Marie Stopes Society, Karachi, Pakistan.
AIPH - AAPNA Institute of Public Health, Jinnah Sindh Medical University, Karachi, Pakistan.
Front Public Health. 2024 Mar 12;12:1293278. doi: 10.3389/fpubh.2024.1293278. eCollection 2024.
Pakistan has a mixed-health system where up to 60% of health expenditures are out of pocket. Almost 80% of primary healthcare (PHC) facilities are in the private sector, which is deeply embedded within the country's health system and may account for the unaffordability of healthcare. Since 2016, the existing national health insurance program or Sehat Sahulat Program (SSP), has provided invaluable coverage and financial protection to the millions of low-income families living in Pakistan by providing inpatient services at secondary and tertiary levels. However, a key gap is the non-inclusion of outpatient services at the PHC in the insurance scheme. This study aims to engage a private provider network of general practitioners in select union councils of Islamabad Capital Authority (ICT) of Pakistan to improve access, uptake, and satisfaction and reduce out-of-pocket expenditure on quality outpatient services at the PHC level, including family planning and reproductive health services.
A 24-month research study is proposed with a 12-month intervention period using a mixed method, two-arm, prospective, quasi-experimental controlled before and after design with a sample of 863 beneficiary families from each study arm, i.e., intervention and control groups ( = 1726) will be selected through randomization at the selected beneficiary family/household level from four peri-urban Union Councils of ICT where no public sector PHC-level facility exists. All ethical considerations will be assured, along with quality assurance strategies. Quantitative pre/post surveys and third-party monitoring are proposed to measure the intervention outcomes. Qualitative inquiry with beneficiaries, general practitioners and policymakers will assess their knowledge and practices.
PHC should be the first point of contact for accessing health services and appears to serve as a programmatic engine for universal health coverage (UHC). The research aims to study a service delivery model which harnesses the private sector to deliver an essential package of health services as outpatient services under SSP, ultimately facilitating UHC. Findings will provide a blueprint referral system to reduce unnecessary hospital admissions and improve timely access to healthcare. A robust PHC system can improve population health, lower healthcare expenditure, strengthen the healthcare system, and ultimately make UHC a reality.
巴基斯坦的医疗体系较为复杂，高达 60%的医疗支出需要自费。近 80%的初级医疗保健（PHC）设施都位于私营部门，而私营部门在该国的医疗体系中根深蒂固，这可能导致医疗服务的负担难以承受。自 2016 年以来，现有的国家健康保险计划或 Sehat Sahulat 计划（SSP）为居住在巴基斯坦的数以百万计的低收入家庭提供了宝贵的覆盖范围和财务保障，为二级和三级医疗机构的住院服务提供了保障。然而，一个关键的差距是，该保险计划未将 PHC 的门诊服务纳入其中。本研究旨在与巴基斯坦伊斯兰堡首都区（ICT）的选定联盟理事会的私人医生网络合作，以改善初级保健水平的门诊服务的可及性、利用率和满意度，并降低自费支出，包括计划生育和生殖健康服务。
拟开展一项为期 24 个月的研究，其中包括 12 个月的干预期，采用混合方法、两臂、前瞻性、准实验对照前后设计，从每个研究臂中抽取 863 户受益家庭作为样本，即干预组和对照组（=1726 户）将通过在没有公共部门 PHC 设施的四个城郊联盟理事会中以随机方式从选定的受益家庭/住户层面抽取。所有伦理问题都将得到保证，并采取质量保证策略。建议进行定量预/后调查和第三方监测，以衡量干预结果。将对受益者、全科医生和政策制定者进行定性调查，以评估他们的知识和实践。
PHC 应该是获取医疗服务的第一站，并且似乎是实现全民健康覆盖（UHC）的计划引擎。该研究旨在研究一种服务提供模式，利用私营部门提供 SSP 下的基本卫生服务套餐，最终促进 UHC。研究结果将提供一个转诊系统蓝图，以减少不必要的住院治疗并改善及时获得医疗服务的机会。强大的 PHC 系统可以改善人口健康、降低医疗支出、加强医疗体系，并最终使 UHC 成为现实。
