)
171.81
(100.0)
66.04
(100.0)
114.73
(100.0)
149.14
(100.0)
109.07
(100.0)
'115.42
(100.0)
13027
(100.0)
171.52
(100.0)
64.48
(100.0)
90.71
(100.0)
58.43
(100.0)
70.46
(100.0)
59.91
(100.0)
45.90
(100.0)
62.06
(100.0)
79.74
(100.0)
0.80
(0.9)
13.10
(14.5)
0.77
(0.8)
90.48
(100.0)
132.29
(77.0)
49.62
(75.1)
86.05
(75.0)
102.05
(68.4)
73.22
(66.1)
64.46
(54.9)
93.11
(71.5)
125.67
(733)
42.04
(652)
58.80
(64.8)
41.71
(713)
46.58
(66.1)
40.08
(66.8)
26.66
(58.1)
46.99
(75.7)
56.15
(70.4)
10.69
(62)
2.18
(33)
6.42
(5-6)
124
(0.8)
9.94
(9-1)
524
(4.5)
421
(32)
12.76
(7.4)
1.83
(2-8)
1.99
(22)
2.14
(3.7)
9.68
(13.7)
0.76
(13)
123
(2.7)
1.67
(2.7)
2.54
(32)
10.35
(6.0)
1.89
(2.9)
11.70
(10.3)
14.00
(9.4)
15.53
(142)
8.23
(7.1)
3.14
(2-4)
6.99
(4-1)
629
(9.8)
939
(10.4)
5.11
(8.8)
223
(32)
7.91
(132)
4.43
(9-6)
4.95
(7.9)
12.76
(16.0)
0.23
(0.1)
0.69
(1.0)
1.18
(1.0)
0.55
(0.4)
0.49
(0.5)
8.11
(7-0)
0.00
64.51
(71.3)
3.95
(4.4)
7.34
(8.1)
0.04
0.00
039
(03)
1.42
1. Figures in brackets indicate percentage to total.
2. AlUndia figures include the States/Union Territories of Goa, Meghalaya,
Pondicherry, Chandigarh and Delhi.
86
Household Survey of Health Care Utilisation and Expenditure
Table 38 : State-wise Breakup of Average Expenditure Per Illness Episode
for Non-Hospitalised Illnesses — Urban
(In Rupees)
Fees &
Clinical Special Rituals Transport Bribes,
Medicine Tests
Diet
Tips &
Miscellaneous
State
Andhra Pradesh
Total
Expen
diture
103.63
(82.1)
Assam
71.14
(66.8)
Bihar
118.67
(75.4)
Gujarat
88.86
(80.0)
Haryana
112.13
(72.8)
Himachal Pradesh
61.79
(68.0)
Karnataka
109.60
(75.3)
Kerala
65.47
(812)
Madhya Pradesh
5125
(74.5)
Maharashtra
105.76
(77.4)
Orissa
100.77
(73.7)
Punjab
81.12
(69.3)
Rajasthan
6323
(71.8)
Tamil Nadu
61.57
(76.6)
Uttar Pradesh
81.46
(81.0)
Wes* Bengal
110.81
(83.7)
Delhi
125.14
(77.7)
521
(4.1)
5.79
(5.4)
926
(5.9)
6.39
(5.8)
13.77
(8.9)
7.52
(83)
12.35
(8.5)
4.07
(5.1)
5.05
(73)
6.61
(4.8)
11.58
(8.5)
16.41
(14.0)
10.64
(12.1)
6.56
(82)
4.40
(4.4)
1037
(7.8)
12.8
(7.9)
10.61
0.00
(8.4)
21.12
0.00
(19.8)
20.20
0.43
(12.9)
(03)
6.72
035
(6.0)
(03)
16.41
2.76
(10.7)
(1.8)
7.20
5.22
(7.9)
(5-7)
8.15
0.71
(5.6)
(0.5)
3.78
0.04
(4.7)
(0.1)
6.81
0.14
(9.9)
(02)
14.47
033
(10.6)
(02)
12.47
0.00
