Health Seeking Pathways in Four Indian States (4IS)

Health Seeking Pathways in Four Indian States (4IS)

This study aims to provide an understanding of health seeking behaviour in two States with low levels of health system development: Odisha and Uttar Pradesh; and two with higher levels of health system development: Maharashtra and Punjab’.

The study sheds light on the questions of out-of-pocket spending, catastrophic health expenditure and distress financing, and treatment pathways in four states of India – Odisha, Uttar Pradesh (UP), Maharashtra and Punjab. The rationale for this is to better understand the differences between health seeking behaviour in more and less developed health systems at the State level in India, and to sharpen hypotheses about the evolution of health seeking behaviour as health systems develop effectively. The study provides valuable insights for health system interventions yet to be introduced, that seek to strengthen elements such as public primary care.

Using multiple methods the study delves into the following questions,

What factors are associated with (a) the decision to use medical care and (b) the choice among available medical providers?

What are the health expenditure consequences of both decisions, and with respect to Catastrophic and Impoverishing Health Expenditures?

What are the earnings (wages and other sources of income of households) consequences of both decisions?

What are the patterns of resort (what are the common pathways between providers and provider type including primary and higher levels; public and private; qualified and unqualified) in relation to a chronic condition common among adults, an acute condition common among children, and gynaecological problems among women?


Nossal Institute For Global Health, The University of Melbourne (Lead)
The Population Council, India

Bill and Melinda Gates Foundation




  • 2716Health Seeking Pathways in Four Indian States (4IS)

    Barbara McPake is Professor, Nossal Institute for Global Health, University of Melbourne and Professor at NCAER. Prior to this, she was Director of the Nossal Institute (2014-23) and the Institute for International Health and Development, Queen Margaret University, Edinburgh (2005-2014); Programme Director, Health Systems Development Knowledge Programme (2001-6) and Head of Health Policy Unit (2001-4)...   Read More

  • 2712Health Seeking Pathways in Four Indian States (4IS)

    Sumit Kane is a Professor at the Nossal Institute of the Melbourne School of Population and Global Health, and Professor at NCAER. His research focus is on low and middle-income country societies and health systems transitioning to a post-service availability phase. His research examines the questions these transitions raise for health systems. Prof Kane has...   Read More

  • 2717Health Seeking Pathways in Four Indian States (4IS)

    Ajay Mahal is a Professor of Health Economics and Global Health Systems Research at the Nossal Institute for Global Health in the University of Melbourne and Professor at NCAER. From 2010 until 2015, he was the Alan and Elizabeth Finkel Chair of Global Health and Professor at the School of Public Health and Preventive Medicine...   Read More

  • 2272Health Seeking Pathways in Four Indian States (4IS)

    Prabir Kumar Ghosh is a Senior Fellow at NCAER. Currently, he is involved in coordinating all-India level survey work and analysis of large scale primary data. His research interests include development economics, human development, income, expenditure, poverty & nutrition, demography, and budgetary analysis on social sector & poverty alleviation programs.