Effect of User Charges on Secondary Level Surgical Care Utilization and Out-of-Pocket Expenditures in Haryana State, India.
BACKGROUND
Generation of resources for providing health care services is an important issue in developing countries. User charges in the form of Surgical Package Program (SPP) were introduced in all district hospitals of Haryana to address this problem. We evaluate the effect of this SPP program on surgical care utilization and out-of-pocket (OOP) expenditures.


METHODS
Data on 25437 surgeries, from July 2006 to June 2013 in 3 districts of Haryana state, was analyzed using interrupted time series analysis to assess the impact of SPP on utilization of services. Adjustment was made for presence of any autocorrelation and seasonality effects. A cross sectional survey was undertaken among 180 patients in District hospital, Panchkula during June 2013 to assess the extent of out of pocket (OOP) expenditure incurred, financial risk protection and methods to cope with OOP expenditure. Catastrophic health expenditure, estimated as any expenditure in excess of 10% of the household consumption expenditure, was used to assess the extent of financial risk protection.


RESULTS
User charges had a negative effect on the number of surgeries in public sector district hospitals in all the 3 districts. The mean out-of-pocket expenditure incurred by the patients was Rs.4564 (USD 74.6). The prevalence of catastrophic expenditure was 5.6%. A higher proportion among the poorest 20% population coped through borrowing money (47.2%), while majority (86.1%) of those belonging to richest quintile paid from their monthly income or savings, or had insurance.


CONCLUSIONS
There is a need to increase the public financing for curative services and it should be based on the needs of population. Any form of user charge in public sector hospitals should be removed.
School of Public Health, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India.
Deepak
D
Balasubramanian
School of Public Health, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India.
Shankar
S
Prinja
School of Public Health, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India.
Arun Kumar
AK
Aggarwal
D000328:Adult; D003710:Demography; D005260:Female; D005382:Financing, Personal / Q000191:economics* / Q000706:statistics & numerical data*; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D063127:Secondary Health Care / Q000191:economics* / Q000706:statistics & numerical data*; D013514:Surgical Procedures, Operative / Q000191:economics* / Q000706:statistics & numerical data*; D055815:Young Adult