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      Utilization of alternative systems of medicine as health care services in India: Evidence on AYUSH care from NSS 2014

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          Abstract

          AYUSH, an acronym for Ayurveda, Yoga and Naturopathy, Unani, Siddha, Sowa-Rigpa and Homeopathy represents the alternative systems of medicine recognized by the Government of India. Understanding the patterns of utilization of AYUSH care has been important for various reasons including an increased focus on its mainstreaming and integration with biomedicine-based health care system. Based on a nationally representative health survey 2014, we present an analysis to understand utilization of AYUSH care across socioeconomic and demographic groups in India. Overall, 6.9% of all patients seeking outpatient care in the reference period of last two weeks have used AYUSH services without any significant differentials across rural and urban India. Importantly, public health facilities play a key role in provisioning of AYUSH care in rural areas with higher utilization in Chhattisgarh, Kerala and West Bengal. Use of AYUSH among middle-income households is lower when compared with poorer and richer households. We also find that low-income households display a greater tendency for AYUSH self-medication. AYUSH care utilization is higher among patients with chronic diseases and also for treating skin-related and musculo-skeletal ailments. Although the overall share of AYUSH prescription drugs in total medical expenditure is only about 6% but the average expenditure for drugs on AYUSH and allopathy did not differ hugely. The discussion compares our estimates and findings with other studies and also highlights major policy issues around mainstreaming of AYUSH care.

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          Correcting the concentration index.

          In recent years attention has been drawn to several shortcomings of the Concentration Index, a frequently used indicator of the socioeconomic inequality of health. Some modifications have been suggested, but these are only partial remedies. This paper proposes a corrected version of the Concentration Index which is superior to the original Concentration Index and its variants, in the sense that it is a rank-dependent indicator which satisfies four key requirements (transfer, level independence, cardinal invariance, and mirror). The paper also shows how the corrected Concentration Index can be decomposed and generalized.
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            Econometric analysis

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              ‘First we go to the small doctor’: First contact for curative health care sought by rural communities in Andhra Pradesh & Orissa, India

              Background & objectives: Against the backdrop of insufficient public supply of primary care and reports of informal providers, the present study sought to collect descriptive evidence on 1st contact curative health care seeking choices among rural communities in two States of India - Andhra Pradesh (AP) and Orissa. Methods: The cross-sectional study design combined a Household Survey (1,810 households in AP; 5,342 in Orissa), 48 Focus Group Discussions (19 in AP; 29 in Orissa), and 61 Key Informant Interviews with healthcare providers (22 in AP; 39 in Orissa). Results: In AP, 69.5 per cent of respondents accessed non-degree allopathic practitioners (NDAPs) practicing in or near their village; in Orissa, 40.2 per cent chose first curative contact with NDAPs and 36.2 per cent with traditional healers. In AP, all NDAPs were private practitioners, in Orissa some pharmacists and nurses employed in health facilities, also practiced privately. Respondents explained their choice by proximity and providers’ readiness to make house-calls when needed. Less than a quarter of respondents chose qualified doctors as their first point of call: mostly private practitioners in AP, and public practitioners in Orissa. Amongst those who chose a qualified practitioner, the most frequent reason was doctors’ quality rather than proximity. Interpretation & conclusions: The results of this study show that most rural persons seek first level of curative healthcare close to home, and pay for a composite convenient service of consulting-cum-dispensing of medicines. NDAPs fill a huge demand for primary curative care which the public system does not satisfy, and are the de facto first level access in most cases.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                4 May 2017
                2017
                : 12
                : 5
                : e0176916
                Affiliations
                [1 ]Associate Fellow, Observer Research Foundation, New Delhi, India
                [2 ]Population Research Centre, Institute of Economic Growth, Delhi University North Campus, Delhi, India
                Universita degli Studi di Firenze, ITALY
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                • Conceptualization: SR WJ.

                • Data curation: WJ A. Kalra A. Kumar.

                • Formal analysis: SR WJ.

                • Investigation: SR WJ A. Kalra A. Kumar.

                • Methodology: SR WJ.

                • Supervision: WJ.

                • Validation: SR WJ A. Kalra A. Kumar.

                • Visualization: A. Kumar WJ.

                • Writing – original draft: SR WJ A. Kalra.

                • Writing – review & editing: SR WJ A. Kalra A. Kumar.

                Author information
                http://orcid.org/0000-0003-3282-658X
                Article
                PONE-D-16-30654
                10.1371/journal.pone.0176916
                5417584
                28472197
                25b3df33-458e-4683-96e9-d80988d67078
                © 2017 Rudra et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 2 August 2016
                : 19 April 2017
                Page count
                Figures: 2, Tables: 7, Pages: 20
                Funding
                The author(s) received no specific funding for this work.
                Categories
                Research Article
                People and Places
                Geographical Locations
                Asia
                India
                Medicine and Health Sciences
                Health Care
                Patients
                Outpatients
                Medicine and Health Sciences
                Complementary and Alternative Medicine
                Traditional Medicine
                Medicine and Health Sciences
                Complementary and Alternative Medicine
                Homeopathy
                Earth Sciences
                Geography
                Geographic Areas
                Urban Areas
                Medicine and Health Sciences
                Health Care
                Health Care Policy
                Medicine and Health Sciences
                Complementary and Alternative Medicine
                Naturopathy
                Medicine and Health Sciences
                Health Care
                Health Care Providers
                Custom metadata
                All relevant data are within the paper and its Supporting Information files. The analysis is based on anonymized secondary data from household surveys conducted by the National Sample Survey Organization (NSSO), Government of India and is available in the public domain.

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                Uncategorized

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