Equity in the utilzation of healthcare services in India: evidence from National Sample Survey
Equity in the utilzation of healthcare services in India: evidence from National Sample Survey
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DOI：
10.15171/ijhpm.2014.06
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发表时间：
2014-01-01
影响因子：
3.5
通讯作者：
Ghosh, Soumitra
中科院分区：
文献类型：
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作者：
Ghosh, Soumitra
背景：追求健康和医疗保健的公平一直是印度卫生政策的主要特点。然而，尽管这一问题具有政策意义，但关于这一问题的现有文献数量很少。因此，本文是一种尝试，以探讨横向不平等的医疗保健利用，包括门诊和住院治疗在15个主要国家和东北regionsofIndia.Methods：横截面数据取自国家抽样调查组织（NSSO）第60轮（2004年），调查“发病率和医疗保健”。虽然使用调查日期前15天的门诊就诊概率来评估门诊治疗，但住院治疗利用率的指标基于以下变量：12个月期间的住院概率和住院时间。所有这些措施的医疗保健利用标准化的需要差异和社会经济因素的控制。需要标准化的浓度指数被用来衡量州际和州内的收入相关的不平等，在healthcare utilization.Results：绝对不平等被发现国家之间的人口比例报告访问门诊提供者，在4.42%至21.72%的范围内。同样，住院治疗从1%到10%不等。在印度的农村和城市地区以及大多数邦，门诊和住院护理的不平等程度都偏向富人。事实上，在大多数州，农村人口中各类治疗护理之间的横向不平等明显高于城市人口。分析表明，高人均政府卫生支出显着相关的低不公平利用住院care.Conclusion：该研究的结论是，有必要解决普遍存在的不公平，在医疗保健的大幅度扩大公共卫生支出，并实现有效的全民覆盖的医疗保健在印度。
Background: The pursuit of equity in health and healthcare has been the key feature of health policy in India. However, despite the policy significance, the volume of literature available on this issue is scarce. Therefore, this paper is an attempt to examine the horizontal inequities in healthcare utilization, consisting of outpatient and inpatient care in 15 major states and north-eastern region of India.Methods: Cross-sectional data were taken from the National Sample Survey Organization (NSSO) 60th round (2004), the survey on 'morbidity and healthcare'. While outpatient care was assessed using the probability of outpatient visit 15 days prior to the survey date, the indicators of inpatient care utilization were based on the following variables: the probability of hospital admission and length of stay in hospital over a 12-month period. All these measures of healthcare utilization were standardized for need differences and controlled for socio-economic factors. Need standardized concentration indices were used to measure interstate and intrastate income-related inequities in healthcare utilization.Results: Absolute inequalities were found between states in the proportion of the population reporting a visit to an outpatient provider, in the range of 4.42% to 21.72%. Similarly, inpatient care varied from 1% to 10%. The magnitude of inequity for both outpatient and inpatient care was pro-rich across rural and urban areas of India and in majority of the states. In fact, in majority of the states, the horizontal inequity across types of curative care was noticeably higher within the rural population than in the urban population. The analysis demonstrated that high per capita government health spending was significantly associated with low inequity in utilization of inpatient care.Conclusion: The study concludes that it would be necessary to address the prevailing inequities in healthcare by substantially scaling up the public spending on health, and achieving effective universal coverage of healthcare in India.