(9.1)
6.65
2.71
(5.7)
(2.2)
9.13
0.60
(10.4)
(0.7)
4.07
0.54
(5.1)
(0.7)
737
0.84
(7.3)
(0.8)
7.09
0.16
(5.4)
(0.1)
11.31
1.82
(7.0)
(1.1)
6.66
(53)
8.48
(8-0)
8.54
(5.4)
8.62
(7.8)
8.68
(5.6)
8.78
(9.7)
14.12
(9.7)
6.52
(8.0)
520
(7.6)
9.22
(6.7)
11.81
(8.6)
8.08
(6.8)
4.36
(5-0)
6.72
(83)
6.38
(6.4)
3.61
(2-7)
9.95
(62)
0.90
(1.1)
0.05
(0.1)
0.29
(0.3)
0.12
(0.1)
12625
(100.0)
106.52
(100.0)
157.25
(100.0)
111.00
(100.0)
154.14
(100.0)
90.93
(100.0)
145.56
(100.0)
80.57
(100.0)
68.82
(100.0)
136.6
(100.0)
136.75
(100.0)
116.84
(100.0)
87.99
(100.0)
8037
(100.0)
100.50
(100.0)
13233
(100.0)
161.15
(100.0)
ALL-INDIA
7.89
(6.9)
9.31
(8.2)
7.42
(6.5)
0.31
(0.3)
113.93
(100.0)
Notes .
88.42
(77.6)
0.56
(0.5)
0.15
(0.1)
0.00
0.15
(0.1)
0.06
(0.1)
039
(02)
0.41
(0.4)
0.64
(0-4)
0.69
(0.9)
037
(0.5)
021
(03)
0.12
(0.1)
1.15
(10)
1. Figures in brackets indicate percentage to total.
2. AlUndia figures iinclude the States/Union Territories of Goa, Meghalaya,
Pondicherry, Chandigarh and Delhi.
'i
S7
Tables
Table 39 : State-wise Average Expenditure Per Illness Episode for
Hospitalisation by Type of Treatment
(In Rupees)
Urban
Rural
Public
Private
Total
Public
Private
Total
Andhra Pradesh
474.07
1388.60
1108.48
628.48
1954.61
1211.08
Assam
448.70
448.70
577.23
Bihar
205.11
2872.32
1298.46
392.63
1495.80
800.22
Gujarat
912.32
1076.91
1023.92
496.08
2295.51
1806.53
Haryana
690.31
2257.55
1105.86
579.34
2392.14
1197.70
Himachal Pradesh
659.01
659.01
460.64
1730.38
845.10
Karnataka
293.19
2252.59
1055.14
465.27
2263.93
1224.60
Kerala
493.48
2430.79
1177.92
342.92
2153.87
991.24
Madhya Pradesh
420.10
1172.51
629.29
412.25
2690.55
1035.33
Maharashtra
664.85
112.72
981.51
461.98
1976.32
1085.61
Orissa
407.59
’1385.00
426.21
580.87
1041.04
725.05
Punjab
434.21
762.50
449.62
372.81
1357.31
696.03
Rajasthan
437.57
1897.65
757.30
465.81
845.07
508.29
Tamil Nadu
500.00
1857.66
1658.96
150.07
2396.47
1282.93
Uttar Pradesh
949.10
2304.58
1424.38
299.66
2405.68
1147.61
West Bengal
359.11
359.11
398.46
2844.14
966.86
550.01
5832.15
2145.74
452.55
2318.84
1196.87
Delhi
ALL-IN DIA
535.20
1877.21
1044.49
577.23
Note : All-India figures include the States/Union Territories of Goa, Meghalaya,
Pondicherry Chandigarh and Delhi rural.
