Poor quality for the poor? A study of inequalities in service readiness and provider knowledge in Indonesian primary health care facilities.
Poor quality for the poor? A study of inequalities in service readiness and provider knowledge in Indonesian primary health care facilities.
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DOI：
10.1186/s12939-021-01577-1
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发表时间：
2021-11-04
影响因子：
4.8
通讯作者：
Wiseman V
中科院分区：
文献类型：
--
作者：
Haemmerli M;Powell-Jackson T;Goodman C;Thabrany H;Wiseman V
在许多低收入和中等收入国家，保健质量差造成的死亡人数超过了保健不足造成的死亡人数。这反过来又引起了人们对中低收入国家医疗质量分布的关切：与富人相比，穷人获得的医疗质量是否较低？本研究的目的是调查在整个印度尼西亚卫生系统提供高质量的卫生服务的不平等程度，特别侧重于在公共和私营部门提供的护理之间的差异。利用印度尼西亚家庭生活调查（第5波，2015年），312个社区的15，877个家庭与同一社区的公共和私人卫生设施的代表性样本相关联。卫生设施的质量进行了评估，使用设施服务准备得分和知识得分构建使用临床小插曲。普通最小二乘回归模型被用来调查公共和私人卫生设施的质量的决定因素。在这两个部门，各大岛屿之间在这两个质量分数方面都存在不平等。在公共设施方面，农村和城市地区之间的准备程度得分持续存在不平等，富裕社区和贫穷社区之间的不平等程度较低。为了实现在印度尼西亚实现全民健康覆盖这一雄心勃勃的既定目标，应优先解决目前护理质量不平等的问题。在线版本包含补充材料，可通过10.1186/s12939-021-01577-1获得。
For many low and middle-income countries poor quality health care is now responsible for a greater number of deaths than insufficient access to care. This has in turn raised concerns around the distribution of quality of care in LMICs: do the poor have access to lower quality health care compared to the rich? The aim of this study is to investigate the extent of inequalities in the availability of quality health services across the Indonesian health system with a particular focus on differences between care delivered in the public and private sectors. Using the Indonesian Family Life Survey (wave 5, 2015), 15,877 households in 312 communities were linked with a representative sample of both public and private health facilities available in the same communities. Quality of health facilities was assessed using both a facility service readiness score and a knowledge score constructed using clinical vignettes. Ordinary least squares regression models were used to investigate the determinants of quality in public and private health facilities. In both sectors, inequalities in both quality scores existed between major islands. In public facilities, inequalities in readiness scores persisted between rural and urban areas, and to a lesser extent between rich and poor communities. In order to reach the ambitious stated goal of reaching Universal Health Coverage in Indonesia, priority should be given to redressing current inequalities in the quality of care. The online version contains supplementary material available at 10.1186/s12939-021-01577-1.
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