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. Access Costs A recent

. Access Costs A recent study by Dash, Acharya, Muraleedhran and Vaidyanathan (2008) has studied the efficiency and other features of the public health care system in Tamil Nadu. They observe that access to health facilities continues to be a major problem in various parts of Tamil Nadu. One useful indicator of the state of public health care facilities is the extent of population covered by each Primary Health Centre (PHC) and Health Sub Centre (HSC). The Government of India has laid down population based norms for establishing primary health centre and health sub centre: 30,000 persons per PHC and 5000 per HSC in the plains; 20,000 persons per PHC and 3000 per HSC in hilly regions. For comparison in broad terms, however, Dash et. al. (2008) uses the same population norms across districts in each state. As per 2001 Census, several settlements/villages have no pubic health facilities within 10 km. It is shown that about 16 percent of villages in Tamil Nadu have no Public Health Centres (PHCs) within in a range of 10 km. In other words, 52 percent of villages in the state have no PHCs within a 5 km range. The conditions vary from district to district. The districts of Dharmapuri, Villupuram, Sivagangai, Virudhunagar, Pudukkottai and Karur suffer more than other districts, with about 60 percent of villages having no PHC within 5 kms. Thiruvarur, Nagapatinam and Thanjavur are the better-off districts, with nearly 60 percent of villages having a PHC within a 5 km range. They highlight the following features of Tamil Nadu health services: 1. The rural-urban differences in Death Rate (DR) and Infant Mortality Rate (IMR) have substantially declined over the years. Although urban DR has been far below the rural DR, it has shown less consistent fall and in fact exhibited a rather disturbing trend by remaining more or less constant for a decade since 1993. 2. The rural-urban differential in Birth Rate (BR) has fallen much more dramatically than DR and IMR over the same period. 3. Since the mid-1990s until recent years (2003-06), the relative positions of rural and urban areas with regard to DR have remained more or less unchanged. 4. The years 1984-90 witnessed a steep fall in BR and IMR. During the same period, neo-natal death rate hardly declined, and remained above 50, with rural areas showing a rate almost double that of urban areas. 5. The under-5 mortality rate has also shown a steady decline from 189 (in 1971) to140 (in 1980) and further from 81 (in 1990) to about 50 in 2003. 82

Regarding access costs in availing health services in Tamil Nadu the following points are highlighted: a. In Tamil Nadu, the out of pocket expenditure, or "direct medical expenditure", per visit for out patient (OP) care in a public facility was Rs 43, while it was Rs. 284 in private facility. It is noted that on an average, a rural patient spends 1.8 times per OP visit in public hospitals than his counterpart does in urban area (Rs.28). This difference is about 0.7 times in private facilities. b. Overall, the average out of pocket direct medical expenditure for OP care increases with economic status. This is true of both rural and urban areas. c. A rural patient visiting public facility on an average suffers a loss of income of Rs.80 per visit, which is nearly twice the amount lost by his counterpart in urban areas. For those visiting private facility, the difference in loss of income between urban and rural areas is not as significant as in public facilities. d. As for inpatient care in Tamil Nadu, out of pocket direct medical expenditure per hospitalization in a private facility was Rs. 11,130, which was nearly ten times the amount (Rs.928) spent per hospitalization in a public facility. e. Direct medical expenditure per hospitalization in a public facility in urban area was 2.4 times (Rs.1523) than that in rural area (Rs.633). Like-wise, the direct medical expenditure per hospitalization in a private facility in urban areas was 1.9 times (Rs.15995) than that in rural areas (Rs.8355). f. Overall, direct medical (out of pocket) expenditure per hospitalization increases with economic status, more perceptibly among those utilizing private facilities. On an average, loss of income due to hospitalization was around Rs.400 in Tamil Nadu, and did not show wide variations across rural/ urban and public/private facilities. As for indirect medical expenditure, public patients in rural areas on an average spent Rs.516 per hospitalization, compared to Rs. 338 by their counterparts in urban areas. In the private sector, patients from urban areas spent on an average Rs.774 towards indirect medical expenditure per hospitalization compared to Rs.588 by their counter parts in rural areas. These comparisons highlight the high access costs as well as the high private cost in seeking health services from public hospitals. c. Efficiency in Providing Health Services Dash et. al. (2008) also measure district-wise technical efficiency and scale efficiency using a data envelope analysis (DEA) for the public hospitals in Tamil Nadu. Of the 29 83

World Comparative Economic And Social Data
Nammakal - Tamil Nadu Police
Police Stations - Tamil Nadu Police
N u m b e r o f S c h o o l s - DISE
Census 2011 population of Latur district
PDF: 1.0MB - Population Reference Bureau