Healthcare seeking behaviour among self-help group households in Rural Bihar and Uttar Pradesh, India

TLDR

Community‑based health insurance schemes, supported by NGOs, have been operating in rural India with benefit packages tailored to local priorities. This study investigates healthcare‑seeking behavior among self‑help group households to inform the design of CBHI benefit packages. Using cross‑sectional data from two of India’s poorest states, the authors estimate an alternative‑specific conditional logit model to analyze provider choice. Most respondents seek care, predominantly from private providers and rural medical practitioners, with proximity driving acute illness choices and cost influencing chronic illness decisions, indicating CBHI should cover transportation and lost wages.

Abstract

In recent years, supported by non-governmental organizations (NGOs), a number of community-based health insurance (CBHI) schemes have been operating in rural India. Such schemes design their benefit packages according to local priorities. This paper examines healthcare seeking behaviour among self-help group households with a view to understanding the implications for the benefit packages offered by such schemes. We use cross-sectional data collected from two of India’s poorest states and estimate an alternative-specific conditional logit model to examine healthcare seeking behaviour. We find that the majority of respondents do access some form of care and that there is overwhelming use of private providers. Non-degree allopathic providers (NDAP) also called rural medical practitioners are the most popular providers. In the case of acute illnesses, proximity plays an important role in determining provider choice. For chronic illnesses, cost of care influences provider choice. Given the importance of proximity in determining provider choice, benefit packages offered by CBHI schemes should consider coverage of transportation costs and reimbursement of foregone earnings.