提供医疗保健服务是否足以确保更好的获得机会？对印度公私伙伴关系范围的探索。
Is provision of healthcare sufficient to ensure better access? An exploration of the scope for public-private partnership in India.
机构信息
DumDum Motijheel Rabindra Mahavidyalaya, Kolkata, West Bengal, India.
Surendranath College, Kolkata, West Bengal, India.
出版信息
Int J Health Policy Manag. 2015 Apr 8;4(7):467-74. doi: 10.15171/ijhpm.2015.77.
BACKGROUND
India's economic growth rate in recent years has been fairly impressive. But, it has been consistently failing to make considerable progress in achieving health related Millennium Development Goal (MDG) targets. Lack of coherence between provisions and utilization becomes the face of the problem. Inadequacies in outreach, access and affordability coupled with escalating healthcare costs have aggravated the problem. Here the application of Public-Private Partnership (PPP) model seems to have enormous potential to ease the impasse.
METHODS
This paper tries to find the gap between the provisions and access in healthcare. The paper attempts to construct a Health Infrastructure Index (HII) and Health Attainment Index (HAI) for different states of India. Considering the presence of regional variations found in health infrastructure and attainment among the states, two states, viz. Maharashtra (MAH) and West Bengal (WB) have been chosen. Then contributions of health programs like Rashtriya Swasthya Bima Yojana (RSBY), National Rural Telemedicine Network (NRTN) and Fair Price Shops (FPS), all PPP initiatives, have been assessed for both the states by carrying out comprehensive benefit-cost analysis.
RESULTS
The health infrastructure for population per unit area captures the outreach/delivery issue and the health attainment reveals the true scenario about how far the infrastructure has been accessed by the people; and the gap between the two, as the paper finds, is the root of the problem. The combined effect of RSBY and NRTN will leave both MAH and WB higher benefits in terms of health attainment. The contributions of RSBY and NRTN have been assessed for both the states by carrying out comprehensive benefit-cost analysis. FPS comes up with immense benefits for WB. It is yet to be implemented in MAH.
CONCLUSION
The outreach and access problems arising from deficiencies in infrastructure, human resources and financial ability are expected to be well-addressed by the spread of RSBY and NRTN jointly. The FPS mechanism under PPP initiative can be an effective tool in solving affordability problem by reducing the cost of treatment.
背景
近年来，印度的经济增长率相当可观。但在实现与卫生相关的千年发展目标（MDG）方面，印度一直未能取得重大进展。规定与利用之间缺乏一致性是问题的症结所在。服务覆盖面不足、可及性和负担能力差以及医疗保健费用不断攀升加剧了这一问题。在这里，公私合作伙伴关系（PPP）模式的应用似乎具有巨大的潜力来缓解僵局。
方法
本文试图找出医疗保健中规定与可及性之间的差距。本文试图为印度的不同邦构建卫生基础设施指数（HII）和卫生实现指数（HAI）。考虑到邦际之间卫生基础设施和实现方面存在的区域差异，选择了马哈拉施特拉邦（MAH）和西孟加拉邦（WB）两个邦。然后，通过进行全面的效益成本分析，评估了 RSBY、NRTN 和 FPS 等卫生计划（均为 PPP 倡议）对这两个邦的贡献。
结果
每单位面积的人口卫生基础设施涵盖了服务覆盖面/提供问题，而卫生实现情况则揭示了基础设施在多大程度上被人民所利用的真实情况；正如本文所发现的，两者之间的差距是问题的根源。RSBY 和 NRTN 的综合效应将使 MAH 和 WB 在卫生实现方面获得更高的效益。通过进行全面的效益成本分析，评估了 RSBY 和 NRTN 对这两个邦的贡献。FPS 为 WB 带来了巨大的效益。它尚未在 MAH 实施。
结论
由基础设施、人力资源和财务能力不足引起的服务覆盖面和可及性问题有望通过 RSBY 和 NRTN 的普及得到很好的解决。PPP 倡议下的 FPS 机制可以通过降低治疗成本成为解决负担能力问题的有效工具。
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