Health Research Institute, University of Canberra, Canberra, ACT, Australia.
PLoS One. 2023 Feb 7;18(2):e0281539. doi: 10.1371/journal.pone.0281539. eCollection 2023.
In this paper, we examine whether access to treatment for major morbidity conditions is determined by the social class of the person who needs treatment. Secondly, we assess whether health insurance coverage and the presence of a PHC have any significant impact on the utilisation of health services, either public or private, for treatment and, more importantly, whether the presence of health insurance and PHC modify the treatment use behaviour for the two excluded communities of interest namely Indigenous communities and older widows using data from two rounds (2005 and 2012) of the nationally representative India Human Development Survey (IHDS). We estimated a multilevel mixed effects model with treatment for major morbidity as the outcome variable and social groups, older widows, the presence of a PHC and the survey wave as the main explanatory variables. The results confirmed access to treatment for major morbidity was affected by social class with Indigenous communities and older widows less likely to access treatment. Health insurance coverage did not have an effect that was large enough to induce a positive change in the likelihood of accessing treatment. The presence of a functional PHC increased the likelihood of treatment for all social groups except Indigenous communities. This is not surprising as Indigenous communities generally live in locations where the terrain is more challenging and decentralised healthcare up to the PHC might not work as effectively as it does for others. The social class to which one belongs has a significant impact on the ability of a person to access healthcare. Efforts to address inequity needs to take this into account and design interventions that are decentralised and planned with the involvement of local communities to be effective. Merely addressing one or two barriers to access in an isolated fashion will not lead to equitable access.
本文探讨了治疗主要疾病的机会是否取决于需要治疗的人的社会阶层。其次，我们评估了健康保险覆盖范围和初级卫生保健的存在是否对公共或私人卫生服务的使用（特别是治疗）有任何重大影响，更重要的是，健康保险和初级卫生保健的存在是否会改变两个被排除在利益共同体之外的人群（即土著社区和老年寡妇）的治疗使用行为，所用数据来自两轮（2005 年和 2012 年）具有全国代表性的印度人类发展调查（IHDS）。我们使用多水平混合效应模型，以主要疾病治疗为结果变量，以社会群体、老年寡妇、初级卫生保健的存在和调查波次为主要解释变量。结果证实，获得主要疾病治疗的机会受到社会阶层的影响，土著社区和老年寡妇获得治疗的可能性较小。健康保险覆盖范围没有大到足以引起获得治疗的可能性发生积极变化的影响。功能齐全的初级卫生保健的存在增加了所有社会群体（除了土著社区）获得治疗的可能性。这并不奇怪，因为土著社区通常居住在地形更具挑战性的地方，而且到初级卫生保健机构的分散式医疗保健可能不如其他地方有效。一个人所属的社会阶层对其获得医疗保健的能力有重大影响。解决不平等问题的努力需要考虑到这一点，并设计分散和有当地社区参与的干预措施，以确保有效。仅仅孤立地解决一两个获得医疗保健的障碍，并不会导致公平获得医疗保健。
