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Managing Healthcare Provision and Health Outcomes through Local Governance

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Name of the Asset | Managing Healthcare Provision and Health Outcomes through Local Governance
Type of Asset | Working Paper
Date | September 2013


This study analyzes how privatization affects the relative health status of men and women in rural areas in India, a country with comparatively poor rural health and one of the most privatized healthcare systems in the world. The study singles out factors such as the quality of healthcare providers, the impact of local governance on healthcare and health satisfaction, the choice of providers and health expenditures, as well as impact on incomes.

An analysis of data from the Additional Rural Incomes Survey (ARIS) and Rural Economic & Demographic Survey (REDS) of the Indian National Council of Applied Economic Research (NCAER) reveals significant positive impacts of private healthcare availability on local governance, women’s empowerment and gender differences in treatment. It finds that private clinics are doing better than public facilities on a number of quality indicators. Private clinics have higher quality scores than public facilities. The study found that sickness is significantly reduced through improved access to drinking water, clean surroundings, and awareness about health campaigns.  These factors reduce the use of public and private healthcare, as well as private health expenditures. Women have a slightly lower probability of becoming ill compared to men, but they lose more days at work from being ill. Therefore, being ill has a greater impact on women’s income. Private expenditures on health have grown less than the incomes of both men and women. Private healthcare does more for the earnings of men than public healthcare, but for women, this difference is not that large.

  • Hans P. Binswanger-Mkhize (School of Economics and Management, China Agricultural University, Beijing, China and Department of Agricultural Economics, University of Pretoria, Pretoria, South Africa)
  • Hari K. Nagarajan (Institute of Rural Management Anand, Anand, India)
  • Kailash C. Pradhan (National Council for Applied Economic Research, Delhi, India)
Name of the Program | Global Research Project 'Varieties of Governance: Effective Public Service Delivery'
Country and/or Region | India
Date | September 2013
Funder(s) | Australian Agency for International Development (AusAID), Department for International Development (DFID), UK, French Ministry of Foreign and European Affairs, Inter‐American Development Bank (IDB), International Development Research Centre (IDRC), Open Society Institute (OSI), The Partnership for African Social and Governance Research (PASGR), The World Bank
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