Entitlements to health care: Why is there a preference for private facilities among poorer residents of Chennai, India?
Entitlements to health care: Why is there a preference for private facilities among poorer residents of Chennai, India?
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DOI：
10.1016/j.socscimed.2010.09.042
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发表时间：
2011-02-01
影响因子：
5.4
通讯作者：
Kearns, Robin A.
中科院分区：
文献类型：
--
作者：
Ergler, Christina R.;Sakdapolrak, Patrick;Kearns, Robin A.
本文考察了印度金奈较贫困居民获得医疗保健的机会。它揭示了寻求治疗的贫困用户的限制和有利条件。我们通过居民自己以及参与为这些用户提供护理的利益相关者的推理来探索寻求健康行为的模式。特别注意的是，有需要的居民宁愿选择私人保健提供者，尽管费用高昂，而且有免费的公共设施。我们通过将Sen的权利方法与Penchansky和Thomas在获得医疗保健方面的工作相结合来解决这个问题。根据定性实地研究设计收集的数据，包括对14名居民和58名参与照顾穷人的利益相关者的访谈，我们认为，在步行距离内提供卫生保健设施是令人满意的获得的必要但不是充分的先决条件。相反，我们展示了“医疗保健权利”的影响，它使拥有收入、知识和社会网络等资源的贫困家庭能够实现获得医疗保健的机会。我们呈现的叙述不仅揭示了医疗保健的经历，而且还揭示了对其利用的感受。我们认为，后者在决定卫生保健设施的选择方面至关重要。这一发现表明，对欠发达国家医疗保健的可负担性和实际可及性的分析应包括对利用的情感层面的关注。换句话说，不仅需要考虑有效获得保健的机会，而且还需要考虑对较贫穷公民的治疗的情感层面。(C) 2010 Elsevier Ltd.版权所有。
This paper examines access to health care by poorer residents in Chennai, India. It reveals constraining and enabling conditions for impoverished users seeking treatment. We explore patterns of health-seeking behaviour through the reasoning of residents themselves as well as stakeholders involved in providing care for these users. Particular attention is paid to the needy residents' preference for private health care providers despite the costs involved and that free public facilities are available. We address this issue by combining Sen's entitlement approach with Penchansky and Thomas' work on access to health care. Based on data gathered in a qualitative field-based research design including interviews with 14 residents and 58 stakeholders involved in caring for poor people, we argue that the availability of health care facilities within walking distance is a necessary but not sufficient precondition for satisfactory access. Rather, we demonstrate the influence of 'entitlements to health care' which allow poor households that are endowed with resources such as income, knowledge and social networks to realise access. The narratives we present reveal not only experiences of health care, but also feelings about its utilisation. The latter, we contend, are crucial in determining choice of health care facilities. This finding suggests that analyses of affordability and physical access to health care in less developed countries should include a focus on emotional dimensions of utilisation. In other words, there is a need to consider not only effective access to health care, but also affective dimensions of treatment for poorer citizens. (C) 2010 Elsevier Ltd. All rights reserved.