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印度医疗保健方面的州际差异以及穷人的经济负担。

Inter-state disparities in health care and financial burden on the poor in India.

作者信息

Purohit Brijesh C

机构信息

Centre for Policy Research, New Delhi, India.

出版信息

J Health Soc Policy. 2004;18(3):37-60. doi: 10.1300/J045v18n03_03.


DOI:10.1300/J045v18n03_03
PMID:15201118
Abstract

Over five decades of independence, India has made rapid strides in various sectors. However, its performance in social sectors and particularly the healthcare sector has not been too rosy. Being the State's responsibility the healthcare has traditionally been influenced by individual State's budgetary allocation. Consequently inter-state disparity in availability and utilization of health services and health manpower are distinctly marked. This has implications for achievement of Health for All for the nation as a whole. Keeping in view the significance of studying inter-state variations in healthcare, this study focuses on the performance of healthcare sector in 15 major States in India. This is attempted through a comparative analysis of various parameters depicting availability of health services, their utilization and health outcomes. Our analysis depicts the prevalence of considerable inequity favoring high income group of States. In terms of healthcare resources, for instance, it indicates that the high income States hold a superior position in terms of: per capita government expenditure on medical and public health, total number of hospitals and dispensaries, per capita availability of beds in hospitals and dispensaries and health manpower in rural and urban areas. These parameters of availability have an impact on utilization levels and health outcomes in these States. A comparative profile of high and low income States as well as middle and low income States, both in rural and urban areas, reaffirms a greater financial burden in availing treatment at OPD and inpatient in low income States. In line with the higher financial burden and low per capita health expenditure, the health outcome indicators also depict a disconcerting situation in regard to low income States. These States are marked by lower life expectancy and higher incidence of diseases as well as high mortality rates. In this regard, demand as well as supply side constraints are observed which restrain the optimum utilization of existing health services. Among the low income States the main constraints on the demand side include illiteracy, malnutrition, and lack of infrastructure in accessing the facilities. Certain state specific supply side factors add significantly to under-utilization in low income States. In some of the States, however, corrective actions have been initiated to overcome the problem of the quality and low utilization of health facilities. In due course of time, it is likely that proper implementation of these measures may result in improved utilization level of existing health services, which may be useful to improve health status indicators. Nonetheless, overcoming the current levels of regional disparities in healthcare across three income groups of States may also require additional resources. The latter could be mobilized through assistance of donor agencies and appropriate mix of social and private insurance. Ultimately mitigating the problem of regional disparities in healthcare and protecting the poor and vulnerable from financial burden may require establishing and maintaining proper linkages between socio-economic development and healthcare planning.

摘要

在独立后的五十多年里,印度在各个领域都取得了长足的进步。然而,其在社会领域尤其是医疗保健领域的表现并不太乐观。由于医疗保健是国家的责任,传统上它受到各个邦预算分配的影响。因此,各邦在卫生服务和卫生人力的可及性与利用方面的差距十分明显。这对整个国家实现全民健康产生了影响。鉴于研究各邦之间医疗保健差异的重要性,本研究聚焦于印度15个主要邦的医疗保健部门表现。这是通过对描述卫生服务可及性、利用情况和健康结果的各种参数进行比较分析来实现的。我们的分析表明,存在相当严重的不公平现象,高收入邦占据优势。例如,在医疗资源方面,它表明高收入邦在以下方面占据优势:人均政府医疗和公共卫生支出、医院和诊疗所总数、医院和诊疗所的人均病床数以及城乡卫生人力。这些可及性参数对这些邦的利用水平和健康结果产生影响。对高收入邦与低收入邦以及中等收入邦与低收入邦在城乡地区的比较概况再次表明,低收入邦在门诊和住院治疗方面承担着更大的经济负担。与更高的经济负担和较低的人均卫生支出相一致,健康结果指标也显示低收入邦的情况令人担忧。这些邦的特点是预期寿命较低、疾病发病率较高以及死亡率较高。在这方面,观察到需求方和供给方都存在制约因素,限制了现有卫生服务的最佳利用。在低收入邦中,需求方的主要制约因素包括文盲、营养不良以及获取设施方面缺乏基础设施。某些邦特有的供给方因素也显著加剧了低收入邦的利用不足情况。然而,在一些邦已经开始采取纠正措施来克服卫生设施质量和利用率低的问题。随着时间的推移,这些措施的妥善实施可能会提高现有卫生服务的利用水平,这可能有助于改善健康状况指标。尽管如此,要克服三个收入组邦之间目前在医疗保健方面的地区差距,可能还需要额外的资源。后者可以通过捐助机构的援助以及社会和私人保险的适当组合来筹集。最终,减轻医疗保健方面的地区差距问题并保护穷人和弱势群体免受经济负担,可能需要在社会经济发展与医疗保健规划之间建立并维持适当的联系。

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