1
Household Survey of Health Care
88
Utilisation and Expenditure
Tab,C 40 :
(In Rupees)
Female
Male
Nature of Illness
Public
Private
Total
Public
private
Total
RURAL
Serious Communi
cable Diseases
701.50
263.40
858.69
1065.57
138124
578.30
500.53
479.12
651.33
Acute Illness
967.05
893.16
301.59
520.58
1273.30
Chronic Illness
2782.42 1741.05
2374.19
720.71
2907.29 1741.05
500.00
660.44
616.06
710.56
Accident/Injury
2116.62 1105.09
441.02 1545.10
934.66
578.88
ALL
URBAN
Serious Communi
cable Diseases
2064.84
616.27
261.47
1370.93
596.22
265.38
881.55
843.09
1916.61
1597.66
278.20
248.22
Acute Illness
3233.65 1931.65
2377.80
1338.48
760.03
550.45
Chronic Illness
2039.62 1239.07
832.64
584.46
547.48
478.52
Accident/Injury
2623.14 133934
382.64
188351
988.71
499.74
ALL
Table 41: Breakup of Average Expenditure Per Illness Episode for Hospitalisation Cases
(In Rupees)
Nature of
Illness
Serious Communi
cable Diseases
Acute Illness
Chronic Illness
Accident/ Injury
ALL ILLNESS
Serious Communi
cable Diseases
Rees/
Medicine
Clinical
Test
Surgery
Hospita
lisation
Special
Diet
Rituals
Trans
port
Bribes/
Tips &
Miscel
laneous
Total
127.08
(16.8)
36.05
(6.2)
52.48
(3-7)
100.53
(5.9)
0.29
(0.0)
1.08
(0.2)
0.9
(0-1)
4.23
(0.3)
99.5
(13.2)
79.16
(13.7)
166.61
(11.7)
175.33
(10.3)
6.56
(0-9)
8.00
(1.4)
19.9
(1.3)
15.3
(0-9)
753.76
(100.0)
579.94
(100.0)
1419.85
(100.00
1703.12
(100.0)
79.4
(7.6)
1.11
(0.1)
125.93
(12.1)
12.02
(1.1)
1044.49
(100.0)
104.08
(12.1)
134.64
(8.0)
86.82
(7.5)
123.40
(20.3)
175.04
(20.4)
354.02
(20.9)
263.33
(22.8)
92.82
(15.2)
46.20
(5.4)
80.79
(4.8)
62.41
(5-4)
3.40
(0.6)
6.97
(0.8)
1.68
(0-1)
5.54
(0.5)
38.38
(6.3)
51.70
(6.0)
67.42
(4.0)
65.23
(5.7)
3.53
(0.6)
3.94
(0.5)
14.42
(0.9)
10.53
(0.9)
608.61
(100.0)
858.63
(100.0)
1692.73
(100.0)
1153.00
(100.00
93.22
(7.8)
251.57
(21.0)
72.38
(6.0)
3.84
(0.3)
57.45
(4.8)
9.15
(0.8)
1196.87
(100.0)
RURAL
387.24
(51.4)
311.67
(53.7)
718.71
(50.6)
909.54
(53.4)
31.37
(4.2)
18.11
(3-1)
156.8
(11.1)
204.41
(12.0)
36.52
(6.3)
72.2
(5-1)
101.66
(6-0)
101.73
(13.5)
89.35
(15.4)
233.05
(16.4)
192.12
(11.2)
539.97
(51.7)
89.73
(8.6)
43.49
(4.2)
152.85
(14.6)
URBAN
320.62
(52.7)
412.22
(48.0)
866.32
(51.1)
554.04
(48.1)
26.47
(4-3)
Acute Illness
58.48
(6.8)
Chronic Illness
173.45
(W.2)
Accident/ Injury
105.07
(9-1)
ALL ILLNESS
602.81
106.45
(50.4)
(8.9)
Note: Figures in brackets indicate percentages to total.
