Samir Garg - Academia.edu (original) (raw)

Papers by Samir Garg

Research paper thumbnail of Coverage of home-based newborn care and screening by ASHA community health workers: Findings from a household survey in Chhattisgarh state of India

Journal of Family Medicine and Primary Care

Research paper thumbnail of Role of publicly funded health insurance in financial protection of the elderly from hospitalisation expenditure in India-findings from the longitudinal aging study

BMC Geriatrics

Background The elderly face a greater burden of illnesses than other age groups and have a more f... more Background The elderly face a greater burden of illnesses than other age groups and have a more frequent need of healthcare, including in-patient hospitalisations. Catastrophic expenditure on hospitalisation of the elderly poses a significant challenge to India’s aim of achieving Universal Health Coverage (UHC). India has implemented a policy of Publicly Funded Health Insurance (PFHI) to provide free inpatient care by empanelling private and public hospitals. The existing studies have examined the performance of PFHI in financial protection of the elderly. Methods This study utilised the Longitudinal Ageing Study in India (LASI) Wave 1, conducted in 2017–18. LASI is a large-scale nationally representative survey collecting data on elderly health including illness burden, healthcare use and out of pocket expenditure (OOPE). It covered a sample 72,250 individuals aged 45 or above. Financial Protection was measured in terms of Catastrophic Health Expenditure (CHE). Multivariate analysi...

Research paper thumbnail of A Study of Strategic Purchasing as a Policy Option for Public Health System in India

Research paper thumbnail of Additional file 1 of Comparing the average cost of outpatient care of public and for-profit private providers in India

Research paper thumbnail of Additional file 2 of Performance of India's national publicly funded health insurance scheme, Pradhan Mantri Jan Arogaya Yojana (PMJAY), in improving access and financial protection for hospital care: findings from household surveys in Chhattisgarh state

Additional file 2. A note on Instrumental Variable (IV) method - This provides a brief note on th... more Additional file 2. A note on Instrumental Variable (IV) method - This provides a brief note on the problem of endogeneity and the IV as a method of addressing it.

Research paper thumbnail of Assessment of Home Based Newborn Care Practices in rural Chhattisgarh

SHRC was supported by NRHM, Chhattisgarh to carry out this study in year 2010. This survey was fu... more SHRC was supported by NRHM, Chhattisgarh to carry out this study in year 2010. This survey was funded by NRHM in order to inform the plans being made by the state for promoting appropriate Home Based Newborn Care (HBNC). We are thankful to NRHM, Chhattisgarh for their support. We thank Dr KR Antony, Director, SHRC and an expert with for his inputs during the initial design of the survey. We thank Nikita Powar for her contribution in assisting us at different stages of the survey. The survey was done by a group of Three-year Diploma holders in Rural Medicine (RMAs) and physiotherapists (BPT, Raipur). They also became part of our state training team for HBNC. We thank them for the hard work they put in the field. We also thank all others divisions of SHRC, especially the accounts section for their active support to this study project.

Research paper thumbnail of Malaria case detection in Chhattisgarh, 2015–2019: Comparison of cases reported by the National Vector Borne Disease Control Programme and community health workers

The National Medical Journal of India, 2020

Research paper thumbnail of Effectiveness of ‘Universal’ Health Insurance for Women in Urban Slums of Raipur, Chhattisgarh

Research paper thumbnail of The Implementation of RSBY in Chhattisgarh, India: A study of the Durg district

Health, Culture and Society, 2012

The Rashtriya Swasthya Bima Yojana (RSBY) scheme is a health insurance model currently being impl... more The Rashtriya Swasthya Bima Yojana (RSBY) scheme is a health insurance model currently being implemented by the Indian government. It is a model, however, still in nascent state, subject to tensions and value testing. Very few studies have hitherto assessed the scheme’s implementation and whether the stated objectives of the government initiative are being fulfilled. This short study undertaken in the Durg district of Chhattisgarh reveals that RSBY fails to cover the population living Below the Poverty Line (BPL). Likewise there is discrepancy in the consistency of information and knowledge regarding the scheme among the beneficiaries who are themselves continuing to incur high out-of-pocket expenses. There are thus severe issues in transparency and accountability within the RSBY scheme. Unless the public health delivery system is strengthened and the private sector regulated and indeed monitored, the scheme will not yield the desired results, and the cost of healthcare will further...

