印度医疗服务利用中的公平性：国家抽样调查证据。
Equity in the utilization of healthcare services in India: evidence from National Sample Survey.
机构信息
Centre for Health Policy, Planning and Management, School of Health Systems Studies, Tata Institute of Social Sciences (TISS), Mumbai, India.
出版信息
Int J Health Policy Manag. 2014 Jan 6;2(1):29-38. doi: 10.15171/ijhpm.2014.06. eCollection 2014 Jan.
BACKGROUND
The pursuit of equity in health and healthcare has been the key feature of health policy in India. However, despite the policy significance, the volume of literature available on this issue is scarce. Therefore, this paper is an attempt to examine the horizontal inequities in healthcare utilization, consisting of outpatient and inpatient care in 15 major states and north-eastern region of India.
METHODS
Cross-sectional data were taken from the National Sample Survey Organization (NSSO) 60th round (2004), the survey on 'morbidity and healthcare'. While outpatient care was assessed using the probability of outpatient visit 15 days prior to the survey date, the indicators of inpatient care utilization were based on the following variables: the probability of hospital admission and length of stay in hospital over a 12-month period. All these measures of healthcare utilization were standardized for need differences and controlled for socio-economic factors. Need standardized concentration indices were used to measure interstate and intrastate income-related inequities in healthcare utilization.
RESULTS
Absolute inequalities were found between states in the proportion of the population reporting a visit to an outpatient provider, in the range of 4.42% to 21.72%. Similarly, inpatient care varied from 1% to 10%. The magnitude of inequity for both outpatient and inpatient care was pro-rich across rural and urban areas of India and in majority of the states. In fact, in majority of the states, the horizontal inequity across types of curative care was noticeably higher within the rural population than in the urban population. The analysis demonstrated that high per capita government health spending was significantly associated with low inequity in utilization of inpatient care.
CONCLUSION
The study concludes that it would be necessary to address the prevailing inequities in healthcare by substantially scaling up the public spending on health, and achieving effective universal coverage of healthcare in India.
背景
在印度，追求卫生和医疗保健公平一直是卫生政策的关键特征。然而，尽管具有政策意义，但关于这个问题的文献数量却很少。因此，本文试图考察印度 15 个主要邦和东北地区医疗利用的水平不公平现象，包括门诊和住院护理。
方法
本研究使用横断面数据，数据来源于国家抽样调查组织（NSSO）第 60 轮（2004 年）的“发病率和医疗保健”调查。门诊护理使用调查日期前 15 天门诊就诊的概率进行评估，住院护理利用的指标则基于以下变量：住院的概率和在 12 个月内住院的时间长度。所有这些医疗保健利用措施都针对需求差异进行了标准化，并控制了社会经济因素。使用需要标准化的集中指数来衡量医疗保健利用的州际和州内与收入相关的不公平现象。
结果
各州在报告门诊就诊的人口比例、范围在 4.42%至 21.72%之间存在绝对不平等。同样，住院护理的比例从 1%到 10%不等。无论是在农村还是城市地区，无论是在印度的多数邦还是在多数邦，门诊和住院护理的不公平程度都偏向富人。事实上，在多数邦，城乡人口的门诊和住院治疗的水平不公平现象在农村人口中明显高于城市人口。分析表明，人均政府卫生支出高与住院护理利用的不公平程度低显著相关。
结论
研究得出结论，需要通过大幅增加卫生支出，实现印度有效的全民医疗保健覆盖，来解决医疗保健方面存在的不公平现象。
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