Managing health outcomes through local governance
Date
2012-05
Journal Title
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Publisher
National Council of Applied Economic Research (NCAER), New Delhi, IN
Abstract
Has the devolution of responsibilities and finances to local governments in India
produced positive impacts on health status and incomes of men and women?
Using a national data set with details on health, health seeking behavior and local
governance, we estimate a system of simultaneous equations to analyze the
incidence of illness via a health production function and show that health care
expenditures at the household level, choice of health care provider by members,
and the incidence of illness will jointly impact individual incomes. The incidence
of illness is significantly reduced by better access to drinking water, clean
surroundings and awareness about health campaigns. Discussions of health issues
in the Gram Sabha reduce illnesses for both men and women and their private
health expenditures. Reserving the position of the village head to women leads to
greater participation in Gram Sabha meetings; better problem resolution in water
supply, sanitation and health; greater village health expenditures; and greater
satisfaction with access to health. The increased expenditures of Panchayats on
health care reduce the incidence of illness three times more for women than for
men, but reduce their private health care expenditures about equally. It also shifts
the choice of health care providers from private to public facilities, more so for
women than for men. Family inheritance increase the use of private health care
for both genders, while a woman’s individual land inheritance increases her use of
both public and private health care. While women do not have lower access to
health care or are discriminated within the household in terms of access to
different providers, their earnings are adversely affected to a greater degree by
illness compared to that of men. Women’s private health expenditures tend to
improve their incomes more compared to that of men.
Description
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Working Paper
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Keywords
POLITICAL AGENCY, GENDER, HEALTH, HEALTH ADMINISTRATION, DECENTRALIZATION, LOCAL GOVERNMENT, HOUSEHOLD INCOME, HEALTH EXPENDITURE, RURAL AREAS, GENDER ROLES, INDIA