Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Dec;18(1):2480413.
doi: 10.1080/16549716.2025.2480413. Epub 2025 Apr 14.

Determinants of outpatient healthcare-seeking behaviors among the rural poor affected by chronic conditions in India: a population-based cross-sectional study in seven states

David Grossmann  1 , Swati Srivastava  1 , Volker Winkler  1 , Stephan Brenner  1 , Keerti Jain Gupta  2 , Amit Paliwal  2 , Kavita Singh  1   3 , Manuela De Allegri  1
Affiliations

Determinants of outpatient healthcare-seeking behaviors among the rural poor affected by chronic conditions in India: a population-based cross-sectional study in seven states

David Grossmann et al. Glob Health Action. 2025 Dec.

Abstract

Background: A rising burden of chronic non-communicable diseases (CNCDs) increases demand for outpatient healthcare. Yet, evidence on preferences and barriers to healthcare services for India's most disadvantaged population, the target of India's largest public health insurance scheme (PM-JAY), is lacking.

Objective: We explore determinants of outpatient healthcare-seeking behavior among PM-JAY eligible individuals with CNCDs in rural areas of seven states.

Methods: Using cross-sectional data from a household survey (conducted between November 2019 and March 2020), we employed multilevel multinomial logistic regression to identify factors associated with seeking care from informal (home treatment, pharmacies, traditional healers), formal public, or formal private providers, compared with no care. Anderson's behavioral model informed the selection of independent variables.

Results: Of 51,820 individuals, 5,061 (9.8%) reported a chronic condition. Despite their disease, 1,168 (23.1%) reported not using regular outpatient care. Another 2,421 individuals (48.0%) used formal private, 922 (18.3%) used formal public, and 535 (10.6%) used informal care. Predictors of formal private care were higher socioeconomic status (RRR = 2.441, 95% CI [1.61, 3.70]) and health insurance coverage (RRR = 1.478, 95% CI [1.12, 1.95]). Residents of Tamil Nadu, Kerala, and Gujarat were more likely to use formal public care (RRR = 23.915, 95% CI [9.01, 63.44]). Suffering from Major CNCDs or experiencing limitations in daily activities increased the probability of using healthcare across all options.

Conclusion: Future research should explore the reasons for non-utilization of chronic care and the preference for private providers. Policies to enhance public healthcare utilization and expand insurance for outpatient care could improve access and reduce health inequities.

Keywords: Health services; India; Quality of Care for Chronic Conditions; low-and-middle-income countries; multinomial logistic regression; non-communicable diseases; primary health care; private sector; public sector; socio-economic; treatment.

Plain language summary

Main findings: Among India's rural populations, outpatient health service use for chronic non-communicable diseases is largely concentrated in the private sector and primarily determined by a patient's socioeconomic status.Added knowledge: We shed light on healthcare-seeking behavior for socioeconomically disadvantaged individuals eligible for India's largest publicly funded health insurance system and highlight substantial interstate disparities in public healthcare utilization.Global health impact for policy and action: To meet the 2030 Sustainable Development Goals, India's public healthcare system must be strengthened to provide equitable access to effective chronic disease treatment, improve health outcomes, and tackle the growing global burden of chronic non-communicable diseases.

PubMed Disclaimer

Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
Sampling strategy and data collection.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Bennett JE, Stevens GA, Mathers CD, et al. NCD countdown 2030: worldwide trends in non-communicable disease mortality and progress towards sustainable development goal target 3.4. Lancet. 2018;392:1072–14. doi: 10.1016/S0140-6736(18)31992-5 - DOI - PubMed
    1. World Health Organization . Non communicable diseases. [cited 2024 May 26]. Available from: https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases
    1. Reidpath DD, Allotey P.. The burden is great and the money little: changing chronic disease management in low– and middle–income countries. J Glob Health [Internet]. 2012;2. doi: 10.7189/jogh.02.020301 - DOI - PMC - PubMed
    1. Luna F, Luyckx VA. Why have non-communicable diseases been left behind? Asian Bioeth Rev. 2020;12:5–25. doi: 10.1007/s41649-020-00112-8 - DOI - PMC - PubMed
    1. Beaglehole R, Bonita R, Horton R, et al. Priority actions for the non-communicable disease crisis. Lancet. 2011;377:1438–1447. doi: 10.1016/S0140-6736(11)60393-0 - DOI - PubMed

LinkOut - more resources