Public Health Care Delivery System Research Articles

Machine Learning in Medicare Fraud Detection: Safeguarding Public Resources

Fraud in receipt and provision of Medicare is one of the most dangerous threats to public healthcare delivery systems, wasting billions of dollars annually and distorting the foundations upon which healthcare solutions are based. Conventional approaches to identifying fraud have become ineffective owing to the new and complex techniques undertaken by fraudsters. Through this paper, an effort is made to discuss the role of ML in identifying and combating Medicare fraud, specifically to preserve public assets. Using supervised learning, unsupervised learning, and deep learning are promising methods to detect patterns that are possibly related to fraud activities. Applying these techniques can help analyze a huge amount of data, learn from precedents, and identify elaborate and sophisticated trends that are hardly discernable using traditional approaches. This paper will provide an extensive investigation of various ML approaches to Medicare fraud detection. At this step, we experimentally analyze the most popular and effective ones, like decision trees, random forests, SVM, creative neural networks, and clusters. From the results obtained, it is clear that these advanced ML techniques can enhance the performance of fraud detection methods by dramatically minimizing false positives and enhancing the early detection of fraudsters in claims processing. In addition, the ethical concerns, future prospects, and difficulties of employing ML in this particular field. The use of machine learning in Medicare fraud prevention and identification mechanisms to prevent fraud greatly has the potential to transform the protection of public resources, which is crucial to ensuring that healthcare funds are used optimally.

Assessment of the Indian Public Healthcare Delivery System and Its Comparison with Public Healthcare Delivery of Global Nations Based on Their Gross Domestic Products Potential as Criteria: A Comparative Study

Aim: The aim of this study is to analyze the Indian public healthcare delivery system and compare it with other countries based on their gross domestic product (GDP) classification. Materials and Methods: The study was conducted to assess the Indian healthcare delivery system and the GDP among global nations based on their GDP potential as criteria. The data from 24 high-, middle-, and low-income countries were gathered from the World Bank from year 2018 to 2021. The parameters included GDP, GDP per capita, total number of population, and healthcare delivery system. The data were collected from various electronic sources of the World Health Organization, the International Monetary Fund, and the US Census Bureau’s international data, National Health Profile 2021. The collected data were compiled and tabulated. The descriptive analysis was done using Microsoft Excel version 2016 and SPSS version 20. Results: India ranks in the high-income group based on the GDP, whereas when ranked based on GDP per capita, it drops down to the lower-middle-income group. This lag may be because of a larger population and lack of priority in public health delivery. In terms of overall expenditure, India spends US$63 million in total health expenditure, of which only US$20 million is spent by the government sector. On the other hand, the United States holds the highest rank with US$10,921 million of total health expenditure, of which US$5,552 million spent by the government sector and US$5,368 million by the private sector. Conclusion: The Indian healthcare delivery system is suffering from a shortage of public health workforce and infrastructure. In the last decade, India has seen remarkable economic development, particularly in terms of the GDP growth rate. Unfortunately, this progress does not accompany with the Indian healthcare delivery system. Still there is a shortage in public health workforce and infrastructure. India should prioritize the expenditure in healthcare delivery.

Kerala’s progress towards universal health coverage: the road travelled and beyond

BackgroundKerala has initiated many Universal Health Coverage (UHC) reforms in the last decade. The Aardram Mission launched in 2017 stands out owing to its scope, objectives, and commitments for strengthening Primary Health Care (PHC) in the State. The current study proposes to explore access and financial protection through the lens of equity in Kerala especially in the context of major UHC reforms carried out during the last decade. This paper will also highlight the key lessons from Kerala’s approach towards UHC and health systems strengthening through a political economy approach.MethodsData from the Kerala state sample of 75th Round (2017-18) National Sample Survey is used for this study. Comparison is also drawn from the 71st Round Sample Survey, 2014, to measure the state’s progress in terms of access and financial protection. Logistic regression was used for the calculation. The findings were further explored through a political economy approach.ResultsThe share of public facilities for outpatient care is 47.5%, which is a significant increase from 34.0% (in 2014) in the state. The share of public sector for out-patient care has increased for the lower socio-economic population in the state. The share of public sector for in-patient care has also increased to 37.3% in 2017-18 from 33.9% in 2014, but not to the extent as the increase shown in outpatient care. The average out-of-pocket-expenditure during hospitalization has increased more in private facilities as compared to public for both outpatient care and hospitalization.ConclusionsOverall increase in the share of public facilities for both outpatient care and hospitalization is indicative of the enhanced trust among the people at large of the public healthcare delivery system in Kerala, post the launch of UHC reforms in the State. The insurance linked UHC reforms would be insufficient for the State to progress further towards UHC. Kerala with a long and successful history in ‘public provisioning’ should focus more on strengthening PHC through Aardram Mission in its journey towards pursuit of UHC.

