David Grossmann, Swati Srivastava, Volker Winkler, Stephan Brenner, Keerti Jain Gupta, Amit Paliwal, Kavita Singh, Manuela De Allegri
{"title":"在印度受慢性病影响的农村贫困人口中，寻求门诊医疗保健行为的决定因素：一项在七个州进行的基于人口的横断面研究","authors":"David Grossmann, Swati Srivastava, Volker Winkler, Stephan Brenner, Keerti Jain Gupta, Amit Paliwal, Kavita Singh, Manuela De Allegri","doi":"10.1080/16549716.2025.2480413","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>A rising burden of chronic non-communicable diseases (CNCDs) increases demand for outpatient healthcare. Yet, evidence on preferences and barriers to healthcare services for India's most disadvantaged population, the target of India's largest public health insurance scheme (PM-JAY), is lacking.</p><p><strong>Objective: </strong>We explore determinants of outpatient healthcare-seeking behavior among PM-JAY eligible individuals with CNCDs in rural areas of seven states.</p><p><strong>Methods: </strong>Using cross-sectional data from a household survey (conducted between November 2019 and March 2020), we employed multilevel multinomial logistic regression to identify factors associated with seeking care from informal (home treatment, pharmacies, traditional healers), formal public, or formal private providers, compared with no care. Anderson's behavioral model informed the selection of independent variables.</p><p><strong>Results: </strong>Of 51,820 individuals, 5,061 (9.8%) reported a chronic condition. Despite their disease, 1,168 (23.1%) reported not using regular outpatient care. Another 2,421 individuals (48.0%) used formal private, 922 (18.3%) used formal public, and 535 (10.6%) used informal care. Predictors of formal private care were higher socioeconomic status (RRR = 2.441, 95% CI [1.61, 3.70]) and health insurance coverage (RRR = 1.478, 95% CI [1.12, 1.95]). Residents of Tamil Nadu, Kerala, and Gujarat were more likely to use formal public care (RRR = 23.915, 95% CI [9.01, 63.44]). Suffering from Major CNCDs or experiencing limitations in daily activities increased the probability of using healthcare across all options.</p><p><strong>Conclusion: </strong>Future research should explore the reasons for non-utilization of chronic care and the preference for private providers. Policies to enhance public healthcare utilization and expand insurance for outpatient care could improve access and reduce health inequities.</p>","PeriodicalId":49197,"journal":{"name":"Global Health Action","volume":"18 1","pages":"2480413"},"PeriodicalIF":2.2000,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11998304/pdf/","citationCount":"0","resultStr":"{\"title\":\"Determinants of outpatient healthcare-seeking behaviors among the rural poor affected by chronic conditions in India: a population-based cross-sectional study in seven states.\",\"authors\":\"David Grossmann, Swati Srivastava, Volker Winkler, Stephan Brenner, Keerti Jain Gupta, Amit Paliwal, Kavita Singh, Manuela De Allegri\",\"doi\":\"10.1080/16549716.2025.2480413\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>A rising burden of chronic non-communicable diseases (CNCDs) increases demand for outpatient healthcare. Yet, evidence on preferences and barriers to healthcare services for India's most disadvantaged population, the target of India's largest public health insurance scheme (PM-JAY), is lacking.</p><p><strong>Objective: </strong>We explore determinants of outpatient healthcare-seeking behavior among PM-JAY eligible individuals with CNCDs in rural areas of seven states.</p><p><strong>Methods: </strong>Using cross-sectional data from a household survey (conducted between November 2019 and March 2020), we employed multilevel multinomial logistic regression to identify factors associated with seeking care from informal (home treatment, pharmacies, traditional healers), formal public, or formal private providers, compared with no care. Anderson's behavioral model informed the selection of independent variables.</p><p><strong>Results: </strong>Of 51,820 individuals, 5,061 (9.8%) reported a chronic condition. Despite their disease, 1,168 (23.1%) reported not using regular outpatient care. Another 2,421 individuals (48.0%) used formal private, 922 (18.3%) used formal public, and 535 (10.6%) used informal care. Predictors of formal private care were higher socioeconomic status (RRR = 2.441, 95% CI [1.61, 3.70]) and health insurance coverage (RRR = 1.478, 95% CI [1.12, 1.95]). Residents of Tamil Nadu, Kerala, and Gujarat were more likely to use formal public care (RRR = 23.915, 95% CI [9.01, 63.44]). Suffering from Major CNCDs or experiencing limitations in daily activities increased the probability of using healthcare across all options.</p><p><strong>Conclusion: </strong>Future research should explore the reasons for non-utilization of chronic care and the preference for private providers. 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Determinants of outpatient healthcare-seeking behaviors among the rural poor affected by chronic conditions in India: a population-based cross-sectional study in seven states.
Background: A rising burden of chronic non-communicable diseases (CNCDs) increases demand for outpatient healthcare. Yet, evidence on preferences and barriers to healthcare services for India's most disadvantaged population, the target of India's largest public health insurance scheme (PM-JAY), is lacking.
Objective: We explore determinants of outpatient healthcare-seeking behavior among PM-JAY eligible individuals with CNCDs in rural areas of seven states.
Methods: Using cross-sectional data from a household survey (conducted between November 2019 and March 2020), we employed multilevel multinomial logistic regression to identify factors associated with seeking care from informal (home treatment, pharmacies, traditional healers), formal public, or formal private providers, compared with no care. Anderson's behavioral model informed the selection of independent variables.
Results: Of 51,820 individuals, 5,061 (9.8%) reported a chronic condition. Despite their disease, 1,168 (23.1%) reported not using regular outpatient care. Another 2,421 individuals (48.0%) used formal private, 922 (18.3%) used formal public, and 535 (10.6%) used informal care. Predictors of formal private care were higher socioeconomic status (RRR = 2.441, 95% CI [1.61, 3.70]) and health insurance coverage (RRR = 1.478, 95% CI [1.12, 1.95]). Residents of Tamil Nadu, Kerala, and Gujarat were more likely to use formal public care (RRR = 23.915, 95% CI [9.01, 63.44]). Suffering from Major CNCDs or experiencing limitations in daily activities increased the probability of using healthcare across all options.
Conclusion: Future research should explore the reasons for non-utilization of chronic care and the preference for private providers. Policies to enhance public healthcare utilization and expand insurance for outpatient care could improve access and reduce health inequities.
期刊介绍：
Global Health Action is an international peer-reviewed Open Access journal affiliated with the Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine at Umeå University, Sweden. The Unit hosts the Umeå International School of Public Health and the Umeå Centre for Global Health Research.
Vision: Our vision is to be a leading journal in the global health field, narrowing health information gaps and contributing to the implementation of policies and actions that lead to improved global health.
Aim: The widening gap between the winners and losers of globalisation presents major public health challenges. To meet these challenges, it is crucial to generate new knowledge and evidence in the field and in settings where the evidence is lacking, as well as to bridge the gaps between existing knowledge and implementation of relevant findings. Thus, the aim of Global Health Action is to contribute to fuelling a more concrete, hands-on approach to addressing global health challenges. Manuscripts suggesting strategies for practical interventions and research implementations where none already exist are specifically welcomed. Further, the journal encourages articles from low- and middle-income countries, while also welcoming articles originated from South-South and South-North collaborations. All articles are expected to address a global agenda and include a strong implementation or policy component.
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