ABSTRACT
Health system reforms in India during the past decade yielded an impressive growth of medical, dental and nursing education opportunities, but health workforce density remains low in comparison to the World Health Organization (WHO) norms. Apart from shortage, retaining qualified health workforce in the rural and underserved areas remains a huge challenge. This crisis is likely to persist until and unless health system addresses the fundamental requirements of health workers as envisaged in health policies. Concerted attention and long term political commitments are required to overcome health system barriers to achieve rural recruitment and retention across various cadres in states. As the major share of health workforce belongs to the private sector, their resources need to be harnessed to meet health system goals through partnerships and collaborations. There is an urgent need for better regulation and enforcement of standards in medical education and delivery of health services across the public and private sectors.
ABSTRACT
Background: According to WHO, responsiveness is an important goal of the health system, in addition to the two predominant goals of improving health and fairness of financing. Responsiveness includes non-medical aspects of health care. As the progress to universal health coverage is gaining pace, the present study has attempted to study the domains of responsiveness in the government and private health services and health care providers.Methods: A community based cross-sectional study for a period of 3 months in the households of the urban field practising area. Sampling technique was simple random sampling. Assuming the prevalence of 50% and allowable error of 5%, 400 households were surveyed. KISH table method was used at household level. Study tool was World Health Survey responsiveness module questionnaire for the eight responsiveness domains-prompt attention, dignity, communication, autonomy, confidentiality, choice, quality of basic facilities and social support (for inpatients).Results: The mean age (yrs) of the study subjects is 46.078±13.998. 68.25% (273) were males.31.75% (127) were females. 46.25% (185) were using government services and 53.75% (215) were using private services. The mean waiting time (min) in the public health facilities was 135.2±111.2 which was more than private facilities, 62.4±40.8.Conclusions: All the responsiveness domains (except confidentiality) were found to be positively associated (p<0.05) with the government health services. Proportion of people rating the responsiveness domains from most important to the least important showed prompt attention (52%) and dignity (30%) as the most important domains.
ABSTRACT
No study has yet attempted to measure mean out-of-pocket expenditure on health care at household level, separately for government and private health facilities in India. Therefore, this study analyses the change in the out-of-pocket expenditure between 1995-96 and 2004 for fifteen major states of India, separately for rural/urban sector and inpatient/outpatient care. Using data from the 52nd and 60th rounds of the National Sample Survey, we present a disaggregated analysis of the trends and patterns of inflation adjusted household expenditure on health care. The analysis of average household expenditure on health care demonstrated that the mean outpatient care expenditure in government health sector decreased marginally at the aggregate level in both rural and urban sector, whereas it showed a significant increase in private facilities. A substantial rural-urban differential was also observed regarding households’ mean hospitalization expenditure in private hospitals while the same was not true for government hospitals. Almost all states observed a very high growth in households’ mean hospitalization expenditure in the private sector, while it was quite low in the government sector and even negative in rural areas of some states. The same pattern was observed in the growth pattern of households’ outpatient care expenditure. The analyses indicated a little improvement in the performance of government health sector in terms of out-of pocket expenditure. The improvement was more visible in developed and less developed states than in least developed states. Similarly, the improvement was more visible in rural areas than in urban areas.
Subject(s)
Health Expenditures , Delivery of Health Care , IndiaABSTRACT
Introdução: Este trabalho visa a apresentar um programa de prevenção deinternação hospitalar para idosos na saúde suplementar e descrever as característicasda população sob intervenção do mesmo. Método: o programa realizaa captação de indivíduos de risco, com idade maior ou igual a 65 anos, aplicandoum questionário de risco para internação hospitalar. Indivíduos de riscosão contatados por telefone e convidados a participar do programa. Idosos querecusam o programa permanecem em cuidado usual, e os que o aceitam sãovisitados por enfermeira, em ambiente domiciliar para uma avaliaçãomultidimensional. De acordo com essa avaliação, idosos são distribuídos emgrupos funcionais que vão determinar seu acompanhamento por equipemultidisciplinar. Resultados: 627 indivíduos aceitam o programa e 392 recusam.O sexo feminino é prevalente em ambos os grupos, assim como a idade médiaé semelhante. A maioria é casada, 19% das mulheres vivem sós, em oposiçãoa 9% dos homens. Percentual de analfabetos é menor do que outros estudos;67% dos usuários do programa apresentam têm três ou mais doenças crônicas;49,6% apresentam limitação funcional em ao menos uma atividade de vidadiária, enquanto 20% apresentam dependência total. Conclusão: É marcante adependência funcional nos idosos do programa, o que fala a favor da presença de seleção adversa na adesão ao programa. A diferença para escolaridade sugereuma representação da classe socioeconômica na saúde suplementar. Sugere seque modelos assistenciais de atenção integral à saúde do idoso sejam desenvolvidosna saúde suplementar.
Introduction: This paper aims to present a program on prevention ofhospitalization for the elderly in the health insurance and describe thecharacteristics of the population under the same intervention. Method: theprogram applies a screening questionnaire for those of 65 years old and aboveaiming to identify individuals at risk for hospitalization. Those at risk arecontacted by phone and invited to participate in the program. Elderly whorefuse the program are kept under usual care. Individuals who accepted theprogram are visited by a nurse, at their houses, for a multidimensional healthevaluation. According to the latter, individuals are distributed in functionalgroups which will determine their health care model by the program. Results:627 accepted the program and 392 refused it. Female is prevalent in bothgroups as the average age is similar for both. The majority is married, 19% ofwomen live alone as opposed to 9% of men. The percentage of analphabets issmaller than other studies; 67% of program users have 3 or more chronicdiseases; 49.6% have limited functional activity for at least one activity ofdaily living and 29% have total dependence. Conclusion: There is an importantfunctional dependence in the elderly under the program, suggesting that thereis an advertion selection criteria for those who accept the program. The literacydifference may be justified by the social economical class of the elderly inthe private health care sector. It is suggested that integrated health care modelsfor the elderly should be developed in the private care sector.