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Handa A, Choudhari SG, Gaidhane A. Joseph William Bhore (1878-1960): The Architect Behind the Bhore Committee Legacy. Cureus 2024; 16:e67405. [PMID: 39310596 PMCID: PMC11414765 DOI: 10.7759/cureus.67405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Accepted: 08/21/2024] [Indexed: 09/25/2024] Open
Abstract
Sir Joseph William Bhore was a civil official from India. He pioneered the health survey and development committee, known as the Bhore Committee, which set the direction for India's public health facilities and investments. The chairmanship of the Health Survey and Development Committee, which the British colonial administration formed in 1943, is arguably the most well-known role Bhore has held. The committee was founded in 1943 and produced a thorough report in 1946. The committee's suggestions shaped India's health policy and planning and the course of the country's health care growth.
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Affiliation(s)
- Alisha Handa
- Department of Community Medicine, Jawaharlal Nehru Medical College, School of Epidemiology and Public Health, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Sonali G Choudhari
- Department of Community Medicine, Jawaharlal Nehru Medical College, School of Epidemiology and Public Health, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Abhay Gaidhane
- Department of Community Medicine, Jawaharlal Nehru Medical College, School of Epidemiology and Public Health, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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2
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Lamb S, Goswami N. Healthy aging, self-care, and choice in India: Class-based engagements with globally circulating ideologies. J Aging Stud 2024; 68:101194. [PMID: 38458731 DOI: 10.1016/j.jaging.2023.101194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 11/11/2023] [Accepted: 11/13/2023] [Indexed: 03/10/2024]
Abstract
Euro-American notions of successful and healthy aging are taking root globally, shaped and inflected by local cultural and political contexts. India is one place where globally inflected discourses of healthy, active, and successful aging are on the rise. However, notions about just what constitutes healthy aging and how to achieve such a goal do not play out the same way across the globe. This article explores how older Indians of diverse social classes are thinking about their own lives in relation to broader discourses of healthy aging circulating within India and abroad. Analyses of in-depth interviews with 25 individuals (11 women and 14 men, ages 57 to 81, across a range of social classes) reveal that while many among the urban elite are enjoying participating in a globally informed healthy-aging culture, such trends are not at all widespread among the non-elite. Moreover, Indians across social classes tend to interpret their own "healthy aging" goals in ways at odds with their perceptions of Western paradigms of healthy and successful aging, sometimes incorporating critiques of the West into their own reflections about health and well-being in later life. By examining how healthy-successful aging ideologies play out across divergent national-cultural and social-class contexts, our aim is to challenge universalizing models and heighten understanding of social inequalities while opening up a wider set of possibilities for imagining what it is to live meaningfully in later life.
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Affiliation(s)
- Sarah Lamb
- Department of Anthropology, MS 006, Brandeis University, Waltham, MA 02454-9110, USA.
| | - Nilanjana Goswami
- Department of Humanities and Social Sciences, BITS Pilani K.K. Birla Goa Campus, Sancoale, Goa, India.
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3
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Hasan MR, Tabassum T, Tabassum T, Tanbir MA, Kibria M, Chowduary M, Nambiar R. Navigating Cultural Diversity in the Selection of Cardiovascular Device Treatments: A Comprehensive Review. Cureus 2023; 15:e38934. [PMID: 37313070 PMCID: PMC10259755 DOI: 10.7759/cureus.38934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2023] [Indexed: 06/15/2023] Open
Abstract
In cardiology, patients' cultural beliefs, linguistic differences, lack of knowledge, and socioeconomic status can create barriers to choosing device treatment. To address this issue, we conducted a thorough literature review using online databases such as PubMed, Google Scholar, and Texas Tech University Health Sciences Center's research portal. Our review found that cultural, religious, and linguistic barriers can contribute to patients' apprehension and reservations about device placement. These barriers can also impact patients' adherence to treatment and clinical outcomes. Patients from lower socioeconomic backgrounds may have difficulty accessing and affording device-based treatments. Additionally, fear and inadequate understanding of surgical procedures can deter patients from accepting device treatment in cardiology. To overcome these cultural barriers, healthcare providers must raise awareness about the benefits of device treatment and provide better training to overcome these challenges. It is crucial to address the unique needs of patients from different cultural backgrounds and socioeconomic statuses to ensure they receive the care they need.