$
QO
Household Survey of Health Care Utilisation and Expenditure
I
Table 42 : Average Expenditure Per Immunisation by Type of Health Care
(In Rupees)
Rural
Urban
Boys
Girls
All
Boys
Girls
All
Public
3.27
4.70
3.91
5.16
3.11
4.19
Private
49.41
46.35
47.68
41.36
30.03
36.53
TOTAL
6.31
8.99
7.53
9.95
6.12
8.15
Table 43 : Average Expenditure Per Delivery/Abortion by
Type of Health Care
(In Rupees)
Delivery
Abortion
Rural
Urban
Rural
Home Delivery
76.23
52.32
7.77
Public
256.57
230.79
192.94
98.83
Private
1497.08
1858.26
588.46
1048.03
TOTAL
400.04
631.7
324.86
739.92
Urban
I
Table 44 : Average Expenditure Per Illness Episode by Nature of Illness and System of Treatment
(In Rupees)
Nature of Illness
Allopathy
Homeopathy
Ayurveda/
Sidha
Unani
Any
Combination
Rituals
Total
RURAL
Serious Communicable Diseases
Acute Illness
Chronic Illness
Accident/ Injury
180.82
57.05
210.70
130.35
114.00
45.01
186.80
87.84
23.11
94.02
48.62
94.99
40.00
148.52
76.84
212.37
58.56
34.57
276.97
170.14
55.71
207.07
124.91
ALLILLNESS
91.62
70.40
38.33
78.14
130.23
63.68
89.94
URBAN
aSerious Communicable Diseases
Acute Illness
Chronic Illness
Accident/injury
200.67
71.83
204.33
288.63
142.78
62.26
134.63
128.97
60.28
160.70
26.44
0.00
7.33
240.94
111.69
201.74
551.78
47.33
10.00
113.28
196.77
71.69
200.03
284.45
ALL ILLNESS
114.27
82.65
97.05
7.33
165.44
80.00
113.50
tn
Annexure
Results of NCAER's 1990 and 1993
Surveys : A Comparison
Table A.l : Prevalence Rate of Illness Per '000 Population
1993**
1990*
Treated +
Illnesses
All
Illnesses
Treated
Illnesses
RURAL
Adults — Male
Female
Children — Male
Female
105.34
59.80
93.95
45.72
108.0
116.6
100.3
90.4
94.3
102.1
90.0
82.1
ALL
79.06
106.7
94.1
URBAN
■
Adults — Male
Female
Children — Male
Female
88.07
46.62
90.78
40.49
99.7
118.0
95.0
83.7
91.6
107.1
88.5
76.9
ALL
67.70
103.0
94.4
*
Prevalence Rates are calculated for two-week reference period.
Prevalence Rates are calculated for one month reference period.
T 1990 Survey included only treated illnesses.
92
93
Annexure
Table
: Distribution of Illness Episodes by Type of Treatment
(Percentage)
1990*
1993
All
Illnesses
Non-Hospitalised
Illnesses
Hospitalised
Illnesses
38.3
41.7
62.0
55.5
52.7
38.0
RURAL
Public
Private
Medical Shop
2.5
Home Remedy
3.1
2.0
Others
3.7
0.5
TOTAL
100.0
100.0
100.0
URBAN
Public
39.1
34.0
60.1
Private
54.8
59.8
39.9
5.2
Medical Shop
4.7
0.7
Others
1.4
0.3
TOTAL
100.0
100.0
Home Remedy
100.0
*■
Data on Hospitalised and Non-Hospitalised Illnesses are not available separately.
94
Household Survey of Health Care Utilisation and Expenditure
Table A3 : Average Household Expenditure Per Illness Episode
(Rs.)
1990
1993
151.79
212.26
96.59
87.23
234.25
156.36
76.06
77.06
151.81
160.29
159.02
161.00
298.43
200.86
99.02
82.56
144.69
78.80
142.60
241.89
RURAL
Adults — Male
Female
Children - Male
Female
ALL
URBAN
Adults — Male
Female
Children - Male
Female
ALL
I
References
Das Gupta, Monica (1987), "Selective Discrimination Against Female Children in Rural
Punjab", Population and Development Review 13, No.l, March, 1987.