Artificial Intelligence in Healthcare With an Emphasis on Public Health.

Artificial Intelligence (AI), since its inception, has revolutionized multiple sectors, including healthcare in the 20th century, and has applications in data interpretation, leading to advancements in diagnostics, therapeutics, and clinical decision-making.AI is referred to as the capability of a software program to accurately analyze extrinsic information and utilize it for accomplishing desired goals and objectives through appropriate flexibility. It makes use of complicated operative algorithms to excel in humanlearning potential with overwhelming abilities to interpret large sets of data. The scope and implications of AI are consistently amplifying and have contributed significantly in nearly all phases of human life, especially healthcare. The integration of AI-related advancements would surely ameliorate the delivery of healthcare by allowing its accessibility, affordability, and level of care provided. For instance, reading CT scans is feasible by both AI as well as a radiologist. The screening of Tuberculosis is possible through AI via Chest X-rays with comparability in performance as molecular testing and mammography scans can predict the onset of breast cancer prior to the appearance of the ocular signs. Therefore, AI has been realized as one of the core areas by researchers and the governmentfor public health benefit. For the same reason, it is imperative to adopt an ethically sound policy framework for guiding the further development of AI-based technologies and their application in public health. AI-based interpretations themselves cannot be fully trusted for their diagnostic decisions and judgements, and hence, it is vital to assess their accountability through all phases of development and deployment in the field of health. This article emphasizes the advancements in AI-based technologies, their assistance in public healthcare delivery systems, and their merits and demerits. It also explores the various ethical directives that need to be adhered to while utilizing it for public health welfare.

The San Francisco Health Systems Collaborative: Public Health and Health Care Delivery Systems’ Response to the Covid-19 Pandemic

The Covid-19 pandemic challenged health care delivery systems worldwide. Many acute care hospitals in communities that experienced surges in cases and hospitalizations had to make decisions such as rationing scarce resources. Hospitals serving low-income communities, communities of color, and those in other historically marginalized or vulnerable groups reported the greatest operational impacts of surges. However, cross-institutional collaborations within jurisdictions offer unique opportunities to prevent or mitigate health disparities in resource utilization and access to care. In January 2020, in response to the emerging coronavirus epidemic, the San Francisco Department of Public Health (SFDPH) and local hospital and health systems partners convened to align and coordinate medical surge planning and response. Adopting a governance structure of mutual accountability and transparency, the San Francisco Health Systems Collaborative guided local medical and public health response in the areas of medical surge, vaccination administration, testing, and therapeutics. Four principles guided the collaborative response: (1) shared priorities, (2) clear governance and accountability, (3) data transparency, and (4) operational coordination. High-level priorities established included protecting vulnerable people, protecting health care workers, and maintaining health system capacity. The governance structure consisted of three layers: local hospital and health systems’ CEOs coordinating with SFDPH executives; hospital chief medical and nursing officers coordinating high-level surge capacity assessments and mitigation plans; and local clinical operational managers working with public health response operational leaders to coordinate scarce resource utilization. Fluctuating with the tempo of the disease indicators and medical surge, governance and coordination were maintained through a tiered meeting and reporting system. Data visibility and transparency were key principles facilitating operational decision-making and executive-level coordination of resources, including identifying additional surge bed capacity for use systemwide, as well as ensuring efficient and equitable vaccine distribution through implementation of five mass-vaccination sites with prioritized access for vulnerable communities. Applying these four principles of shared priorities, accountability, transparency, and operational coordination and pragmatism helped the public health and individual hospital systems make contributions to the overall response that were aligned with their unique strengths and resources. Publication here represents the first official public use of the name San Francisco Health Systems Collaborative (which had served as the term used internally to refer to the group) and the first time codifying this structure. Through this coordination, San Francisco achieved one of the lowest Covid-19 death rates and had one of the highest vaccination and booster rates, compared with rates across California or the United States. Similar principles and implementation methods can be adopted by other health jurisdictions for future emergency outbreak response.

