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The Privatization Imperative: Women Negotiating Healthcare in Kandy, Sri Lanka

机译:私有化势在必行:斯里兰卡康提的女性参与医疗保健谈判

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摘要

Since the 1980s, poorer countries have shifted health reform efforts from strengthening public systems to increasing the private sector's role in healthcare provision. Empirical research on healthcare access focuses on quantifying out-of-pocket payments or service utilization, making invisible both user experiences and how the dynamics of public and private provision are contingent on place and social relations. Historically a model for poorer countries, Sri Lanka's public healthcare system is seeing steady privatization following decades of insufficient state investment alongside incentivized private expansion. However, little is known about what this restructuring means for healthcare access in Sri Lanka.;I employed a Third World Marxist feminist qualitative methodology to explore how the presence of private healthcare shapes access for women in Kandy, Sri Lanka. I asked: Where do women go for healthcare? What are their impressions of the health services they use? How do they navigate public and private systems? And how are these questions shaped by social location? Using focus groups, interviews, meetings, and a short survey, I gathered data from 40 residents of Udawatta Division. My analysis linked macrostructures and processes of healthcare restructuring with women's everyday experiences of utilizing healthcare.;Economic exclusion and quality concerns limited the range of private healthcare 'choices' available to users. Almost all women mixed public and private services, with these hybrid arrangements differing by social location. Economically disadvantaged users were compelled to consume private healthcare owing to service deficits in the public system. Middle-class women mostly used private outpatient services, and exploited 'dual practice' to access more responsive public inpatient care. Socially disadvantaged women, particularly ethnic minorities, relied on the same pathway to avoid neglect and/or abuse within the public system.;The state's 'withdrawal' from healthcare provision, and its incentives for private expansion, has wide-ranging implications for users in Kandy. As women struggle to address service gaps in the public sector, hybrid arrangements stratify services along class and ethnic lines, creating opportunities for private accumulation. My findings interrogate the direction of Sri Lanka's health reform and call into question global health advocacy for 'mixed health systems' as a path to achieving 'Universal Health Coverage.'
机译:自1980年代以来,较贫穷的国家已将医疗改革的努力从加强公共系统转移到增加私营部门在医疗保健提供中的作用。关于医疗保健获取的实证研究侧重于量化自付费用或服务利用,使用户体验以及公共和私人提供的动态如何取决于场所和社会关系都是不可见的。从历史上讲,这是贫穷国家的典范,在几十年的国家投资不足以及激励性私人扩张的推动下,斯里兰卡的公共医疗体系正在实现稳定的私有化。但是,对于这种结构调整对斯里兰卡医疗服务的意义知之甚少。我采用了第三世界马克思主义女权主义定性方法论来探讨私人医疗服务如何影响斯里兰卡康提妇女的医疗服务。我问:妇女在哪里去医疗?他们对使用的医疗服务有什么印象?他们如何导航公共和私有系统?这些问题如何受到社会定位的影响?通过焦点小组,访谈,会议和简短调查,我收集了Udawatta部门40位居民的数据。我的分析将医疗保健重组的宏观结构和过程与女性利用医疗保健的日常经验联系在一起;经济上的排斥和对质量的担忧限制了用户可使用的私人医疗保健“选择”的范围。几乎所有妇女都混合了公共和私人服务,而这些混合安排因社会地位而异。由于公共系统服务不足,经济上处于不利地位的用户被迫消费私人医疗保健。中产阶级妇女大多使用私人门诊服务,并利用“双重实践”来获得反应更快的公共住院服务。社会处境不利的妇女,特别是少数族裔妇女,依靠相同的途径避免在公共系统内受到忽视和/或虐待。该州从医疗保健服务中“退出”及其对私人扩张​​的激励措施,对使用者的广泛影响康提随着妇女努力解决公共部门服务方面的差距,混合安排将阶级和种族界限的服务分层,为私人积累创造了机会。我的发现询问了斯里兰卡卫生改革的方向,并质疑全球卫生倡导“混合卫生系统”作为实现“全民健康覆盖”的途径。

著录项

  • 作者

    Kumar, Ramya.;

  • 作者单位

    University of Toronto (Canada).;

  • 授予单位 University of Toronto (Canada).;
  • 学科 Public health.;Social research.;South Asian studies.
  • 学位 Ph.D.
  • 年度 2018
  • 页码 208 p.
  • 总页数 208
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

  • 入库时间 2022-08-17 11:53:12

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