ABSTRACT
Using Demographic and Health Survey data (2015-16) from the state of Andhra Pradesh, we estimate the differential probability of hysterectomy (removal of uterus) for women (aged 15-49 years) covered under publicly funded health insurance (PFHI) schemes relative to those not covered. To reduce the extent of selection bias into treatment assignment (PFHI coverage) we use matching methods, propensity score matching, and coarsened exact matching, achieving a comparable treatment and control group. We find that PFHI coverage increases the probability of undergoing a hysterectomy by 7-11 percentage points in our study sample. Sub-sample analysis indicates that the observed increase is significant for women with lower education levels and higher order parity. Additionally, we perform a test of no-hidden bias by estimating the treatment effect on placebo outcomes (doctor's visit, health check-up). The robustness of the results is established using different matching specifications and sensitivity analysis. The study results are indicative of increased demand for surgical intervention associated with PFHI coverage in our study sample, suggesting a need for critical evaluation of the PFHI scheme design and delivery in the context of increasing reliance on PFHI schemes for delivering specialised care to poor people, neglect of preventive and primary care, and the prevailing fiscal constraints in the healthcare sector.
ABSTRACT
Background: Countries, including India, were quick to adopt telemedicine for delivering primary care in response to the widespread disruptions due to the coronavirus disease 2019 (COVID-19) pandemic. This expeditious adoption was critical and the challenges faced during this exigency could guide the design and delivery of future telemedicine applications toward strengthening primary healthcare services. Methods: To identify the challenges in delivering primary care via telemedicine technology in the Indian context, a scoping review was conducted. Drawing from the systems approach in healthcare delivery, the review findings are summarized at four levels, patient, provider, healthcare organizations, and policy. Results: The initial search yielded 247 articles and 13 met our inclusion criteria. This review highlighted that telemedicine facilitated the continuity of care during COVID-19 but not without challenges. Low levels of education and computer literacy along with the language barriers posed the predominant challenges at the patient level. Providers had concerns related to digital literacy, clinical process flows, legal liabilities, and unethical behavior of the patients. The policy-level challenges include data privacy and security, reimbursement models, unethical behavior by the patient, or provider, and regulating prescriptions of psychotropic drugs. A lack of an integrated telehealthcare model covering diagnostics, prescriptions, and medication supply mirrored the existing fragmentation of care delivery. Conclusion: Telemedicine has the potential to improve primary healthcare delivery even beyond COVID-19. Currently, telemedicine applications in India are only facilitating a remote consultation wherein an integrated person-centered care is lacking. There is a need to acknowledge and factor in the inter-connectedness of health system elements for ensuring an effective and efficient healthcare delivery via telemedicine.
ABSTRACT
There is a growing body of literature focusing on the direct relationship between women's relative resources (WRR) and intimate partner violence (IPV). However, the underlying mechanism remains largely unexplored. Grounded in the popular sociological theories, Relative Resource Theory (RRT) and Gendered Resource Theory (GRT), this study addresses the research gap by proposing a moderated-mediation model to i) understand the process through which WRR influences the relational empowerment and violence victimization, and, ii) explain the role of husband's patriarchal attitude in the proposed linkages. We posit that the relationship between WRR and IPV is mediated by relational empowerment, and husband's patriarchal attitude moderates the relationship between relational empowerment and physical abuse. The proposed model is tested in the Indian context using secondary data collected from 47,514 married couples. As our variables of interest were latent constructs, we first used factor analysis in AMOS v.22. Then, using the Structural Equation Modelling (SEM) technique, the proposed model is tested in SPSS v.22 using the bootstrap Confidence Interval (C.I.) method. In our study sample, about 28% of ever-married women reported experiencing spousal violence in the last 12 months. The study finds that WRR is a significant predictor of relational empowerment (ß = 0.21, p < 0.01), and relational empowerment is negatively associated (ß = -0.06; p < 0.01) with violence victimization, thus supporting mediating role of relational empowerment in WRR-Abuse linkage. The interaction of the husband's patriarchal attitude with relational empowerment significantly predicts violence victimization. Our study results indicate the critical role of socio-cultural norms, rooted in patriarchy, in understanding IPV. The study findings suggest that the potential of women empowerment initiatives against IPV is conditional on men's progressive attitude. The study findings call for acknowledging the complexity of the interaction between patriarchal attitude and IPV on the one hand, and women's position in society, in any attempt at empowerment.