Exploring help-seeking pathways and disparities in substance use disorder care in India: A multicenter cross-sectional study.

Substance use disorders (SUDs) are among the leading causes of morbidity in the population. In low- and medium-income countries like India, there is a wide treatment gap for SUD. A multicentric study on the care pathways for SUD in India can help to understand service provision, service utilization, and challenges to improve existing SUD care in India. We aimed to map pathways to care in SUD. We compared the clinical and demographic characteristics of patients who first consulted specialized services versus other medical services. This was a cross-sectional study of consecutive, consenting adults (18-65 years) with SUD registered to each of the nine participating addiction treatment services distributed across five Indian regions. We adapted the World Health Organization's pathway encounter form. Of the 998 participants, 98% were males, 49.4% were rural, and 20% were indigenous population. Addiction services dominated initial (50%) and subsequent (60%) healthcare contacts. One in five contacted private for-profit healthcare. Primary care contact was rare (5/998). Diverse approaches included traditional healers (4-6%) and self-medication (2-8%). There was a 3-year delay in first contact; younger, educated individuals with opioid dependence preferred specialized services. There is a need to strengthen public healthcare infrastructure and delivery systems and integrate SUD treatment into public healthcare.

Need for operational simplicity and timely disbursal of benefits—a qualitative exploration of the implementation of a direct benefit transfer scheme for persons with tuberculosis in India

BackgroundNi-kshay Poshan Yojana (NPY) is a direct benefit transfer scheme of the Government of India introduced in 2018 to support the additional nutritional requirements of persons with TB (PwTB). Our recent nationwide evaluation of implementation and utilization of NPY using programmatic data of PwTB from nine randomly selected Indian states, reported a 70% coverage and high median delay in benefit credit. We undertook a qualitative study between January and July 2023, to understand the detailed implementation process of NPY and explore the enablers and barriers to effective implementation and utilization of the NPY scheme.MethodsWe followed a grounded theory approach to inductively develop theoretical explanations for social phenomena through data generated from multiple sources. We conducted 36 in-depth interviews of national, district and field-level staff of the National Tuberculosis Elimination Programme (NTEP) and NPY beneficiaries from 30 districts across nine states of India, selected using theoretical sampling. An analytical framework developed through inductive coding of a set of six interviews, guided the coding of the subsequent interviews. Categories and themes emerged through constant comparison and the data collection continued until theoretical saturation.ResultsStakeholders perceived NPY as a beneficial initiative. Strong political commitment from the state administration, mainstreaming of NTEP work with the district public healthcare delivery system, availability of good geographic and internet connectivity and state-specific grievance redressal mechanisms and innovations were identified as enablers of implementation. However, the complex, multi-level benefit approval process, difficulties in accessing banking services, perceived inadequacy of benefits and overworked human resources in the NTEP were identified as barriers to implementation and utilization.ConclusionThe optimal utilization of NPY is enabled by strong political commitment and challenged by its lengthy implementation process and delayed disbursal of benefits. We recommend greater operational simplicity in NPY implementation, integrating NTEP activities with the public health system to reduce the burden on the program staff, and revising the benefit amount more equitably.

