Abstract
Delivery of affordable healthcare services to communities is a necessary precondition to poverty alleviation. Co-creation approaches to the development of business models in the healthcare industry proved particularly suitable for improving the health-seeking behavior of BOP patients. However, scant research was conducted to understand BOP consumers’ decision-making process leading to specific healthcare choices in slum settings, and the relative balance of socio-cultural and socio-economic factors underpinning patients’ preferences. This article adopts a mixed-method approach to investigate the determinants of BOP patients’ choice between private and public hospitals. Quantitative analysis of a database, composed of 436 patients from five hospitals in Ahmedabad, India, indicates that BOP patients visit a public hospital significantly more than top-of-the-pyramid (TOP) patients. However, no significant difference emerges between BOP and TOP patients for inpatient or outpatient treatments. Qualitative findings based on 21 interviews with BOP consumers from selected slum areas led to the development of a grounded theory model, which highlights the role of aspirational demand of BOP patients toward private healthcare providers. Overall, healthcare provider choice emerges as the outcome of a collective socio-cultural decision-making process, which often assigns preference for private healthcare services because of the higher perceived quality of private providers, while downplaying affordability concerns. Implications for healthcare providers, social entrepreneurs, and policy-makers are discussed.
Highlights
There is a major discrepancy in the global economic market; private-sector companies continually seek to reach economically well-off consumers, while simultaneously ignoring a vast majority of the world population, estimated to be over four billion [1]
Recent base of the pyramid (BOP) studies, recognized that BOP solutions should primarily be socio-culturally acceptable, leverage needs awareness, and promote accessibility, in addition to meeting affordability constraints [21]. This framework is relevant in the case of healthcare services [23]. In accordance with these recent developments, and in an attempt to contribute to the progress of the BOP scholarship, the present study considers the determinants of the choice of BOP patients between public and private healthcare providers, with a focus on the role played by socio-cultural acceptability in the decision-making process
In the private hospitals, most patients came from the TOP areas (72.2%), while, in the public hospitals, the majority of patients came from the BOP areas (59%)
Summary
There is a major discrepancy in the global economic market; private-sector companies continually seek to reach economically well-off consumers, while simultaneously ignoring a vast majority of the world population, estimated to be over four billion [1]. BOP proponents argue that private-sector involvement in the BOP market would lead to poverty eradication and improvement in the quality of life [1,2,7]. This view gained momentum in the last few years, after the United Nations’ (UN) release of the 17 Sustainable Development Goals (SDGs) in support of the development agenda 2015–2030. The private sector accounted for 79% of the outpatient care for people living below the poverty line in India [34], which suggests a difference in the degree to which BOP vs TOP patients resort to private or public hospitals for inpatient vs outpatient healthcare services. The public sector accounted for the largest share of care in the domain of vaccination (93%), prenatal care (74%), inpatient bed days (66%), and inpatient bed days concerning childbirth (63%) [37]
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