Healthcare utilization from the informal providers in India: what can we learn from the 75 th Round National Sample Survey

Background Informal healthcare providers (IPs) play a significant role in low- and middle-income countries including India. They operate outside the regulatory systems and are not registered with the government as healthcare providers in India. This study aims to study the share of IPs in outpatient care utilization, out of pocket expenditures (OOPE) during access to care, and reasons behind utilization of IPs compared to formal healthcare providers in India. Methods This study uses data from the 75th Round National Sample Survey, 2017-18, by Government of India. A total of 5,55,114 individuals (Rural: 3,25,883; Urban: 2,29,232) from randomly selected 1,13,823 households from across all districts of the country were sampled. Bivariate and multivariate analyses were used for the study. Results The share of IPs in total outpatient care utilization was 3.03% in India. The share of IPs in utilization was greater among the lower socioeconomic population. The chances of IP utilization were 1.6 (95% CI: 1.14–2.24, p < 0.001) times higher in rural areas compared to urban areas, and 2.2 times higher in illiterate population compared to primary level educated. Infectious diseases (49.6%) form the largest proportion of the patients IPs handle, followed by respiratory (12.1%), and musculoskeletal conditions (8.6%). The average OOPE on receiving care from IPs per outpatient visit was Indian Rupees (INR) 572 for overall India. Reasons for not going to formal public providers included unavailability of services (6.6%) in the public sector, and poor quality (21.2%) of care in public facilities. Conclusions The 75th NSS probably underestimates IPs proportion in healthcare provision. There is a need for improvements in NSS data collection on IPs. Despite this limitation, the survey allows a meaningful study of the determinants of such utilization. A greater proportion of those in the poor socioeconomic population use the services of IPs. Most of the healthcare provided by them is for acute ailments and the prices are based on capacity to pay. The major reasons reported for choosing IP over public providers included longer distances in rural areas and waiting time in urban facilities. Trial registration: Not applicable.