An estimation of willingness to pay for secondary health care services in Tamil Nadu, India


  • K Ramu Department of EconomicsAnnamalai UniversityAnnamalai NagarTamil Nadu 608 002India





Willingness to Pay, Secondary Healthcare Services, User Fee, Public Health, Private Health, Acute and Chronic Diseases and Cost.


The present study has estimated the willingness to pay (WTP) for secondary health care services (SHCS) in rural and urban environment of three districts in the state of Tamil Nadu during 2009-2011. Since the governments are struggling to mobilise additional financial        resources to provide essential health care services to the deprived population in the country, assessing the WTP for utilising the public health care services are realised as very important at this juncture. In realizing the importance of augmentation of resources, it has been decided to introduce contingent valuation method (CVM) for WTP of SHCS. A disproportionate systematic random sampling method has been adopted for the selection of 720 households; representing 240 respondents from each of the three districts represent 120 from rural and 120 from urban. A major portion (92%) of the surveyed respondents’ gender was male, literacy was high (90%) and they belonged to productive age group. They generally involve themselves in the farm and non - farm activities and avail employment. Their per capita income is Rs.17871, and it is lower than the India’s PCI. The SHCS are classified into 26 categories as per the guidelines provided by public health medical officers in the state of Tamil Nadu. The different health care services started with entry fee to dental problem. The 98.6 per cent of the total surveyed respondents are ready to pay for SHCS in a public hospital and the remaining 2.4 per cent of them are not willing to pay for the same. The range of WTP for 26 SHCS is Rs. 2 - 7000; the range of mean value is Rs. 6 - 5008 and the range of SD is 2 - 2854. Considering the view of majority of the respondents, this study prescribes to introduce the range of user fee for the identified major public health care services. Since the range is differed significantly, it is suggested to follow the minimum amount initially and in a phased manner, the policy makers may prescribe to enhance the user fee after assessing the ground realities and loopholes. The estimated R2 value for SHCS is 20 per cent, which indicates that the selected 12 independent variables have low influence on WTP for SHCS. The study reports that the other exogenous factors like intensity of disease, accessibility of services, quality, urgency, need and perception are the predominant determinants of WTP for SHCS. The present research contends that constitution of district level co-ordination committee for fixing and implementing user fee for SHCS. Introduction of nominal fee (user fee) for SHCS may be fixed for affordable population, free services for BPL population and it would improve the efficiency and equity of the public health care services for the marginalised population. Finally, it is of utmost importance for health professionals to follow ethics in their profession.


[1] Abel Smith, B., Dua, A. Community Financing in Developing Countries: The Potential for the Health Sector. Health Policy and Planning 3(2), (1988): 95-108.

[2] Abel Smith. B. Funding Health for all – is insurance the answer? World Health Forum, (7): 1986.

[3] Ahmad J.K, Devarajan, S, Khemani and Shah “Decentralization and service deliveryâ€, World Bank policy Research Working Paper No.3603 (2005).

[4] Andrew Mitchal, Ajay Mahal, Thomas Bossert (2011), “Health care Utilization in Rural Andhra Predeshâ€, Economic and Political Weekly, 25(5): (2010). 15-19

[5] Anil Gumbar “Extending Health Insurance to the Poor: Some Experiences from SEWA Scheme.†Senior Economist, National Council of Applied Economic Research, New Delhi. (2001).

[6] Anil Gumber, “Burden of disease and cost of ill - health in India: setting priority for health interventions during the ninth planâ€. Margin. 29:2 (1997).

[7] Appel, L.J., Steinberg, E.P., Power, N.R., Anderson, G.F., Dwyer, S.A., Faden, R.R. (1990). The reduction from low osmolality contrast media: what do patients think it is worth? Medical Care 28. 324-337.

[8] Com Donaldson. “Willingness to pay for publicly provided Goods, A Possible Measure of Benefit?†Journal of Health Economics, 9 (1990): 2201-2209

[9] Deepa Shankar and Vinish Kathuria, “Health sector in 2003 – 2004 Budgetâ€. Economic and Political Weekly, 12(2003):76-83

[10] Duraisamy, “Public–Private choice and the cost of health care in Tamil Nadu. The Second Symposium on the Private – Public mix in Health Development in Indiaâ€. A Lesson from Canadian Experience – Organized by Institute of Social and Economic Change and Indo Shastri Canadian Institute, Bangalore, 27-29, March (2002).

[11] Dyson. Tim., Visaria.,Pravin, “Migration and Urbanization: Retrospect and Prospects. In Tim Dyson, Robert Cassen and LeelaVisaria (eds), Twenty – First Century India†Population, Economy, Human Development and the Environment, Oxford University Press 2004

[12] Fauci AS, Braunwald E, Kasper DL & Hauser SL (2008), Principles of Harrison’s Internal Medicine, Vol. 9, 17thedn. McGraw-Hill, New York, NY, pp.2275–2304.

