Parker R L
Soc Sci Med. 1986;22(1):23-7. doi: 10.1016/0277-9536(86)90304-7.
Financing health services is an increasing concern that looms as one of the major obstacles to achieving an equitable distribution of primary health care in developing communities. An important step in solving this problem is the assessment of current levels of health care expenditures in these communities in order to determine the extent to which local resources are being used for these purposes. Ways to maximize the effectiveness of these resources can then be sought. Village level studies carried out between 1968 and 1974 in Punjab, India, revealed that at least 80% of all health care expenditures in this rural area were for services of traditional practitioners or private 'modern' doctors. This paper explores various aspects of these expenditures including the source of services and the effect of individual characteristics such as caste on the amount spent on health care. Out-of-pocket expenditures are contrasted to expenditures in the government system. Assessment of the impact of 'free' village level primary care services in this setting revealed that the poor reduced their expenditures on health care more than the wealthy, but both groups took almost equal advantage of the 'free' services. The results raise the possibility of mobilizing some of the savings accruing to the community to help support the 'free' services as well as the potential of encouraging private traditional and modern practitioners to cooperate in achieving primary health care goals.
卫生服务筹资日益受到关注，这已成为发展中社区实现初级卫生保健公平分配的主要障碍之一。解决这一问题的重要一步是评估这些社区当前的卫生保健支出水平，以确定当地资源用于这些目的的程度。然后可以寻求最大化这些资源效益的方法。1968年至1974年间在印度旁遮普邦进行的村级研究表明，该农村地区至少80%的卫生保健支出用于传统从业者或私立“现代”医生的服务。本文探讨了这些支出的各个方面，包括服务来源以及种姓等个体特征对卫生保健支出金额的影响。将自付费用支出与政府系统的支出进行了对比。对这种情况下“免费”村级初级保健服务影响的评估表明，穷人在卫生保健方面的支出减少幅度大于富人，但两组几乎同等程度地利用了“免费”服务。研究结果提出了动员社区产生的一些储蓄来帮助支持“免费”服务的可能性，以及鼓励私立传统和现代从业者合作以实现初级卫生保健目标的潜力。
