Levesque Jean-Frédéric, Haddad Slim, Narayana Delampady, Fournier Pierre
Institut national de santé publique du Québec, Montreal, Canada.
Trop Med Int Health. 2007 Jul;12(7):802-14. doi: 10.1111/j.1365-3156.2007.01870.x.
To identify individual and urban unit characteristics associated with access to inpatient care in public and private sectors in urban Kerala, and to discuss policy implications of inequalities in access.
We analysed the NSSO survey (1995-1996) for urban Kerala with regard to source and trajectories of hospitalization. Multinomial multilevel regression models were built for 695 cases nested in 24 urban units.
Private sector accounts for 62% of hospitalizations. Only 31% of hospitalizations are in free wards and 20% of public hospitalizations involve payment. Hospitalization pathways suggest a segmentation of public and private health markets. Members of poor and casual worker households have lower propensity of hospitalization in paying public wards or private hospitals. There were important variations between cities, with higher odds of private hospitalization in towns with fewer hospital beds overall and in districts with high private-public bed ratios. Cities from districts with better economic indicators and dominance of private services have higher proportion of private hospitalizations.
The private sector is the predominant source of inpatient care in urban Kerala. The public sector has an important role in providing access to care for the poor. Investing in the quality of public services is essential to ensure equity in access.
确定喀拉拉邦城市地区公立和私立部门住院治疗可及性相关的个人及城市单元特征，并探讨可及性不平等的政策影响。
我们分析了喀拉拉邦城市地区1995 - 1996年全国抽样调查组织（NSSO）关于住院来源和轨迹的数据。针对嵌套在24个城市单元中的695个案例建立了多项多水平回归模型。
私立部门占住院治疗的62%。只有31%的住院治疗在免费病房，且20%的公立部门住院治疗涉及付费。住院途径表明公立和私立医疗市场存在分割。贫困家庭和临时工家庭的成员在付费公立病房或私立医院住院的倾向较低。不同城市之间存在重要差异，总体病床较少的城镇以及私立与公立病床比例较高的地区私立住院的几率更高。经济指标较好且私立服务占主导地位地区的城市私立住院比例更高。
私立部门是喀拉拉邦城市地区住院治疗的主要来源。公立部门在为贫困人口提供医疗服务可及性方面发挥着重要作用。投资于公共服务质量对于确保可及性公平至关重要。
