School of Health Sciences, City, University of London, UK.
Cass Business School, City, University of London, UK.
Soc Sci Med. 2019 Feb;222:285-293. doi: 10.1016/j.socscimed.2019.01.028. Epub 2019 Jan 17.
We assess the impact of India's National Rural Employment Guarantee (NREG) scheme, the world's largest workfare scheme, on healthcare utilisation - specifically maternal healthcare. The primary objective of NREG is to improve the income of rural households by guaranteeing 100 days of employment. We expect that by improving household income, thereby reducing some of the financial barriers, such as out-of-pocket payments, NREG can increase utilisation of maternal health services. Using a nationally representative household survey and a difference-in-differences approach that exploits the phased rollout of the scheme, we estimate the impact of NREG on utilisation of maternal health services: mainly deliveries at health facilities. We find that NREG did not increase overall facility deliveries, even though it led to an increase in deliveries at public facilities. There is weak evidence to suggest that deliveries at private facilities reduced due to NREG. Furthermore, sub-group analyses reveal that among poorer households, who are more likely to participate in NREG, there is a reduction in facility deliveries while home deliveries increased. Among richer households, NREG increased deliveries at public facilities. There was no impact on households belonging to marginalised castes. We conclude by discussing the possible mechanisms for these effects and its impact on equity in healthcare utilisation.
我们评估了印度国家农村就业保障（NREG）计划对医疗保健利用的影响——特别是产妇保健。NREG 的主要目标是通过保证 100 天的就业来提高农村家庭的收入。我们预计，通过改善家庭收入，从而减少一些经济障碍，如自费支付，NREG 可以增加产妇保健服务的利用。我们使用全国代表性的家庭调查和一种差异中的差异方法，利用该计划的分阶段推出，估计 NREG 对产妇保健服务利用的影响：主要是在卫生设施分娩。我们发现，尽管 NREG 导致公共设施分娩增加，但它并没有增加总体设施分娩。有微弱的证据表明，由于 NREG，私人设施的分娩减少了。此外，分组分析表明，在更有可能参与 NREG 的较贫困家庭中，设施分娩减少，而家庭分娩增加。在较富裕的家庭中，NREG 增加了公共设施的分娩。属于边缘化种姓的家庭没有受到影响。我们最后讨论了这些影响的可能机制及其对医疗保健利用公平性的影响。
