Department of Economics, University of Calcutta, Kolkata, India.
Bethune College, University of Calcutta, Kolkata, India.
Int J Health Plann Manage. 2019 Jan;34(1):e557-e568. doi: 10.1002/hpm.2671. Epub 2018 Sep 20.
Many federal states in India have recently taken steps to improve distribution and affordability of medicines across public hospitals for reducing high out-of-pocket (OOP) expenditure. West Bengal has introduced a Public-Private Partnership (PPP) scheme, Fair Price Medicine Shops (FPMS) within government hospitals in 2012, which offers high discounts on maximum retail price of the drugs. This model introduces the state as a facilitator, rather than provider or financer, of health care. This paper attempts to measure its impact on OOP expenditure (OOPE) of patients using propensity-score-matching technique on the data collected from primary survey among patients. The study finds that although for non-poor patients, the average OOPE has reduced significantly, the impact has been counter-productive for the poor patients, hinting that PPP intervention seems to work only for relatively better-off people, as the best alternative for the poorest remains to be free provision of drugs from the government. The difference in outcome lay in the fact that the nature of control groups differed between poor and non-poor patients. Those poor patients who did not visit FPMS received most of the medicines free (hence OOPE nearly zero), while for the non-poor patients not visiting FPMS bought the drugs from outside retail shops.
印度的许多邦最近采取措施，改善公立医院的药品供应和可负担性，以降低高额自付费用（OOP）。西孟加拉邦于 2012 年在公立医院引入了公私合作（PPP）计划“平价药房（FPMS）”，为药品的最高零售价提供大幅折扣。该模式将国家定位为医疗保健的促进者，而不是提供者或资金提供者。本文试图使用倾向评分匹配技术，根据对患者进行的初步调查中收集的数据，衡量该模式对患者自付费用（OOPE）的影响。研究发现，虽然对于非贫困患者而言，平均 OOPE 显著降低，但对于贫困患者而言，这种影响适得其反，这表明 PPP 干预似乎仅对相对较富裕的人群有效，因为对于最贫困的人而言，最好的选择仍然是政府免费提供药品。结果存在差异，因为贫困和非贫困患者的对照组性质不同。那些没有去 FPMS 的贫困患者大部分药品都是免费的（因此 OOPE 几乎为零），而非贫困患者没有去 FPMS 的则从零售药店购买药品。
