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Objective: To examine the choice of healthcare providers for treating kala azar (KA) in Nepal., Methods: Information was collected from clinically diagnosed KA patients seeking care from public hospitals located in KA endemic districts. The survey collected information from more than 25 percent of total KA cases in the country. For empirical estimation of probability of choosing a provider-type as a first contact healthcare provider, a multinomial logit model was defined with five alternative options with self care as the reference category., Results: The empirical model found that price of medical care services, income of households, knowledge of patients on KA and KA treatment, borrowing money, age of patient, perceived quality of provider types, etc. determine the likelihood of seeking care from the alternative options considered in the analysis. All variables have expected signs and are consistent with earlier studies. The price and income elasticity were found to be very high indicating that poorer households are very sensitive to price and income changes, even for a severe disease like KA. Using the empirical models, we have analyzed two policy instruments: demand side financing and interventions to improve the knowledge index about KA., Conclusions: Due to high price elasticity of KA care and high spillover effects of KA on the society, policy makers may consider demand side financing as an instrument to encourage utilization of public hospitals., (Copyright © 2011 Hainan Medical College. Published by Elsevier B.V. All rights reserved.)

Background & Objectives: Visceral leishmaniasis, locally known as kala-azar (KA) has been considered as a major public health problem in Bangladesh, India and Nepal that affects 100,000 people per year with 147 million people at risk. Elimination of infectious disease is an ultimate goal of the public health system, therefore, the efforts have recently gained momentum from various organizations and governments to expand KA interventions in the endemic countries. The paper aims to estimate discounted net benefits and internal rate of return (IRR) to evaluate the economic feasibility for elimination of KA by utilizing available secondary information., Methods: Cross-sectional data were collected from different sources to estimate societal costs of and benefits from KA interventions with a 13-year project period. Total costs are estimated based on the unit cost of inputs used for interventions. The benefits are derived from productivity change and resources saved due to reduction of KA incidence. Net benefits and IRRs are estimated based on standard procedures used in the field of economics, subsequently the sensitivity analysis is conducted., Results: A total discounted net benefit of KA intervention is Nepalese Rupees (NRs) 65,287 million with 35% IRR. The result suggests that for every rupee invested in KA intervention at present will yield NRs 71 in future. The regional benefits from the interventions will be greater than the sum of benefits gained by the individual country due to its nature of public goods., Conclusion: Elimination of KA is a good investment opportunity for the Government and international partners involved in the health sector.

Households obtaining health care services in developing countries incur substantial costs, despite services generally being provided free of charge by public health institutions. This constitutes an economic burden on low-income households, and contributes to deepening their level of poverty. In addition to the economic burden of obtaining health care, the method of financing these payments has implications for the distribution of household assets. This effect on resource-poor households is amplified since they have decreased access to health insurance. Recent literature, however, ignores the importance of the method of financing health care payments. This paper looks at the case of Nepal and highlights the impact on households of paying for hospital-based care of Kala-azar (KA) by analysing the catastrophic, impoverishment and economic consequences of their coping strategies. The paper utilizes micro-data on a random selection of 50% of the KA-affected households of Siraha and Saptari districts of Nepal. The empirical results suggest that direct costs of hospital-based treatment of KA are catastrophic since they consume 17% of annual household income. This expenditure causes more than 20% of KA-affected households to fall below the poverty line, with the remaining households being pushed into the category of marginal poor; the poverty gap ratio is more than 90%. Further, KA incidence can have prolonged and severe economic consequences for the household economy due to the mechanisms of informal sector financing to which households resort. A heavy burden of loan repayments can lead households on a downward spiral that eventually becomes a poverty trap. In other words, the method of financing health care payments is an important ingredient in understanding the economic burden of disease.