Mapping the Geographic Inequalities in Psychiatrist Distribution across Madhya Pradesh, India: An Exploratory Study

Objective: The National Mental Health Survey identified a vast treatment gap across India. This treatment gap is partly attributed to the availability and accessibility of mental health services in different states. Accessibility to a psychiatrist in Madhya Pradesh (MP) is essential due to the significant disparity among urban, rural, and tribal regions across the state. The study attempted to identify the geographical disparity of psychiatrists in MP to improve future mental health service delivery. Methods: An online survey of practicing psychiatrists was conducted in December 2022 in the settings of public and private healthcare service delivery systems through offline and online accessibility/availability of psychiatrists practicing in MP, and the data were mapped using geo-locations of psychiatrists and were analyzed using ArcMap 10.8.1. Results: In total, 152 psychiatrists were practicing in MP across 195 locations, which amounts to 0.21 psychiatrists per 100,000 population with a concentration around big cities. Out of 54 districts, 24 districts did not have any practicing psychiatrists. A total of 155 health facilities were identified across 30 (55.6%) districts where at least one psychiatrist provided mental health services. The nearest-neighbor index for 152 points was –13.69. Conclusions: Combining psychiatrist geo-mapping data with population data comprehensively explains the MP state’s mental health service delivery needs. It could be wise to improve the spatial distribution of psychiatrists in each district rather than achieving the recommended ratio of doctors to patients per state. These data need to be supplemented with qualitative inquiry to help policymakers and health planners generate effective public–private partnerships in mental health service delivery in the coming time.

563 Team Science to Assess Effectiveness and Impact in Public Healthcare Delivery System Contracting

OBJECTIVES/GOALS: Healthcare organizations and payers are moving from accountability to effectiveness frameworks. Static vendor contracts for full-scale implementation limit organizations' ability to evaluate impact before scale-up, or to iteratively improve. Our team science innovation employs science and learning methods as systems engage vendors. METHODS/STUDY POPULATION: Our team science innovation is a method to assess and model impact of interventions at scale in healthcare delivery systems. We are integrating expertise in learning processes of an academic medical center (UCLA CTSI) with the organizational knowledge and methodological expertise of the nation’s largest Medicaid managed care plan (LA Care Health Plan), which has over 2 million members. The LA Care Advanced Analytics Lab has unique capability in machine learning, while enables deep learning of variation. Our innovative product is a template to quickly mobilize evaluation and learning for a diverse population in a varied and distributed delivery system. The template design enables rapid learning for the full-scale policy implementation often imposed by government, and in the short timeframes involved. RESULTS/ANTICIPATED RESULTS: LA Care and the UCLA CTSI partnered to provide subject matter expertise and design effective pilots for interventions such as transitional care services, complex care management, and physician home visit strategies, accounting for confounding factors affecting the intervention and outcome. So far, collaborative modeling and design has produced a successful pilot of a physician home visit program intended to reduce avoidable emergency department visits. This pilot quickly revealed several major changes that would need to be incorporated for the contracted vendor to produce results if operated at scale, further informed by machine learning, in sufficient time to inform the contracting process. There are multiple evolving applications, including housing/homelessness. DISCUSSION/SIGNIFICANCE: Integrating the large data and analytics of a large healthcare organization with learning methods from the CTSI -- including learning from variation and designs for studying impact during scale-up -- fosters academic-community team science that could significantly improve the value of our largest delivery systems, public and commercial.

A Study on the Attitude and Perception of Bachelor of Medicine and Bachelor of Surgery (MBBS) Students Regarding Post-MBBS Compulsory Service Bond in Uttar Pradesh, India.