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Affiliation(s)
- Md Rockyb Hasan
- Department of Internal Medicine, Amarillo Campus, Texas Tech University Health Sciences Center, Amarillo, USA
| | - Tahsin Tabassum
- Department of Public Health, School of Community Health and Policy, Morgan State University, Baltimore, USA
| | - Tanzin Tabassum
- Department of General Surgery, West Suffolk Hospital, Bury St Edmunds, GBR
| | - Mohammed A Tanbir
- Department of Internal Medicine, Amarillo Campus, Texas Tech University Health Sciences Center, Amarillo, USA
| | - Mahzabin Kibria
- Department of Medicine, Sir Salimullah Medical College, Dhaka, BGD
| | - Mahidul Chowduary
- Department of Internal Medicine, Interfaith Medical Center, Brooklyn, USA
| | - Rajesh Nambiar
- Department of Cardiology, Amarillo Campus, Texas Tech University Health Sciences Center, Amarillo, USA
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4
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Al Dahdah M, Mishra RK. Digital health for all: The turn to digitized healthcare in India. Soc Sci Med 2023; 319:114968. [PMID: 35459554 DOI: 10.1016/j.socscimed.2022.114968] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/21/2022] [Accepted: 04/07/2022] [Indexed: 10/18/2022]
Abstract
In India, the use of digital technologies has become the key to the everyday operation of the welfare state in terms of accessing essential and life-sustaining entitlements. In this context, our article explores the genesis of India's digital turn in healthcare and maps the characteristics of a 'digital health for all' policy, based on empirical analysis of India's first digital-based universal health coverage programme - Rashtriya Swasthya Bima Yojana (RSBY) - with fieldwork material from the states of Jharkhand and Chhattisgarh. Being a smart-card-centred programme, RSBY marks the genesis of a digital approach to healthcare in India. The experiences of this scheme hold crucial implications for the digital healthcare landscape in India, as in the past its promoters pitched for its use to provide quality healthcare at lower cost. The technological design of the programme illustrates the construction and politics of a digitalized public-private welfare policy intended to meet the health needs of the poorest. By examining data on digital access to healthcare in the RSBY programme, as propounded and sustained by public health policies and a public-private model of governance, our article raises questions about the construction of new digital health policies and their contribution to private health markets. In doing so, it explores the key question of how digital technologies are transforming access to healthcare in India.
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Affiliation(s)
- Marine Al Dahdah
- Sociologist at the French National Centre for Scientific Research (CNRS), Centre for Studies of Social Movements (CEMS) and French Institute of Pondicherry (IFP), India.
| | - Rajiv K Mishra
- Centre for Studies in Science Policy (CSSP), School of Social Sciences, Jawaharlal Nehru University (JNU), New Delhi, India
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5
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Pandey N, Jha S. Universal Health System in India: Review and Directions for Future Research. JOURNAL OF HEALTH MANAGEMENT 2021. [DOI: 10.1177/09720634211052408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The universal health system (UHS) was considered a utopian idea in emerging markets until countries like India initiated its implementation. The UHS is not a new phenomenon with countries, such as Canada, Ireland and the UK, having implemented it many decades ago in their respective countries. This study revisits the entire literature on UHS till date. The extant literature analysis has resulted in five research themes and has highlighted the challenges faced during the implementation of UHS in India. The future research directions for academia and a conceptual framework of UHS implementation is also proposed. This study suggests that there is a need for more studies on policy paradigms, improving accessibility, funding models, healthcare grid, manpower mapping and audit metrics for achieving the goal of equitable UHS implementation in India.