Das Gupta, M., T.N.Krishnan and L.C.Chen (1992), "Health and Transitions in India: Public
Policies and Action", Paper presented at NCAER Harvard Workshop on Health and Development
in India, India International Centre, New Delhi, 2-4 Jan., 1992.
Duggal, Ravi (1992), Health Care Services and Financing: A Report for the Health Financing Review
Mission of World Bank, F.R.C.H., Bombay, March, 1992.
Duggal, R. and Amin Sucheta (1989), Cost ofHealth Care: A Household Survey in An Indian District,
F.R.C.H., Bombay, 1989.
George Alex, Ila Shah and Sunil Nandraj (1994), A Study of Household Health Expenditure in
Madhya Pradesh, F.R.C.H., Bombay, 1994.
Indian Council of Medical Research (1991), Evaluation of Quality of Family Welfare Services at
Primary Health Centre Level, An ICMR Task Force Study, ICMR, New Delhi, 1991.
Irudaya Rajan, S., and K.S. James (1993), "Kerala's Health Status: Some Issues", Economic and
Political Weekly, September 4,1994.
Kannan, K.P., K.R. Thankappan, V. Raman Kutty and K.P. Aravindan (1991), Heath and
Development in Rural Kerala, K.S.S.P., Thiruvananthapuram, Kerala, 1991.
Kumar, Gopalakrishna B. (1993), "Low Mortality and High Morbidity in Kerala Reconsidered
Population and Development Review 19, No.l, March, 1993.
National Council of Applied Economic Research (1992 a). Household Survey of Medical Care.
♦
NCAER, New Delhi, 1992.
National Council of Applied Economic Research (1992 b). Rural Household Health Care Needs
and Availability ( A Study of Six Districts), NCAER, New Delhi, November, 1992.
National Council of Applied Economic Research (1994), Survey of Primary Health Care, NCAER,
New Delhi, January, 1994.
National Sample Survey Organisation (NSSO), Morbidity and Utilisation ofMedical Services, 42nd
Round, July 1986-June 1987, Report No.364, Department of Statistics, Government of India,
New Delhi.
Panikar, P.R.G. and C.R. Soman (1984), Health Status of Kerala: Paradox of Economic Backwardness
and Health Development, Centre for Development Studies, Trivandrum, Kerala.
Sen, A. and Sengupta (1983), "Malnutrition of Rural Children and the Sex Bias", Economic and
Political Weekly, 18,1983.
Sundar, Ramamani (1993),"Sex Differential in Education and Health Among Children: Some
Empirical Evidence", Special Issue on Human Development, Margin, NCAER, New Delhi, Vol.
25, Jan.-March, 1993.
Tulasi Dhar, V.B. (1992); State's Financing of Health Care in India: Some Recent Trends, National
Institute of Public Finance and Policy, New Delhi, March, 1992.
World Health Organization (1978), Lay Reporting of Health Information, WHO, Geneva.
95
Also by NCAER
Household Survey of Medical Care
(1992)
This is one of the first attempts to provide macro-level household
data on all aspects of medical care. The sample consists of 18,102 households
spread over 21 states and union territories of India covering both rural
and urban areas.
The focus of the study is on the nature and type of illness suffered
by the household members, the systems of medicines that they used;
whether they went to private or public facilities and their perception of
the effectiveness of the systems that they used. The study provides
valuable data on the household expenditure on medical care.
Price: Rs. 60.00
$ 5.00
r
About the book
I
This is the second such study by NCAER. It collected information
on the prevalence of illness, utilisation and sources of health services,
types of providers, systems of medicine used and the distances travelled
to seek treatment. It is a national survey and gives information by
states as well.
Price: Rs. 120.00
$10.00
ISBN 81-85877-24-6
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- Media
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