TYPE I AND TYPE II ERRORS IN TARGETING HEALTH CARE RESOURCES: A CASE OF MEANS TESTING IN SELECTED PUBLIC SECTOR TERTIARY HEALTH FACILITIES IN KERALA, INDIA

Abstract

Developing country health systems are characterized by underfunded health care provision, distorted priorities in resource allocation, weak governance and regulatory structures, sub-optimal policy interventions. The central approach of the reforms has been two-fold: increasing efficiency in resource use and serve equity by excluding the high income groups and include only the poor in all publicity funded actions. The study tries to understand the existing system of means testing in public hospitals in Kerala, India by enquiring on the nature and institutional frame work for means testing as well as the characteristics of the major criteria used to assess means testing. The motivation behind the proposed study comes from the fact out-of pocket at the point of delivery of care for health care problems prove to be a strong barrier to effective utilization of health care, especially by the resource poor. For the purpose of study, means testing has been defined as ‘the criteria, methods and processes involved in classifying them in different gradients of economic and social purchasing power’. The study selected five major public hospitals in Kerala from three districts under Central (Federal) and State (provincial) government ownerships. All institutions have a defined user fee policy suggesting user fees as essential in tertiary care as it increases the compliance of medicines, makes the patients and providers responsible for the use/misuse, ensuring economic sustainability are the major reasons for supporting user fees. All the institutions have a graded pricing system with multiple layers except in provincial government run institutions where only two categories exist while some institutions have five categories. Institutions under the administrative control of the State (provincial) government of Kerala use possession of BPL cards as the sole criterion for categorization with BPL card holders get fully free care compared to full payment by the APL card holders. Despite the fact that these institutions have a declared policy of no patient would be denied of treatment due to inability to pay remains a questionable assurance.