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Affiliation(s)
- Neeraj Pandey
- National Institute of Industrial Engineering (NITIE), Powai, Mumbai, Maharashtra, India
| | - Sumi Jha
- National Institute of Industrial Engineering (NITIE), Powai, Mumbai, Maharashtra, India
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Faruqui N, Bernays S, Martiniuk A, Abimbola S, Arora R, Lowe J, Denburg A, Joshi R. Access to care for childhood cancers in India: perspectives of health care providers and the implications for universal health coverage. BMC Public Health 2020; 20:1641. [PMID: 33143668 PMCID: PMC7607709 DOI: 10.1186/s12889-020-09758-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 10/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are multiple barriers impeding access to childhood cancer care in the Indian health system. Understanding what the barriers are, how various stakeholders perceive these barriers and what influences their perceptions are essential in improving access to care, thereby contributing towards achieving Universal Health Coverage (UHC). This study aims to explore the challenges for accessing childhood cancer care through health care provider perspectives in India. METHODS This study was conducted in 7 tertiary cancer hospitals (3 public, 3 private and 1 charitable trust hospital) across Delhi and Hyderabad. We recruited 27 healthcare providers involved in childhood cancer care. Semi-structured interviews were audio recorded after obtaining informed consent. A thematic and inductive approach to content analysis was conducted and organised using NVivo 11 software. RESULTS Participants described a constellation of interconnected barriers to accessing care such as insufficient infrastructure and supportive care, patient knowledge and awareness, sociocultural beliefs, and weak referral pathways. However, these barriers were reflected upon differently based on participant perception through three key influences: 1) the type of hospital setting: public hospitals constituted more barriers such as patient navigation issues and inadequate health workforce, whereas charitable trust and private hospitals were better equipped to provide services. 2) the participant's cadre: the nature of the participant's role meant a different degree of exposure to the challenges families faced, where for example, social workers provided more in-depth accounts of barriers from their day-to-day interactions with families, compared to oncologists. 3) individual perceptions within cadres: regardless of the hospital setting or cadre, participants expressed individual varied opinions of barriers such as acceptance of delay and recognition of stakeholder accountabilities, where governance was a major issue. These influences alluded to not only tangible and structural barriers but also intangible barriers which are part of service provision and stakeholder relationships. CONCLUSION Although participants acknowledged that accessing childhood cancer care in India is limited by several barriers, perceptions of these barriers varied. Our findings illustrate that health care provider perceptions are shaped by their experiences, interests and standpoints, which are useful towards informing policy for childhood cancers within UHC.
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Affiliation(s)
- Neha Faruqui
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.
| | - Sarah Bernays
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,London School of Hygiene and Tropical Medicine, London, UK
| | - Alexandra Martiniuk
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,George Institute for Global Health, Sydney, NSW, Australia.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Seye Abimbola
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,George Institute for Global Health, Sydney, NSW, Australia
| | - Ramandeep Arora
- Cankids … Kidscan, New Delhi, India.,Max Super Speciality Hospital, New Delhi, India
| | | | - Avram Denburg
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Rohina Joshi
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,George Institute for Global Health, Sydney, NSW, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia.,George Institute for Global Health, New Delhi, India