Background To increase the availability of doctors in the public healthcare delivery system, the state government of Uttar Pradesh, India, has implemented a two-year compulsory service bond since 2018. Students of the 2018 batch are going to complete their Bachelor of Medicine, Bachelor of Surgery (MBBS) in 2023 and are supposed to serve through this bond. There are many dilemmas in the minds of medical students regarding their compulsory service bond. Hence, there is a need to know their attitude and perceptions regarding the compulsory service bond. This study was conducted to assess the attitude and perception of undergraduate medical students toward compulsory service bonds. Methods This was a mixed-method study conducted in July-September 2022 among undergraduate medical students at Baba Raghav Das Medical College, Gorakhpur, Uttar Pradesh, India. For quantitative data, a structured questionnaire was developed using Google Forms (Google LLC, Mountain View, California, United States) and circulated via WhatsApp (Meta Platforms, Inc., Menlo Park, California, United States) through the random sampling method. Focused group discussions were carried out to collect the qualitative data. Result Regarding the compulsory service bond after MBBS, 100 (31.8%) medical students were found to be interested and 56 (17.8%) were disinterested. The majority (n=158; 50.4%) of participants were neutral, while 278 (88.6%) medical students perceived it as an opportunity to help poor people. Higher possibilities of social recognition and respectwere some noticeable perceptions of 243 (77.4%) MBBS students. Lack of confidenceto tackle serious cases without a senior doctor's supervision was perceived as an important hurdle by 286 (91%) participants. Non-availability of advanced medical facilities, issues like the safety of doctors, and the lack of availability of electricity, roads, and infrastructure were also perceived as hurdles. Conclusions and recommendations Students perceived thecompulsory service bond as an opportunity if met with certain conditions like a transparent method of posting and basic facilities or an incentive for accommodation and transportation. The compulsory service bond for addressing the shortfall of doctors in the public healthcare delivery system may be more effective if these hurdles are corrected and certain opportunities are met, as mentioned in the present study. This will help the government move smoothly towards achieving Universal Health Coverage (UHC).

Supporting Evidence-Based Care Through Informatics Innovation to Address the Overdose Epidemic.

Supporting Evidence-Based Care Through Informatics Innovation to Address the Overdose Epidemic.

Assessment of educational environment of midwifery students in Auxillary Nurse and Midwifery Institutes, Tamil Nadu – A descriptive study

Introduction: Tamil Nadu has a well-established public health-care delivery system with the Auxiliary Nurse and Midwifery (ANM) or Village Health Nurses. They learn and qualify for their job from ANM institutes and become the key field level functionary who interacts directly with the community. Their ability to provide quality community care is largely determined by the quality of ANM education they receive during their training. Hence, this study aimed to assess the perception of these students to facilitate a conducive educational environment. Methods: A descriptive study was carried out among 244 ANM students from across 10 randomly selected government ANM schools in Tamil Nadu. A self-administered Dundee Ready Educational Environment Measure (DREEM) questionnaire was used for assessment. The data was analyzed using EpiData. Results: Among the 244 students enrolled in the study, the mean (standard deviation) global DREEM score was 167.39 (±18.06). Student's academic perception was the highest (91%), followed by student's perception of atmosphere (84.2%), learning (84%), and teachers (83.5%), and the least average score was from student's social self-perception (74%). Conclusion: The study showed the nursing students' view on their academic learning environment as “more positive than negative,” Centers were also considered excellent, and this assessment would provide an useful guide into the areas that students felt “good” about, which should be reinforced and the weaker areas that need to be strengthened for better services.

Dengue fever in Nigeria: a mini review

Dengue is a disease caused by dengue virus. It is a major mosquito-borne viral disease of humans that is endemic in areas of tropical and subtropical regions, which are environmentally suitable for vector propagation. The disease poses a major threat to the overwhelmed and weak public healthcare delivery system in the developing world, especially in Africa where febrile illnesses are common. The disease undermines the fight against febrile illnesses as infection with dengue often remains undetected or misdiagnosed as malaria or other febrile diseases. This review article highlights dengue epidemiology in Nigeria, dengue transmission dynamics, pathogenesis, diagnosis and current interventions strategies, challenges in addressing dengue infection and future prospects towards dengue elimination. The literature search for publications on dengue virus infection in Nigeria was performed using Google Scholar, PubMed, Web of Science, African Journals Online and other scholarly online databases. Dengue remains a threat to Nigeria and other African countries. In Nigeria, the occurrence of this infection remains a low priority in the public health sector even though it has been reported in about 17 states across the country. The reports of dengue infection in all the geo-political zones suggests active transmission of dengue, hence the need to consider other etiologies of febrile illnesses and engage the public to sustain local involvement as local risk to dengue outbreaks is linked to the population’s knowledge, attitude and behavioral practices that encourage vector breeding