Research paper thumbnail of What is the out-of-pocket expenditure on medicines in India? An empirical assessment using a novel methodology

Health Policy and Planning

The share of expenditure on medicines as part of the total out-of-pocket (OOP) expenditure on hea... more The share of expenditure on medicines as part of the total out-of-pocket (OOP) expenditure on healthcare services has been reported to be much higher in India than in other countries. This study was conducted to ascertain the extent of this share of medicine expenditure using a novel methodology. OOP expenditure data were collected through exit interviews with 5252 out-patient department patients in three states of India. Follow-up interviews were conducted after Days 1 and 15 of the baseline to identify any additional expenditure incurred. In addition, medicine prescription data were collected from the patients through prescription audits. Self-reported expenditure on medicines was compared with the amount imputed using local market prices based on prescription data. The results were also compared with the mean expenditure on medicines per spell of ailment among non-hospitalized cases from the National Sample Survey (NSS) 75th round for the corresponding states and districts, which...

Research paper thumbnail of How much do government and households spend on an episode of hospitalisation in India? A comparison for public and private hospitals in Chhattisgarh state

Health Economics Review

Background Improvements in the financing of healthcare services are important for developing coun... more Background Improvements in the financing of healthcare services are important for developing countries like India to make progress towards universal health coverage. Inpatient-care contributes to a big share of total health expenditure in India. India has a mixed health-system with a sizeable presence of private hospitals. Existing studies show that out-of-pocket expenditure (OOPE) incurred per hospitalisation in private hospitals was greater than public facilities. But, such comparisons have not taken into account the healthcare spending by government. Methods For a valid comparison between public and for-profit private providers, this study in Indian state of Chhattisgarh assessed the combined spending by government and households per episode of hospitalisation. The supply-side and demand-side spending from public and private sources was taken into account. The study used two datasets: a) household survey for data on hospital utilisation, OOPE, cash incentives received by patients...

Research paper thumbnail of Household expenditure on non-Covid hospitalisation care during the Covid-19 pandemic and the role of financial protection policies in India

Archives of public health, Apr 2, 2022

Background: Despite global guidance for maintaining essential non-Covid health services during th... more Background: Despite global guidance for maintaining essential non-Covid health services during the pandemic, there is a concern that existing services faced a major disruption. The access as well as affordability of healthcare could have suffered during the pandemic, especially in developing countries including India. There are no population based studies available in India on changes in access and financial risk for non-Covid hospitalisation during the pandemic. India has a policy of Publicly Funded Health Insurance (PFHI) to ensure access and financial protection for hospital care but no information is available on its performance during the pandemic. The current study was aimed to find out the change in access and financial protection for non-Covid hospitalisations during the Covid-19 pandemic and to examine the performance of PFHI in this context. Methods: Panel data was analyzed, from two rounds of annual household surveys conducted in Chhattisgarh state for year 2019 and 2020. The survey followed a two-stage population based sample of around 3000 households, representative for the state. Two kinds of measures of catastrophic health expenditure were used-based on annual household consumption expenditure and on non-food consumption expenditure. Multivariate analysis was carried out to find determinants of utilisation and spending. In addition, Propensity Score Matching method was applied to find effect of PFHI schemes. Results: Utilisation of hospital care per 1000 population reduced from 58.2 in 2019 to 36.6 during the pandemic i.e. in 2020. The share of public hospitals in utilisation increased from 60.1% in 2019 to 67.0% in 2020. Incidence of catastrophic expenditure was significantly greater during the pandemic. The median Out of Pocket Expenditure (OOPE) in private hospitals doubled from 2019 to 2020. The size of OOPE and occurrence of catastrophic expenditure were significantly associated with utilisation in private hospitals. Enrolment under PFHI schemes including the Ayushman Bharat-Pradhan Mantri Jan Arogaya Yojana (PMJAY) was not effective in reducing OOPE or catastrophic expenditure. Conclusion: While the utilisation of hospital care dropped during the pandemic, the private hospitals became further unaffordable. The government policy for financial protection through health insurance remained ineffective during the pandemic.