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Das J, Daniels B, Ashok M, Shim EY, Muralidharan K. Two Indias: The structure of primary health care markets in rural Indian villages with implications for policy. Soc Sci Med 2020; 301:112799. [PMID: 32553441 PMCID: PMC9188269 DOI: 10.1016/j.socscimed.2020.112799] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 11/22/2019] [Accepted: 01/11/2020] [Indexed: 11/13/2022]
Abstract
We visited 1519 villages across 19 Indian states in 2009 to (a) count all health care providers and (b) elicit their quality as measured through tests of medical knowledge. We document three main findings. First, 75% of villages have at least one health care provider and 64% of care is sought in villages with 3 or more providers. Most providers are in the private sector (86%) and, within the private sector, the majority are ‘informal providers' without any formal medical training. Our estimates suggest that such informal providers account for 68% of the total provider population in rural India. Second, there is considerable variation in quality across states and formal qualifications are a poor predictor of quality. For instance, the medical knowledge of informal providers in Tamil Nadu and Karnataka is higher than that of fully trained doctors in Bihar and Uttar Pradesh. Surprisingly, the share of informal providers does not decline with socioeconomic status. Instead, their quality, along with the quality of doctors in the private and public sector, increases sharply. Third, India is divided into two nations not just by quality of health care providers, but also by costs: Better performing states provide higher quality at lower per-visit costs, suggesting that they are on a different production possibility frontier. These patterns are consistent with significant variation across states in the availability and quality of medical education. Our results highlight the complex structure of health care markets, the large share of private informal providers, and the substantial variation in the quality and cost of care across and within markets in rural India. Measuring and accounting for this complexity is essential for health care policy in India. In 2010, the average Indian village had 3.2 primary healthcare providers. Of these, 86% were in the private sector and 68% had no formal medical training. In richer states, the share of informal providers did not decrease—quality improved. In high-performing states, quality was higher and per-patient costs were lower. The density and variation of health market cost and quality has policy implications.
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Affiliation(s)
- Jishnu Das
- Georgetown University, Washington, DC, USA; Centre for Policy Research, New Delhi, India.
| | | | - Monisha Ashok
- Center for Innovation and Impact, Global Health Bureau, USAID, USA
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Pramesh CS, Chaturvedi H, Reddy VA, Saikia T, Ghoshal S, Pandit M, Babu KG, Ganpathy KV, Savant D, Mitera G, Sullivan R, Booth CM. Choosing Wisely India: ten low-value or harmful practices that should be avoided in cancer care. Lancet Oncol 2019; 20:e218-e223. [PMID: 30857957 DOI: 10.1016/s1470-2045(19)30092-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/28/2019] [Accepted: 01/29/2019] [Indexed: 12/14/2022]
Abstract
The Choosing Wisely India campaign was an initiative that was established to identify low-value or potentially harmful practices that are relevant to the Indian cancer health-care system. We undertook a multidisciplinary framework-driven consensus process to identify a list of low-value or harmful cancer practices that are frequently undertaken in India. A task force convened by the National Cancer Grid of India included Indian representatives from surgical, medical, and radiation oncology. Each specialty had representation from the private and public sectors. The task force included two representatives from national patient and patient advocacy groups. Of the ten practices that were identified, four are completely new recommendations, and six are revisions or adaptations from previous Choosing Wisely USA and Canada lists. Recommendations in the final list pertain to diagnosis and treatment (five practices), palliative care (two practices), imaging (two practices), and system-level delivery of care (two practices). Implementation of this list and reporting of concordance with its recommendations will facilitate the delivery of high-quality, value-based cancer care in India.
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Affiliation(s)
- C S Pramesh
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India.
