Jana Arnab, Basu Rounaq
Centre for Urban Science & Engineering, Indian Institute of Technology Bombay, Mumbai, Maharashtra 400076 India.
Intelligent Transportation Systems Lab, Department of Civil & Environmental Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139 USA.
Glob Health Res Policy. 2017 Mar 6;2:6. doi: 10.1186/s41256-017-0026-y. eCollection 2017.
Health policy formulations in India have witnessed a shift from a reactive approach to a more proactive approach over the last decade. It is therefore important to understand the effectiveness of recent national health policies (such as the National Rural Health Mission and the National Urban Health Mission) in addressing the varied needs of the heterogeneous population of India.
We use datasets from the National Sample Surveys carried out in 2004 and 2014 to understand the change in the health seeking behavior as a result of these policies. The choice of health care facilities and the associated expenditures are compared through descriptive analyses. A multinomial logistic regression is used to identify the significant parameters which contribute towards the share of health care providers in India. The health status of two economically disparate Indian states (Bihar and Kerala) are also compared through specific metrics of performance.
It is seen that due to increased availability of facilities in close proximity, both rural and urban residents prefer to avail of those facilities which will result in minimization of transportation cost. The effectiveness of national health policies is found to vary on a regional scale. Literacy and health status have a strong correlation, thereby reinforcing that Bihar still lags far behind Kerala in terms of access to equitable health care.
Therefore, a hierarchical system, incorporating medical pluralism and tailor-made policies targeted at diverse health care demands, needs to be put in place to achieve Goal 3 of the Sustainable Development Goals as decreed by the United Nations, i.e., "health for all".
在过去十年中，印度的卫生政策制定已从被动应对方式转向更积极主动的方式。因此，了解近期国家卫生政策（如国家农村卫生使命和国家城市卫生使命）在满足印度异质人群多样化需求方面的有效性非常重要。
我们使用2004年和2014年进行的全国抽样调查数据集，以了解这些政策导致的就医行为变化。通过描述性分析比较医疗保健设施的选择和相关支出。使用多项逻辑回归来确定对印度医疗保健提供者份额有贡献的重要参数。还通过具体的绩效指标比较了印度两个经济差异较大的邦（比哈尔邦和喀拉拉邦）的健康状况。
可以看出，由于附近设施可用性增加，农村和城市居民都更倾向于利用那些能使交通成本最小化的设施。发现国家卫生政策的有效性在区域范围内存在差异。识字率与健康状况有很强的相关性，从而强化了比哈尔邦在获得公平医疗保健方面仍远远落后于喀拉拉邦这一事实。
因此，需要建立一个分级系统，纳入医学多元主义和针对不同医疗保健需求的量身定制政策，以实现联合国颁布的可持续发展目标的目标3，即“全民健康”。