Research paper thumbnail of Universal Healthcare and Universalising Health Insurance: Examining the Binary Through the RSBY/MSBY in Chhattisgarh

Research paper thumbnail of MOESM7 of Utilisation and financial protection for hospital care under publicly funded health insurance in three states in Southern India

Additional file 7. Incidence of CHE10.

Research paper thumbnail of MOESM5 of Utilisation and financial protection for hospital care under publicly funded health insurance in three states in Southern India

Additional file 5. IV PROBIT Regression for CHE25.

Research paper thumbnail of Additional file 13 of Performance of India's national publicly funded health insurance scheme, Pradhan Mantri Jan Arogaya Yojana (PMJAY), in improving access and financial protection for hospital care: findings from household surveys in Chhattisgarh state

Additional file 13. IV Model (IVProbit) for CHE25 – This file has two tables. Table S13.1 provide... more Additional file 13. IV Model (IVProbit) for CHE25 – This file has two tables. Table S13.1 provides IV Model for CHE25 with PMJAY-enrolment as a variable. Table S13.2 provides IV Model for CHE25 with PFHI-enrolment as a variable.

Research paper thumbnail of Additional file 12 of Performance of India's national publicly funded health insurance scheme, Pradhan Mantri Jan Arogaya Yojana (PMJAY), in improving access and financial protection for hospital care: findings from household surveys in Chhattisgarh state

Additional file 12. IV Model (IVProbit) for CHE10 – This file has two tables. Table S12.1 provide... more Additional file 12. IV Model (IVProbit) for CHE10 – This file has two tables. Table S12.1 provides IV Model for CHE10 with PMJAY-enrolment as a variable. Table S12.2 provides IV Model for CHE10 with PFHI-enrolment as a variable.

Research paper thumbnail of Additional file 11 of Performance of India's national publicly funded health insurance scheme, Pradhan Mantri Jan Arogaya Yojana (PMJAY), in improving access and financial protection for hospital care: findings from household surveys in Chhattisgarh state

Additional file 11. Probit Model for CHE40 – This file has two tables. Table S11.1 provides Probi... more Additional file 11. Probit Model for CHE40 – This file has two tables. Table S11.1 provides Probit Model for CHE40 with PMJAY-enrolment as a variable. Table S11.2 provides Probit Model for CHE40 with PFHI-enrolment as a variable.

Research paper thumbnail of Additional file 9 of Performance of India's national publicly funded health insurance scheme, Pradhan Mantri Jan Arogaya Yojana (PMJAY), in improving access and financial protection for hospital care: findings from household surveys in Chhattisgarh state

Additional file 9. Probit Model for CHE10 – This file has two tables. Table S9.1 provides Probit ... more Additional file 9. Probit Model for CHE10 – This file has two tables. Table S9.1 provides Probit Model for CHE10 with PMJAY-enrolment as a variable. Table S9.2 provides Probit Model for CHE10 with PFHI-enrolment as a variable.

Research paper thumbnail of Additional file 1 of Performance of India's national publicly funded health insurance scheme, Pradhan Mantri Jan Arogaya Yojana (PMJAY), in improving access and financial protection for hospital care: findings from household surveys in Chhattisgarh state

Additional file 1. Study Variables - This table lists the variables used in the study.