| | | | - Vijay Anand Reddy
- Department of Radiation Oncology, Apollo Hospitals, Hyderabad, India
| | - Tapan Saikia
- Department of Medical Oncology, Prince Aly Khan Hospital, Mumbai, India
| | - Sushmita Ghoshal
- Department of Radiation Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - K Govind Babu
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, India
| | - K V Ganpathy
- Jeet Association for Support to Cancer Patients, Mumbai, India
| | | | - Gunita Mitera
- Department of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Richard Sullivan
- Institute of Cancer Policy, King's College London, and King's Health Partners Comprehensive Cancer Centre, London, UK
| | - Christopher M Booth
- Department of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, ON, Canada
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Kojima N, Krupp K, Ravi K, Gowda S, Jaykrishna P, Leonardson-Placek C, Siddhaiah A, Bristow CC, Arun A, Klausner JD, Madhivanan P. Implementing and sustaining a mobile medical clinic for prenatal care and sexually transmitted infection prevention in rural Mysore, India. BMC Infect Dis 2017; 17:189. [PMID: 28264668 PMCID: PMC5338078 DOI: 10.1186/s12879-017-2282-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 02/22/2017] [Indexed: 11/20/2022] Open
Abstract
Background In rural India, mobile medical clinics are useful models for delivering health promotion, education, and care. Mobile medical clinics use fewer providers for larger catchment areas compared to traditional clinic models in resource limited settings, which is especially useful in areas with shortages of healthcare providers and a wide geographical distribution of patients. Methods From 2008 to 2011, we built infrastructure to implement a mobile clinic system to educate rural communities about maternal child health, train community health workers in common safe birthing procedures, and provide comprehensive antenatal care, prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV), and testing for specific infections in a large rural catchment area of pregnant women in rural Mysore. This was done using two mobile clinics and one walk-in clinic. Women were tested for HIV, hepatitis B, syphilis, and bacterial vaginosis along with random blood sugar, urine albumin, and anemia. Sociodemographic information, medical, and obstetric history were collected using interviewer-administered questionnaires in the local language, Kannada. Data were entered in Microsoft Excel and analyzed using Stata SE 14.1. Results During the program period, nearly 700 community workers and 100 health care providers were trained; educational sessions were delivered to over 15,000 men and women and integrated antenatal care and HIV/sexually transmitted infection testing was offered to 3545 pregnant women. There were 22 (0.6%) cases of HIV, 19 (0.5%) cases of hepatitis B, 2 (0.1%) cases of syphilis, and 250 (7.1%) cases of BV, which were identified and treated. Additionally, 1755 (49.5%) cases of moderate to severe anemia and 154 (4.3%) cases of hypertension were identified and treated among the pregnant women tested. Conclusions Patient-centered mobile medical clinics are feasible, successful, and acceptable models that can be used to provide quality healthcare to pregnant women in rural and hard-to-reach settings. The high numbers of pregnant women attending mobile medical clinics show that integrated antenatal care with PMTCT services were acceptable and utilized. The program also developed and trained health professionals who continue to remain in those communities.
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Affiliation(s)
- Noah Kojima
- David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Ave, Los Angeles, 90095, CA, USA
| | - Karl Krupp
- Public Health Research Institute of India, 89/B, Ambika, 2nd Cross, 2nd Main, Yadavagiri, Mysuru, Karnataka, 570020, India.,Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, Miami, 33199, FL, USA
| | - Kavitha Ravi
- Public Health Research Institute of India, 89/B, Ambika, 2nd Cross, 2nd Main, Yadavagiri, Mysuru, Karnataka, 570020, India
| | - Savitha Gowda
- Public Health Research Institute of India, 89/B, Ambika, 2nd Cross, 2nd Main, Yadavagiri, Mysuru, Karnataka, 570020, India
| | - Poornima Jaykrishna
- Public Health Research Institute of India, 89/B, Ambika, 2nd Cross, 2nd Main, Yadavagiri, Mysuru, Karnataka, 570020, India
| | - Caitlyn Leonardson-Placek
- Public Health Research Institute of India, 89/B, Ambika, 2nd Cross, 2nd Main, Yadavagiri, Mysuru, Karnataka, 570020, India
| | - Anand Siddhaiah
- Public Health Research Institute of India, 89/B, Ambika, 2nd Cross, 2nd Main, Yadavagiri, Mysuru, Karnataka, 570020, India
| | - Claire C Bristow
- Division of Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Dr, La Jolla, 92093, CA, USA
| | - Anjali Arun
- Public Health Research Institute of India, 89/B, Ambika, 2nd Cross, 2nd Main, Yadavagiri, Mysuru, Karnataka, 570020, India
| | - Jeffrey D Klausner
- David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Ave, Los Angeles, 90095, CA, USA.,Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, Miami, 33199, FL, USA
| | - Purnima Madhivanan
- Public Health Research Institute of India, 89/B, Ambika, 2nd Cross, 2nd Main, Yadavagiri, Mysuru, Karnataka, 570020, India. .,Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, Miami, 33199, FL, USA.