Unpacking the Financial Incentives in Health by Revisiting India’s “Safe Motherhood Program”

Abstract This paper investigates India’s nationwide health reform to understand its various channels of effect. The reform entitled socio-economically backward mothers with cash transfer if they chose to give birth at public health institutions, and simultaneously employed ASHAs as a direct link between pregnant women and the public healthcare delivery system. Using variations in mothers’ eligibility and differential implementation of ASHAs across states, birth-related outcomes are evaluated in a difference-in-difference framework. Results show that eligible mothers with both cash transfer and ASHA’s guidance outperformed those receiving only cash transfer, in institutional birth rate and timely initiation of breastfeeding. An improved outcome in the ASHA’s presence alongside the conditional cash transfer argues for the vitality of the former’s role in spreading information on the importance of health and the uptake of public healthcare.

Financial Toxicity: A Barrier to Achieving Health Equity in Cancer Care

Financial Toxicity: A Barrier to Achieving Health Equity in Cancer Care

The Disease Pattern and Utilisation of Health Care Services in Pakistan

Health is an important aspect of human life. In general terms, better health status of individuals reflects reduced illnesses, low level of morbidity, and less burden of disease in a given population. It is widely recognised that improved health not only lowers mortality, morbidity and level of fertility, but also contributes to increased productivity and regular school attendance of children as a result of fewer work days lost due to illness, which in turn have implications for economic and social well-being of the population at large. Hence investing in health is vital for promoting human resource development and economic growth in a country [World Bank (1993)]. A view of Pakistan’s health profile indicates that the sector has expanded considerably in terms of physical infrastructure and its manpower in both the public and private sector. This has contributed to some improvement in selected health status indicators over the years. However, the public health care delivery system has been inadequate in meeting the needs of the fast growing population and in filtering down its benefits to the gross-root level. As such, Pakistan still has one of the highest rates of infant and child mortality, total fertility and maternal mortality when compared with many other countries in the Asian region [UNDP (2000)]. Due to low priority given to social sector development in the past and low budgetary allocations made to the health sector, the evidence shows that mortality and morbidity indices have not reduced to the desired level and large gaps remain in the quality of care indicators, especially in rural areas [Federal Bureau of Statistics (2000)].

Healthcare providers’ and policymakers’ experiences and perspectives on barriers and facilitators to chronic disease self-management for people living with hypertension and diabetes in Cameroon

BackgroundHypertension and diabetes are chronic noncommunicable diseases ranked among the leading causes of morbidity and mortality in resource-limited settings. Interventions based on patient empowerment (PE) have been shown to be effective in the management of these diseases by improving a variety of important health outcomes. This study aims to examine from the healthcare providers’ and policymakers’ experiences and perspectives, the facilitators and barriers in the management of hypertension and diabetes for patient empowerment to achieve better health outcomes in the context of the healthcare system in Cameroon.MethodsWe carried out a qualitative study involving three levels of embedded analysis in a public primary healthcare delivery system in Cameroon, through 22 semi-structural interviews with healthcare providers and policymakers and 36 observations of physicians’ consultations. We combined thematic and lexicometric analyses to identify robust patterns of differences and similarities in the experiences and perspectives of healthcare providers and policymakers about direct and indirect factors associated with patients’ self-management of disease.ResultsWe identified 89 barriers and 42 facilitators at the central, organizational, and individual levels; they were preponderant at the organizational level. Factors identified by healthcare providers mainly related to self-management of the disease at the organizational and individual levels, whereas policymakers reported factors chiefly at the central and organizational levels. Healthcare providers involved in the decision-making process for the delivery of healthcare tended to have a sense of ownership and responsibility over what they were doing to help patients develop self-management abilities to control their disease.ConclusionWhile interventions focused on improving patient-level factors are essential to PE, there is a need for interventions paying more attention to organizational and political barriers to PE than so far. Interventions targeting simultaneously these multilevel factors may be more effective than single-level interventions.

Assessing Alignment of Patient and Clinician Perspectives on Community Health Resources for Chronic Disease Management.

