印度受慢性病影响的农村贫困人口门诊就医行为的决定因素：一项基于七邦人口的横断面研究

Determinants of outpatient healthcare-seeking behaviors among the rural poor affected by chronic conditions in India: a population-based cross-sectional study in seven states.

作者信息

Grossmann David, Srivastava Swati, Winkler Volker, Brenner Stephan, Gupta Keerti Jain, Paliwal Amit, Singh Kavita, De Allegri Manuela

机构信息

Heidelberg Institute of Global Health, Heidelberg University Hospital and Medical Faculty, Heidelberg, Germany.

Indo German Programme on Universal Health Coverage (IGUHC), Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, New Delhi, India.

出版信息

Glob Health Action. 2025 Dec;18(1):2480413. doi: 10.1080/16549716.2025.2480413. Epub 2025 Apr 14.

DOI:10.1080/16549716.2025.2480413

PMID:40223762

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11998304/

Abstract

BACKGROUND

A rising burden of chronic non-communicable diseases (CNCDs) increases demand for outpatient healthcare. Yet, evidence on preferences and barriers to healthcare services for India's most disadvantaged population, the target of India's largest public health insurance scheme (PM-JAY), is lacking.

OBJECTIVE

We explore determinants of outpatient healthcare-seeking behavior among PM-JAY eligible individuals with CNCDs in rural areas of seven states.

METHODS

Using cross-sectional data from a household survey (conducted between November 2019 and March 2020), we employed multilevel multinomial logistic regression to identify factors associated with seeking care from informal (home treatment, pharmacies, traditional healers), formal public, or formal private providers, compared with no care. Anderson's behavioral model informed the selection of independent variables.

RESULTS

Of 51,820 individuals, 5,061 (9.8%) reported a chronic condition. Despite their disease, 1,168 (23.1%) reported not using regular outpatient care. Another 2,421 individuals (48.0%) used formal private, 922 (18.3%) used formal public, and 535 (10.6%) used informal care. Predictors of formal private care were higher socioeconomic status (RRR = 2.441, 95% CI [1.61, 3.70]) and health insurance coverage (RRR = 1.478, 95% CI [1.12, 1.95]). Residents of Tamil Nadu, Kerala, and Gujarat were more likely to use formal public care (RRR = 23.915, 95% CI [9.01, 63.44]). Suffering from Major CNCDs or experiencing limitations in daily activities increased the probability of using healthcare across all options.

CONCLUSION

Future research should explore the reasons for non-utilization of chronic care and the preference for private providers. Policies to enhance public healthcare utilization and expand insurance for outpatient care could improve access and reduce health inequities.

摘要

背景

慢性非传染性疾病（CNCDs）负担的不断增加，使得门诊医疗保健需求上升。然而，对于印度最大的公共医疗保险计划（PM-JAY）的目标人群，即印度最弱势的人群，关于其对医疗服务的偏好和障碍的证据却很缺乏。

目的

我们探讨了七个邦农村地区符合PM-JAY条件的患有慢性非传染性疾病的个体寻求门诊医疗行为的决定因素。

方法

利用一项家庭调查（于2019年11月至2020年3月进行）的横断面数据，我们采用多水平多项逻辑回归来确定与从不就医相比，从非正式（家庭治疗、药店、传统治疗师）、正式公共或正式私人医疗服务提供者处寻求医疗服务相关的因素。安德森行为模型为自变量的选择提供了依据。

结果

在51820名个体中，5061人（9.8%）报告患有慢性病。尽管患病，但1168人（23.1%）报告未使用常规门诊医疗服务。另外2421人（48.0%）使用正式私人医疗服务，922人（18.3%）使用正式公共医疗服务以及535人（10.6%）使用非正式医疗服务。正式私人医疗服务的预测因素是较高的社会经济地位（相对风险比RRR = 2.441，95%置信区间CI [1.61, 3.70]）和医疗保险覆盖范围（RRR = 1.478，95%置信区间CI [1.12, 1.95]）。泰米尔纳德邦、喀拉拉邦和古吉拉特邦的居民更有可能使用正式公共医疗服务（RRR = 23.915，95%置信区间CI [9.01, 63.44]）。患有主要慢性非传染性疾病或日常生活活动受限会增加在所有选择中使用医疗服务的可能性。