Research paper thumbnail of Coverage of home-based newborn care and screening by ASHA community health workers: Findings from a household survey in Chhattisgarh state of India

Journal of Family Medicine and Primary Care

Research paper thumbnail of Role of publicly funded health insurance in financial protection of the elderly from hospitalisation expenditure in India-findings from the longitudinal aging study

BMC Geriatrics

Background The elderly face a greater burden of illnesses than other age groups and have a more f... more Background The elderly face a greater burden of illnesses than other age groups and have a more frequent need of healthcare, including in-patient hospitalisations. Catastrophic expenditure on hospitalisation of the elderly poses a significant challenge to India’s aim of achieving Universal Health Coverage (UHC). India has implemented a policy of Publicly Funded Health Insurance (PFHI) to provide free inpatient care by empanelling private and public hospitals. The existing studies have examined the performance of PFHI in financial protection of the elderly. Methods This study utilised the Longitudinal Ageing Study in India (LASI) Wave 1, conducted in 2017–18. LASI is a large-scale nationally representative survey collecting data on elderly health including illness burden, healthcare use and out of pocket expenditure (OOPE). It covered a sample 72,250 individuals aged 45 or above. Financial Protection was measured in terms of Catastrophic Health Expenditure (CHE). Multivariate analysi...

Research paper thumbnail of A Study of Strategic Purchasing as a Policy Option for Public Health System in India

Research paper thumbnail of Additional file 1 of Comparing the average cost of outpatient care of public and for-profit private providers in India

Research paper thumbnail of Additional file 2 of Performance of India's national publicly funded health insurance scheme, Pradhan Mantri Jan Arogaya Yojana (PMJAY), in improving access and financial protection for hospital care: findings from household surveys in Chhattisgarh state

Additional file 2. A note on Instrumental Variable (IV) method - This provides a brief note on th... more Additional file 2. A note on Instrumental Variable (IV) method - This provides a brief note on the problem of endogeneity and the IV as a method of addressing it.

Research paper thumbnail of Assessment of Home Based Newborn Care Practices in rural Chhattisgarh

SHRC was supported by NRHM, Chhattisgarh to carry out this study in year 2010. This survey was fu... more SHRC was supported by NRHM, Chhattisgarh to carry out this study in year 2010. This survey was funded by NRHM in order to inform the plans being made by the state for promoting appropriate Home Based Newborn Care (HBNC). We are thankful to NRHM, Chhattisgarh for their support. We thank Dr KR Antony, Director, SHRC and an expert with for his inputs during the initial design of the survey. We thank Nikita Powar for her contribution in assisting us at different stages of the survey. The survey was done by a group of Three-year Diploma holders in Rural Medicine (RMAs) and physiotherapists (BPT, Raipur). They also became part of our state training team for HBNC. We thank them for the hard work they put in the field. We also thank all others divisions of SHRC, especially the accounts section for their active support to this study project.

Research paper thumbnail of Malaria case detection in Chhattisgarh, 2015–2019: Comparison of cases reported by the National Vector Borne Disease Control Programme and community health workers

The National Medical Journal of India, 2020

Research paper thumbnail of Effectiveness of ‘Universal’ Health Insurance for Women in Urban Slums of Raipur, Chhattisgarh

Research paper thumbnail of The Implementation of RSBY in Chhattisgarh, India: A study of the Durg district

Health, Culture and Society, 2012

The Rashtriya Swasthya Bima Yojana (RSBY) scheme is a health insurance model currently being impl... more The Rashtriya Swasthya Bima Yojana (RSBY) scheme is a health insurance model currently being implemented by the Indian government. It is a model, however, still in nascent state, subject to tensions and value testing. Very few studies have hitherto assessed the scheme’s implementation and whether the stated objectives of the government initiative are being fulfilled. This short study undertaken in the Durg district of Chhattisgarh reveals that RSBY fails to cover the population living Below the Poverty Line (BPL). Likewise there is discrepancy in the consistency of information and knowledge regarding the scheme among the beneficiaries who are themselves continuing to incur high out-of-pocket expenses. There are thus severe issues in transparency and accountability within the RSBY scheme. Unless the public health delivery system is strengthened and the private sector regulated and indeed monitored, the scheme will not yield the desired results, and the cost of healthcare will further...