Addressing social determinants of health (SDoH) is associated with improved clinical outcomes for patients with chronic diseases in safety-net settings. This qualitative study supplemented by descriptive quantitative analysis investigates the degree of alignment between patient and clinicians’ perceptions of SDoH resources and referrals in clinics within the public healthcare delivery system in San Francisco. We conducted a qualitative analysis of in-depth interviews, patient-led neighborhood tours, and in-person clinic visit observations with 10 patients and 7 primary care clinicians. Using a convergent parallel mixed methodology, we also completed a descriptive quantitative analysis comparing the categories of neighborhood health resources mentioned by patients or community leaders to the resources integrated into the electronic health record. We found that patients held a wealth of knowledge about neighborhood resources relevant to SDoH that were highly localized and specific to their communities. In addition, multiple stakeholders were involved in conducting SDoH screenings and referrals, including clinicians, system navigators such as case workers, and community-based organizations. Yet, the information flow between these stakeholders and patients lacked systematization, and the prioritization of social needs by patients and clinicians was misaligned, as represented by qualitative themes as well as quantitative differences in resource category distribution analysis (p < 0.001). Our results shed light upon opportunities for strengthening social care delivery in safety-net healthcare settings by improving patient engagement, clinic workflow, EHR engagement, and resource dissemination.

Private Sector Presence in Healthcare in India: Econometric Analysis of Patterns and Consequences

The presence of private providers in the Indian healthcare sector remains one of the most debated issues. This article attempts to contribute to this debate from the angle of the ultimate goal of healthcare provision—a healthy population. We explore whether private sector presence (PSP) has improved the general health status of the people. We develop a theoretical argument to hypothesize that PSP in India would lead to better health status through the route of competition-driven quality, which in turn could lead to adverse economic consequences. We use district-level secondary data from government sources to confirm our hypotheses using robust tools of applied econometrics, correcting for serious problems of endogeneity. Constructing a district-level index of PSP, we identify distinct spatial/geographical clusters, explained by socio-economic prosperity as well as demonstration effect. We also find a robust positive association between PSP and general health outcomes, accompanied by an adverse economic consequence of rising catastrophic out-of-pocket expenditure. In terms of policy, the article concludes that rather than restricting the growth of the private sector, the government must strengthen the quality of the existing public healthcare delivery system and ensure effective monitoring and regulation. JEL Codes: 110, 111, 112, 115

Zika, Nipah and Kala-azar: Emerging lethal infectious diseases amid COVID-19 as an escalating public health threat in South India

As of 6 June 2022, a sum 25,782 of active cases and 524,701 deaths due to Coronavirus disease-19 (COVID-19) have been recorded in India. Stewing in the flares of the pandemic, Kerala is entwined in the wrath of multiple emerging infectious diseases.India, a home to 1.3 billion people, recently faced a devastating second wave of COVID-19 during May of 2021, with a ruckus of chronic shortage of medicine, oxygen supplies, ventilators, besides, being challenged by secondary infections and chronic health ailments. The state of Kerala, alone contributes to 50% COVID-19 caseload, besides, recent simultaneous outbreaks of Zika Virus Disease (ZVD), Nipah Virus Disease (NiVD) and Kala-azar (black fever) on July 8, September 5 and 8, 2021 respectively. Syndemicity and a high case fatality rates of these highly contagious diseases coupled with post infection sequelae, overwhelm the already fragile healthcare system. Thus, these lethal infectious diseases along with an anticipated third wave of COVID-19 pose a serious public health threat in and around South India. With this narrative review, we aim to discuss the challenges that the emergence of intersecting outbreaks of Zika, Nipah, Kala-azar presents with, in the nation, amidst the global pandemic of COVID-19 and provide recommendations so as to help alleviate the situation.The syndemicity of COVID-19 with other infectious diseases, calls for adequate surveillance and monitoring of diseases’ outbreaks. To avoid the worst situations like pandemic, the health ministry, public and private health stakeholders in India should strengthen the public healthcare delivery system and providence of quick medical facilities to control the rate of mortality and morbidity during outbreaks.