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Ahlin T, Nichter M, Pillai G. Health insurance in India: what do we know and why is ethnographic research needed. Anthropol Med 2016; 23:102-24. [PMID: 26828125 DOI: 10.1080/13648470.2015.1135787] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The percentage of India's national budget allocated to the health sector remains one of the lowest in the world, and healthcare expenditures are largely out-of-pocket (OOP). Currently, efforts are being made to expand health insurance coverage as one means of addressing health disparity and reducing catastrophic health costs. In this review, we document reasons for rising interest in health insurance and summarize the country's history of insurance projects to date. We note that most of these projects focus on in-patient hospital costs, not the larger burden of out-patient costs. We briefly highlight some of the more popular forms that government, private, and community-based insurance schemes have taken and the results of quantitative research conducted to assess their reach and cost-effectiveness. We argue that ethnographic case studies could add much to existing health service and policy research, and provide a better understanding of the life cycle and impact of insurance programs on both insurance holders and healthcare providers. Drawing on preliminary fieldwork in South India and recognizing the need for a broad-based implementation science perspective (studying up, down and sideways), we identify six key topics demanding more in-depth research, among others: (1) public awareness and understanding of insurance; (2) misunderstanding of insurance and how this influences health care utilization; (3) differences in behavior patterns in cash and cashless insurance systems; (4) impact of insurance on quality of care and doctor-patient relations; (5) (mis)trust in health insurance schemes; and (6) health insurance coverage of chronic illnesses, rehabilitation and OOP expenses.
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Affiliation(s)
- Tanja Ahlin
- a University of Amsterdam, Amsterdam Institute of Social Science Research , Nieuwe Achtergracht 166 , 1018 WV Amsterdam , the Netherlands
| | - Mark Nichter
- b School of Anthropology , University of Arizona , 1009 E. South Campus drive, Tucson , AZ 85721 , USA
| | - Gopukrishnan Pillai
- c University of Leiden, Leyden Academy on Vitality and Aging , Poortgebouw LUMC, Rijnburgerweg 10, 2333 AA, Leiden , the Netherlands
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11
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Abstract
The Union Budget presented on 28 February 2015 in the Indian parliament has allocated only INR 33,000 crores for health. It allocates more funds for building newer tertiary care hospitals and increases income tax exemptions for buying health insurance. The article explains that model that is being followed, as indicated by these measures, will create havoc to the lives of Indians and make them sicker and healthcare costlier. The budget is not in line with the actual priorities of India's health system and nor paves the road map for Universal Health Coverage. The Government of India needs to gets its priorities right.
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Affiliation(s)
- Soumyadeep Bhaumik
- Executive Editor, Journal of Family Medicine and Primary Care, New Delhi, India
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12
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Ganguly P, Jehan K, de Costa A, Mavalankar D, Smith H. Considerations of private sector obstetricians on participation in the state led "Chiranjeevi Yojana" scheme to promote institutional delivery in Gujarat, India: a qualitative study. BMC Pregnancy Childbirth 2014; 14:352. [PMID: 25374099 PMCID: PMC4289232 DOI: 10.1186/1471-2393-14-352] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 08/17/2014] [Indexed: 11/24/2022] Open
Abstract
Background In India a lack of access to emergency obstetric care contributes to maternal deaths. In 2005 Gujarat state launched a public-private partnership (PPP) programme, Chiranjeevi Yojana (CY), under which the state pays accredited private obstetricians a fixed fee for providing free intrapartum care to poor and tribal women. A million women have delivered under CY so far. The participation of private obstetricians in the partnership is central to the programme’s effectiveness. We explored with private obstetricians the reasons and experiences that influenced their decisions to participate in the CY programme. Method In this qualitative study we interviewed 24 purposefully selected private obstetricians in Gujarat. We explored their views on the scheme, the reasons and experiences leading up to decisions to participate, not participate or withdraw from the CY, as well as their opinions about the scheme’s impact. We analysed data using the Framework approach. Results Participants expressed a tension between doing public good and making a profit. Bureaucratic procedures and perceptions of programme misuse seemed to influence providers to