Research paper thumbnail of What is the out-of-pocket expenditure on medicines in India? An empirical assessment using a novel methodology

Health Policy and Planning

The share of expenditure on medicines as part of the total out-of-pocket (OOP) expenditure on hea... more The share of expenditure on medicines as part of the total out-of-pocket (OOP) expenditure on healthcare services has been reported to be much higher in India than in other countries. This study was conducted to ascertain the extent of this share of medicine expenditure using a novel methodology. OOP expenditure data were collected through exit interviews with 5252 out-patient department patients in three states of India. Follow-up interviews were conducted after Days 1 and 15 of the baseline to identify any additional expenditure incurred. In addition, medicine prescription data were collected from the patients through prescription audits. Self-reported expenditure on medicines was compared with the amount imputed using local market prices based on prescription data. The results were also compared with the mean expenditure on medicines per spell of ailment among non-hospitalized cases from the National Sample Survey (NSS) 75th round for the corresponding states and districts, which...

Research paper thumbnail of How much do government and households spend on an episode of hospitalisation in India? A comparison for public and private hospitals in Chhattisgarh state

Health Economics Review

Background Improvements in the financing of healthcare services are important for developing coun... more Background Improvements in the financing of healthcare services are important for developing countries like India to make progress towards universal health coverage. Inpatient-care contributes to a big share of total health expenditure in India. India has a mixed health-system with a sizeable presence of private hospitals. Existing studies show that out-of-pocket expenditure (OOPE) incurred per hospitalisation in private hospitals was greater than public facilities. But, such comparisons have not taken into account the healthcare spending by government. Methods For a valid comparison between public and for-profit private providers, this study in Indian state of Chhattisgarh assessed the combined spending by government and households per episode of hospitalisation. The supply-side and demand-side spending from public and private sources was taken into account. The study used two datasets: a) household survey for data on hospital utilisation, OOPE, cash incentives received by patients...

Research paper thumbnail of Household expenditure on non-Covid hospitalisation care during the Covid-19 pandemic and the role of financial protection policies in India

Archives of public health, Apr 2, 2022

Background: Despite global guidance for maintaining essential non-Covid health services during th... more Background: Despite global guidance for maintaining essential non-Covid health services during the pandemic, there is a concern that existing services faced a major disruption. The access as well as affordability of healthcare could have suffered during the pandemic, especially in developing countries including India. There are no population based studies available in India on changes in access and financial risk for non-Covid hospitalisation during the pandemic. India has a policy of Publicly Funded Health Insurance (PFHI) to ensure access and financial protection for hospital care but no information is available on its performance during the pandemic. The current study was aimed to find out the change in access and financial protection for non-Covid hospitalisations during the Covid-19 pandemic and to examine the performance of PFHI in this context. Methods: Panel data was analyzed, from two rounds of annual household surveys conducted in Chhattisgarh state for year 2019 and 2020. The survey followed a two-stage population based sample of around 3000 households, representative for the state. Two kinds of measures of catastrophic health expenditure were used-based on annual household consumption expenditure and on non-food consumption expenditure. Multivariate analysis was carried out to find determinants of utilisation and spending. In addition, Propensity Score Matching method was applied to find effect of PFHI schemes. Results: Utilisation of hospital care per 1000 population reduced from 58.2 in 2019 to 36.6 during the pandemic i.e. in 2020. The share of public hospitals in utilisation increased from 60.1% in 2019 to 67.0% in 2020. Incidence of catastrophic expenditure was significantly greater during the pandemic. The median Out of Pocket Expenditure (OOPE) in private hospitals doubled from 2019 to 2020. The size of OOPE and occurrence of catastrophic expenditure were significantly associated with utilisation in private hospitals. Enrolment under PFHI schemes including the Ayushman Bharat-Pradhan Mantri Jan Arogaya Yojana (PMJAY) was not effective in reducing OOPE or catastrophic expenditure. Conclusion: While the utilisation of hospital care dropped during the pandemic, the private hospitals became further unaffordable. The government policy for financial protection through health insurance remained ineffective during the pandemic.

