Junior Public Health Professional (PHC), Department of UHC / Health Systems, WHO-SEARO, New Delhi, India.
Department of Humanities and Social Sciences, IIT Madras, Chennai, India.
Int J Equity Health. 2024 Aug 5;23(1):152. doi: 10.1186/s12939-024-02231-2.
Kerala has initiated many Universal Health Coverage (UHC) reforms in the last decade. The Aardram Mission launched in 2017 stands out owing to its scope, objectives, and commitments for strengthening Primary Health Care (PHC) in the State. The current study proposes to explore access and financial protection through the lens of equity in Kerala especially in the context of major UHC reforms carried out during the last decade. This paper will also highlight the key lessons from Kerala's approach towards UHC and health systems strengthening through a political economy approach.
Data from the Kerala state sample of 75th Round (2017-18) National Sample Survey is used for this study. Comparison is also drawn from the 71st Round Sample Survey, 2014, to measure the state's progress in terms of access and financial protection. Logistic regression was used for the calculation. The findings were further explored through a political economy approach.
The share of public facilities for outpatient care is 47.5%, which is a significant increase from 34.0% (in 2014) in the state. The share of public sector for out-patient care has increased for the lower socio-economic population in the state. The share of public sector for in-patient care has also increased to 37.3% in 2017-18 from 33.9% in 2014, but not to the extent as the increase shown in outpatient care. The average out-of-pocket-expenditure during hospitalization has increased more in private facilities as compared to public for both outpatient care and hospitalization.
Overall increase in the share of public facilities for both outpatient care and hospitalization is indicative of the enhanced trust among the people at large of the public healthcare delivery system in Kerala, post the launch of UHC reforms in the State. The insurance linked UHC reforms would be insufficient for the State to progress further towards UHC. Kerala with a long and successful history in 'public provisioning' should focus more on strengthening PHC through Aardram Mission in its journey towards pursuit of UHC.
在过去十年中，喀拉拉邦已经启动了许多全民健康覆盖（UHC）改革。2017 年启动的 Aardram 使命因其范围、目标和加强该州初级卫生保健（PHC）的承诺而引人注目。本研究旨在通过公平的视角探讨喀拉拉邦的获得途径和财务保护，特别是在过去十年中进行的主要 UHC 改革背景下。本文还将通过政治经济学方法，重点介绍喀拉拉邦实现 UHC 和加强卫生系统的方法的主要经验教训。
本研究使用了来自喀拉拉邦第 75 轮（2017-18 年）全国抽样调查的州样本数据。还从 2014 年第 71 轮抽样调查中进行了比较，以衡量该州在获得途径和财务保护方面的进展。使用逻辑回归进行了计算。通过政治经济学方法进一步探讨了研究结果。
门诊服务的公共设施份额为 47.5%，比该州 2014 年的 34.0%有显著增加。州内较低社会经济人口的门诊服务公共部门份额有所增加。2017-18 年，住院治疗的公共部门份额也从 2014 年的 33.9%增加到 37.3%，但增加幅度不及门诊治疗。与公共设施相比，私人设施的住院治疗平均自付费用在门诊和住院治疗中都有所增加。
门诊和住院治疗的公共设施份额总体增加表明，在该州启动 UHC 改革后，广大民众对公共医疗服务提供系统的信任度有所提高。与保险挂钩的 UHC 改革不足以使该州在实现 UHC 的道路上取得进一步进展。喀拉拉邦在“公共供应”方面有着悠久而成功的历史，在追求 UHC 的过程中，应该更加注重通过 Aardram 使命加强初级卫生保健。
