Health care and equity in India.
Health care and equity in India.
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DOI：
10.1016/s0140-6736(10)61894-6
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发表时间：
2011-02-05
期刊：
影响因子：
168.9
通讯作者：
Subramanian, S. V.
中科院分区：
文献类型：
--
作者：
Balarajan, Y.;Selvaraj, S.;Subramanian, S. V.
印度的卫生系统在满足印度社会最弱势成员的需求方面面临着持续的挑战。尽管在改善获得保健的机会方面取得了进展，但社会经济地位、地域和性别方面的不平等现象继续存在。自付支出高，医疗保健的财务负担日益沉重，私人家庭负担沉重，占印度医疗支出的四分之三以上。印度一半以上的家庭陷入贫困是由于卫生支出造成的;这种情况的影响越来越大，每年使大约3 900万印度人陷入贫困。在本文中，我们确定了在印度的服务提供公平，公平的融资和金融风险保护的主要挑战。这些问题包括资源分配不平衡，获得优质保健服务的实际机会有限，保健人力资源不足;自付保健支出高，保健支出膨胀，以及影响适当保健需求的行为因素。作为对本系列其他论文的补充，我们主张在印度追求卫生保健公平的过程中应用某些原则。这些措施是在监测、评价和战略规划中采用公平衡量标准，投资于建立一个严格的保健系统研究知识库;在保健改革中发展更加注重公平的审议决策进程，以及重新界定主要行动者的具体责任和问责制。执行这些原则，同时加强公共卫生和初级保健服务，为确保印度人民获得更公平的保健提供了一种办法。
India’s health system faces the ongoing challenge of responding to the needs of the most disadvantaged members of Indian society. Despite progress in improving access to health care, inequalities by socioeconomic status, geography and gender continue to persist. This is compounded by high out-of-pocket expenditures, with the rising financial burden of health care falling overwhelming on private households, which account for more than three-quarter of health spending in India. Health expenditures are responsible for more than half of Indian households falling into poverty; the impact of this has been increasing pushing around 39 million Indians into poverty each year. In this paper, we identify key challenges to equity in service delivery, and equity in financing and financial risk protection in India. These include imbalanced resource allocation, limited physical access to quality health services and inadequate human resources for health; high out-of-pocket health expenditures, health spending inflation, and behavioral factors that affect the demand for appropriate health care. Complementing other paper in this Series, we argue for the application of certain principles in the pursuit of equity in health care in India. These are the adoption of equity metrics in monitoring, evaluation and strategic planning, investment in developing a rigorous knowledge-base of health systems research; development of more equity-focused process of deliberative decision-making in health reform, and redefinition of the specific responsibilities and accountabilities of key actors. The implementation of these principles, together with strengthening of public health and primary care services, provide an approach for ensuring more equitable health care for India’s population.