Community health insurance schemes & patient satisfaction - evidence from India.

Background & objectives: Quality of care is an important determinant for utilizing health services. In India, the quality of care in most health services is poor. The government recognizes this and has been working on both supply and demand aspects. In particular, it is promoting community health insurance (CHI) schemes, so that patients can access quality services. This observational study was undertaken to measure the level of satisfaction among insured and uninsured patients in two CHI schemes in India. Methods: Patient satisfaction was measured, which is an outcome of good quality care. Two CHI schemes, Action for Community Organisation, Rehabilitation and Development (ACCORD) and Kadamalai Kalanjiam Vattara Sangam (KKVS), were chosen. Randomly selected, insured and uninsured households were interviewed. The household where a patient was admitted to a hospital was interviewed in depth about the health seeking behaviour, the cost of treatment and the satisfaction levels. Results: It was found that at both ACCORD and KKVS, there was no significant difference in the levels of satisfaction between the insured and uninsured patients. The main reasons for satisfaction were the availability of doctors and medicines and the recovery by the patient. Interpretation & conclusions: Our study showed that insured hospitalized patients did not have significantly higher levels of satisfaction compared to uninsured hospitalized patients. If CHI schemes want to improve the quality of care for their clients, so that they adhere to the scheme, the scheme managers need to negotiate actively for better quality of care with empanelled providers.

Tobacco use and related factors among pre-university students in a college in Bangalore, India.

Background. Tobacco use imposes a huge burden of disease in India. Most studies on the use of tobacco among students in India have focused on secondary school students with a few studies investigating younger children and university students. We aimed to ascertain tobacco use among preuniversity college students in Bangalore. Methods. A cross-sectional study was conducted among 300 students of a purposively selected boys-only, pre-university college in Bangalore. All the students from 4 of 10 randomly selected classes were enrolled in the study. An anonymous self-administered questionnaire was used to collect information on the extent and pattern of tobacco consumption, factors associated with use/non-use of tobacco products, and awareness of the harmful effects of tobacco use. Results. The prevalence of ‘ever use’ of tobacco was 15.7% (95% CI: 11.7–20.3) of which 5.3% (95% CI: 3.1–8.7) were current users of tobacco. The mean (SD) age of initiation of tobacco use was 14.7 (2.05) years; 78.3% of users were aware that tobacco was harmful. The most common reasons by ever users to start using tobacco included peer pressure, having fun/enjoyment, and curiosity. ‘Never users’ abstained from usage because of awareness of the negative health implications of tobacco use, a dislike for tobacco products, and the negative social implications of tobacco use. Conclusion. Interventions need to be designed to reduce the use of tobacco among students. Such interventions should raise awareness on the social and economic implications of the use of tobacco, equip students to overcome peer influence and provide counselling to quit using tobacco.