[13] Human Development Report. Tamil Nadu, Social Science Press, Delhi 2003.

[14] Human Development Report. United Nations Development Program, Oxford University Press. 2012.

[15] Johannesson, M. Fagerberg, B, “A health economic comparison of diet and any treatment in obese man with mild hypertension†Journal of Hypertension (1992):1063-1070

[16] Johannesson. M., Jonsson, B, “Economic evaluation in health care: is there a role of cost-benefit analysisâ€. Health Policy. 17, (1991): 1-23.Journal of Health Economics. 12(1993): 151-69.

[17] Kavitha S and K. Ramu(2010) , Estimation of willingness to pay for rural health insurance in Nagapatinam District of Tamilnadu, Ph.D research proposal, Department of Economics, AnnamalaiUniversity

[18] Kim HS &Jeong HS (2007),A nurse short message service by cellular phone in type-2 diabetic patients for six months. Journal of Clinical Nursing 16, 1082–1087.

[19] Kumaresan R and K.Ramu (2012), “Willingness to Pay for Secondary Health Care Services in Chidambaram Town, Cuddalore District’, Annamalai Economic Papers, Vol.6, 2009 (2009-10 and 2010-11): 47-51.

[20] Kumaresan, R and Ramu. K, M. Phil thesis on “Willingness to pay for primary health care services: A study in Komaratchi village Cuddalore District.†2006.

[21] Lee JR, Kim SA, Yoo JW & Kang YK (2007), The present status of diabetes education and the role recognition as a diabetes educator of nurses in korea. Diabetes Research and Clinical Practice 77, 199–204.

[22] Mangal, “Institutionalization of user charges in Government Hospitals in Rajasthan.†Journal of Health Management, 6(2004):1-5.

[23] Mari Bhat. P.N, “Indian Demographic Scenario 2025.†Discussion Paper Series 27. IEG, 2001.

[24] Mathiyazhagan. K “Willingness to pay for rural health insurance through community participation in Indiaâ€, International Journal of Health Planning and Management, 13 (1998): 47-67.

[25] McMahon GT, Gomes HE, Hohne SH, Hu TM, Levine BA &Conlin PR (2005), Web-based care management in patients with poorly controlled diabetes. Diabetes Care 28, 1624–1629.

[26] Meeta, Rajvlochal, “Inequities in Healthâ€. Economic and Political Weekly, 35(43) (2011): 41-46.

[27] Naryana, K.V. “Changing Health Care Systemâ€. Economic and Political Weekly.38:2 (2003):1230-1241.

[28] Naryana, K.V. “Changing Health Care Systemâ€. Economic and Political Weekly.38:2 (2003):1230-1241.

[29] Peter Berman, Rajeev Ahuja, and Laveesh Bhandari, “The impoverishing effect on healthcare payments in India: new methodology and findings.†Economic and Political Weakly, 59:16 (2010): 65-71

[30] Pranabbaradhan “Challenges for a minimum social Democracy in Indiaâ€, Economic and Political Weekly, 36(10):(2011).

[31] Ramu, K., S, Sathyabama and B. Mathavan, “Assessment of child delivery cost in private and public health care system: A micro level study in Moovalur village Nagapatinam District Tamil Naduâ€. Journal of Humanities, 44(2007):415-426

[32] Ramu,K., and E. Selvarajan (2011) An estimation of willingness to pay for secondary health care services in Tamil Nadu., Major Research Project Report , University Grants Commission, New Delhi.

[33] Ramu. K., and R. Elango, Ph.D. Thesis on “Cost Effective Analysis of Control Strategies for Lymphatic Filarisis in Villupuram District of Tamilnaduâ€. Department of Economics, Annamalai University. 2006.

[34] Ravi Duggal and Abhya Shukla, “A Critique of health care policy in India†Economic and Political Weekly, 22:17 (2006): 4579- 4589.

[35] Sharma, B.B.L, “Health Financing in India: Some Issues.†New Delhi: National Institute of Health and Family Welfare. 2001

[36] Sharma, B.B.L., &Bir. T. (2000). Willingness and economic capacity to pay for health care services. NIHFW, New Delhi, Unpublished study report.

[37] Statistical outline of India 2011-12, Tata Services Limited, Department of Economics and Statistics.

[38] SuganyaSundari, C., and K. Ramu, M.Phil thesis on “Willingness to pay for secondary health care services: A study in Cuddalore Municipality, Cuddalore District.†2007.

[39] Thakurdesai PA, Kole PL &Pareek RP (2004), Evaluation of the quality and contents of diabetes mellitus patient education on Internet. Patient Education and Counseling 53, 309–313.

[40] Thangalakshmi. T, and K. Ramu, M.Phil thesis on “Economic Analysis of Occupational Health Hazards of Neyveli Lignite Corporation Employees, Cuddalore District†2010

[41] World Bank, “Investing in Health.†World Development Report, Oxford University Press, New York, 1993

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