Research paper thumbnail of Universal Healthcare and Universalising Health Insurance: Examining the Binary Through the RSBY/MSBY in Chhattisgarh

Research paper thumbnail of MOESM7 of Utilisation and financial protection for hospital care under publicly funded health insurance in three states in Southern India

Additional file 7. Incidence of CHE10.

Research paper thumbnail of MOESM5 of Utilisation and financial protection for hospital care under publicly funded health insurance in three states in Southern India

Additional file 5. IV PROBIT Regression for CHE25.

Research paper thumbnail of Additional file 13 of Performance of India's national publicly funded health insurance scheme, Pradhan Mantri Jan Arogaya Yojana (PMJAY), in improving access and financial protection for hospital care: findings from household surveys in Chhattisgarh state

Additional file 13. IV Model (IVProbit) for CHE25 – This file has two tables. Table S13.1 provide... more Additional file 13. IV Model (IVProbit) for CHE25 – This file has two tables. Table S13.1 provides IV Model for CHE25 with PMJAY-enrolment as a variable. Table S13.2 provides IV Model for CHE25 with PFHI-enrolment as a variable.

Research paper thumbnail of Additional file 12 of Performance of India's national publicly funded health insurance scheme, Pradhan Mantri Jan Arogaya Yojana (PMJAY), in improving access and financial protection for hospital care: findings from household surveys in Chhattisgarh state

Additional file 12. IV Model (IVProbit) for CHE10 – This file has two tables. Table S12.1 provide... more Additional file 12. IV Model (IVProbit) for CHE10 – This file has two tables. Table S12.1 provides IV Model for CHE10 with PMJAY-enrolment as a variable. Table S12.2 provides IV Model for CHE10 with PFHI-enrolment as a variable.

Research paper thumbnail of Additional file 11 of Performance of India's national publicly funded health insurance scheme, Pradhan Mantri Jan Arogaya Yojana (PMJAY), in improving access and financial protection for hospital care: findings from household surveys in Chhattisgarh state

Additional file 11. Probit Model for CHE40 – This file has two tables. Table S11.1 provides Probi... more Additional file 11. Probit Model for CHE40 – This file has two tables. Table S11.1 provides Probit Model for CHE40 with PMJAY-enrolment as a variable. Table S11.2 provides Probit Model for CHE40 with PFHI-enrolment as a variable.

Research paper thumbnail of Additional file 9 of Performance of India's national publicly funded health insurance scheme, Pradhan Mantri Jan Arogaya Yojana (PMJAY), in improving access and financial protection for hospital care: findings from household surveys in Chhattisgarh state

Additional file 9. Probit Model for CHE10 – This file has two tables. Table S9.1 provides Probit ... more Additional file 9. Probit Model for CHE10 – This file has two tables. Table S9.1 provides Probit Model for CHE10 with PMJAY-enrolment as a variable. Table S9.2 provides Probit Model for CHE10 with PFHI-enrolment as a variable.

Research paper thumbnail of Additional file 1 of Performance of India's national publicly funded health insurance scheme, Pradhan Mantri Jan Arogaya Yojana (PMJAY), in improving access and financial protection for hospital care: findings from household surveys in Chhattisgarh state

Additional file 1. Study Variables - This table lists the variables used in the study.