Abstract
Background: Majority of the citizens in developing country like India seeks healthcare in private facilities. In spite of several sustainable measures taken by the government, public healthcare facilities often face various problems, including worker absenteeism and dual public–private practice, low demand for their use, and shortages of supplies and staff. In contrast, private healthcare varies greatly in quality of care, being unregulated and financed largely through out-of-pocket payments. Accessibility, affordability, and availability to healthcare services are the significant factors in improving utilization of public health facilities.

Objectives: This study explores the challenges faced in healthcare sector especially in terms of indirect cost (user fees) incurred by the rural households of rural Karnataka in seeking a public health care center.

Materials and Methods: A set of well-structured questionnaire was administered to examine the indirect cost incurred by the households in terms of travel cost, waiting cost, and out-of-pocket expenditure. A total of 600 samples were randomly collected. To study the demand for healthcare services provided by public hospitals in rural Karnataka, we conducted a regression analysis.

Results: Findings explains that odds ratio is higher for the nearest healthcare center than that in the next village, which specifies that accessibility to the nearest center is more significant than that in the next village. It is inferred that when distance increases, accessibility to public hospitals is impossible every time. In case of waiting time and out-of-pocket expenditure, both are statistically significant to use.

Conclusion: The economic performance of the healthcare services is crucially linked to the overall economic well-being of country and its citizens; there is a need for alternative option to come out of this indirect cost incurred by rural households.

Key words: Waiting time, distance, utilization, out of pocket