withdraw from the programme or not participate at all. Providers feared that participating in CY would lower the status of their practices and some were deterred by the likelihood of more clinically difficult cases among eligible CY beneficiaries. Some providers resented taking on what they saw as a state responsibility to provide safe maternity services to poor women. Younger obstetricians in the process of establishing private practices, and those in more remote, ‘less competitive’ areas, were more willing to participate in CY. Some doctors had reservations over the quality of care that doctors could provide given the financial constraints of the scheme. Conclusions While some private obstetricians willingly participate in CY and are satisfied with its functioning, a larger number shared concerns about participation. Operational difficulties and a trust deficit between the public and private health sectors affect retention of private providers in the scheme. Further refinement of the scheme, in consultation with private partners, and trust building initiatives could strengthen the programme. These findings offer lessons to those developing public-private partnerships to widen access to health services for underprivileged groups.
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13
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Hipgrave DB, Hort K. Will current health reforms in south and east Asia improve equity? Med J Aust 2014; 200:514-6. [PMID: 24835705 DOI: 10.5694/mja13.10870] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 01/12/2014] [Indexed: 11/17/2022]
Affiliation(s)
- David B Hipgrave
- Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia.
| | - Krishna Hort
- Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
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14
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Abstract
Positive Health of the communities could only be brought out through the interrelationship between conventional health sector and other development sectors. It was a dream that came true when World Health Organization (WHO) accepted Primary Health Care (PHC) as the major tool to achieve its proposed goal of Health For All (HFA) by 2000 A.D., but we could not succeed as expected. Now we have the Millennium Development Goals (MDG), which place health at the heart of development but the achievements in health is still challenging. The literature search in this article has been conducted in Pub Med and Google scholar, with the aim to draw references to discuss the major health issues and ways to tackle them. The current article briefly narrates the burden and complexities of challenges faced by the present global health. Revisiting the concept of PHC and reaffirming our solidarity to this philosophy is the need of this hour.
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Affiliation(s)
- Ts Anish
- Department of Community Medicine, Government Medical College, Thiruvananthapuram, Kerala, India
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De Costa A, Johannson E. By 'default or design'? The expansion of the private health care sector in Madhya Pradesh, India. Health Policy 2011; 103:283-9. [PMID: 21782268 DOI: 10.1016/j.healthpol.2011.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 06/10/2011] [Accepted: 06/19/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Despite an extensive tiered public healthcare system, India has one of the most privatized healthcare systems in world. There is no evidence suggesting that this privatization at anytime has been deliberate. So what has contributed to the private healthcare sector becoming so dominant in the setting? METHODS We explore possible reasons for the rapid expansion of the private sector through in depth interviews with policy makers in the public and private sectors in Madhya Pradesh province, Central India. Interviews were analyzed using qualitative content analysis. RESULTS AND CONCLUSIONS Public and private sector respondents concurred that the expansion of private sector had occurred by default; a passive privatization resulting from an underfunded and underperforming public health sector. Regulation by the public sector has lagged behind the development of a popular private healthcare market. Professional self-regulation functioned poorly, with professional bodies reported as being opportunistic. The private sector is fractured and heterogeneous making it more difficult to regulate. Further, the state has focused on regulating its own public sector, little attention has been paid to the expanding private sector. Income and career opportunities for qualified healthcare professionals are attractive in the private sector. India needs to invest more in the public health system, develop ways of reducing out of pocket expenses through integration of, regulation of and partnerships with segments of the private health sector.
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Affiliation(s)
- Ayesha De Costa
- Division of Global Health, Karolinska Institutet, Stockholm, Sweden.
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