Socio-cultural sustainability of private healthcare providers in an Indian slum setting: A bottom-of-the-pyramid perspective

Federica Angeli, Shila Teresa Ishwardat, Anand Kumar Jaiswal, Antonio Capaldo*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Delivery of affordable healthcare services to communities is a necessary precondition to poverty alleviation. Co-creation approaches to the development of business models in the healthcare industry proved particularly suitable for improving the health-seeking behavior of BOP patients. However, scant research was conducted to understand BOP consumers' decision-making process leading to specific healthcare choices in slum settings, and the relative balance of sociocultural and socio-economic factors underpinning patients' preferences. This article adopts a mixedmethod approach to investigate the determinants of BOP patients' choice between private and public hospitals. Quantitative analysis of a database, composed of 436 patients from five hospitals in Ahmedabad, India, indicates that BOP patients visit a public hospital significantly more than topof- the-pyramid (TOP) patients. However, no significant difference emerges between BOP and TOP patients for inpatient or outpatient treatments. Qualitative findings based on 21 interviews with BOP consumers from selected slum areas led to the development of a grounded theory model, which highlights the role of aspirational demand of BOP patients toward private healthcare providers. Overall, healthcare provider choice emerges as the outcome of a collective socio-cultural decision-making process, which often assigns preference for private healthcare services because of the higher perceived quality of private providers, while downplaying affordability concerns. Implications for healthcare providers, social entrepreneurs, and policy-makers are discussed.

Original languageEnglish
Article number4702
JournalSustainability (Switzerland)
Issue number12
Publication statusPublished - 10 Dec 2018

Bibliographical note

© 2018 by the authors. Licensee MDPI, Basel, Switzerland.


  • Aspirational demand
  • Bottom of the pyramid (BOP)
  • Choice of healthcare providers
  • Emerging markets
  • Grounded theory research
  • Healthcare business models

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