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Assessing geographical inequity in availability of hospital services under the state-funded universal health insurance scheme in Chhattisgarh state, India, using a composite vulnerability index

机译:评估在印度Chhattisgarh州的国家资助的普遍健康保险计划下的医院服务的地理不公平,使用复合漏洞指数

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摘要

Background: Countries are increasingly adopting health insurance schemes for achieving Universal Health Coverage. India’s state-funded health insurance scheme covers hospital care provided by ‘empanelled’ private and public hospitals. Objective: This paper assesses geographical equity in availability of hospital services under the universal health insurance scheme in Chhattisgarh state. Methods: The study makes use of district data from the insurance scheme and government surveys. Selected socio-economic indicators are combined to form a composite vulnerability index, which is used to rank and group the state’s 27 districts into tertiles, named as highest, middle and lowest vulnerability districts (HVDs, MVDs, LVDs). Indicators of hospital service availability under the scheme – insurance coverage, number of empanelled private/public hospitals, numbers and amounts of claims – are compared across districts and tertiles. Two measures of inequality, difference and ratio, are used to compare availability between tertiles. Results: The study finds that there is a geographical pattern to vulnerability in Chhattisgarh state. Vulnerability increases with distance from the state’s centre towards the periphery. The highest vulnerability districts have the highest insurance coverage, but the lowest availability of empanelled hospitals (3.4 hospitals per 100,000 enrolled in HVDs, vs 8.2/100,000 enrolled in LVDs). While public sector hospitals are distributed equally, the distribution of private hospitals across tertiles is highly unequal, with higher availability in LVDs. The number of claims (per 100,000 enrolled) in the HVDs is 3.5-times less than that in the LVDs. The claim amounts show a similar pattern. Conclusions: Although insurance coverage is higher in the more vulnerable districts, availability of hospital services is inversely proportional to vulnerability and, therefore, the need for these services. Equitable enrolment in health insurance schemes does not automatically translate into equitable access to healthcare, which is also dependent on availability and specific dynamics of service provision under the scheme.
机译:背景:各国越来越多地采用健康保险计划,以实现普及健康覆盖。印度的国家资助的健康保险计划涵盖了“Empaneled”私人和公立医院提供的医院护理。目的:本文评估了Chhattisgarh州普遍健康保险计划下的医院服务的地理股权。方法:该研究利用来自保险计划和政府调查的地区数据。选定的社会经济指标组合以形成复合漏洞指数,该指数用于将国家的27个地区分组成立,名为最高,中最低漏洞区(HVDS,MVDS,LVDS)。根据该计划的医院服务可用性指标 - 在地区和特色的情况下,比较私人私人/公共医院,偏离私人/公共医院,数量和金额的人数。两种不等式,差异和比率的措施用于比较泰利物之间的可用性。结果:该研究发现,Chhattisgarh州的脆弱性有一个地理模式。脆弱性随着距离州中心朝向周边的距离而增加。最高的漏洞区拥有最高的保险范围,但最低的医院可用性(每10万位HVDS注册的3.4家医院,VS 8.2 / 100,000)。虽然公共部门医院同样分配,但跨泰利物的私立医院分配高度不平等,在LVDS中有更高的可用性。 HVDS中的索赔人数(注册每10万人)比LVDS中的3.5倍。索赔金额显示了类似的模式。结论:虽然保险范围在更脆弱的地区较高,但医院服务的可用性与脆弱性成反比,以及对这些服务的需求。健康保险计划的公平注册不会自动转化为公平的医疗保健,这也取决于该计划下的服务条款的可用性和具体动态。

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