Better health systems for India's poor: findings, analysis, and options
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Washington, D.C.
World Bank
2002
|
| Schriftenreihe: | Health, nutrition, and population series
|
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | Includes bibliographical references (p. 337-347) |
| Beschreibung: | XXVI, 347 S. Ill. : 23 cm |
| ISBN: | 0821350293 |
Internformat
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| 264 | 1 | |a Washington, D.C. |b World Bank |c 2002 | |
| 300 | |a XXVI, 347 S. |b Ill. : 23 cm | ||
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Datensatz im Suchindex
| _version_ | 1804129327084732416 |
|---|---|
| adam_text | Contents
Foreword xv
Preface xvii
Acknowledgments xxi
Acronyms and Abbreviations xxv
Overview 1
The Indian Health System 3
Which Way Forward? 8
Options at a Glance 17
Part 1: Raising the Sights for India s Health System 2 3
1 A Crossroads 25
Objectives of the Health System and the Health
Transition 27
The Current Policy Context 2 8
Historic Vision and Current Realities 29
Focusing on Four Critical Activities in the Health
System 32
The Approach to Reform 32
2 Problems of the Public and Private Sectors 39
Current Structure of the Public Sector 39
ill
iv • Better Health Systems for India s Poor
Problems of the Public Sector 40
Structure of the Private Sector 44
Problems with the Private Sector 49
Notes 52
3 Policy Actions for Critical Health System Activities 53
Health System Oversight 55
Public Health Service Delivery 64
Ambulatory Curative Services 69
Inpatient Curative Services and Health Insurance 74
Concluding Remarks 83
Notes 84
4 Putting It Together: Raising the Sights of
India s Health System 85
Different Choices for Different Parts of India 86
Choices for the Central Government 92
Choices for the States 96
Putting It All Together: The Case of Maternal
Health 113
Specific Actions for Consideration across India 118
An Agenda for the Future 123
Concluding Remarks 124
Appendix 126
Notes 128
Part 2: Theory and Evidence 131
5 Health System Framework 133
The Descriptive Framework: Health System
Actors, Functions, and Outcomes 135
Framework for the Consideration of Government
Intervention 142
A Framework for Deciding How to Intervene:
Make Buy Regulate Inform 144
Notes 148
Contents • v
6 The Functioning of the Private Sector Market 151
Context: The Private Health Sector in India 155
Methods 157
Ambulatory Care
Inpatient Care
Concluding Remarks 186
187
Appendix
Notes 198
7 Setting National Health Care Priorities and
Ensuring Equitable Delivery of Public Sector
c • 201
Services
Do Centrally Sponsored Schemes Meet India s
Health Care Needs? 201
Households Use of Personal Health Services 212
How Well Are Public Health Services Reaching
the Poor? 21?
How Does the Pattern of Public Spending
229
Affect Health Outcomes?
Appendix ^
Notes
8 Financing Health
Health Sector Spending
Financing Mechanisms
Conclusions
Appendix 264
Notes
9 Health System Outcomes
Health Status
Financial Protection
Responsiveness to the Public
Concluding Remarks
Appendix 321
Notes
vi • Better Health Systems for India s Poor
Appendixes
A Studies Conducted for the Present Report 323
B Background Papers 327
C Major Recommendations of National Health
Policy Reports since Independence 331
D Efforts to Address the Role of Private Providers in
National Tuberculosis Control Programs 335
Bibliography 337
Tables
0.1 Major Indian States, by Stage of Health Transition
and Institutional Capacity 8
O.2 Improving Health System Oversight 17
O.3 Strengthening Public Health Services 18
O.4 Strengthening Ambulatory Curative Services 19
O.5 Inpatient Care and Health Insurance 20
1.1 Examples of Health System Functions and
Challenges in India 36
2.1 International Comparisons of Health Care
Work Force and Hospital Beds, 1990 98 41
2.2 International Comparisons of Health Service
Utilization and DALYs Lost, 1990 98 41
2.3 Health Care Work Force and Health Facilities
in the Public and Private Sectors in India,
Selected Years, 1981 98 46
2.4 Distribution of Outpatient and Inpatient Health
Services across the Public and Private Sectors
in India, 1986 87 and 1995 96 48
3.1 Summary of Actions for Critical Areas of Activity
in the Health System 54
3.2 International Examples of Varying Public Private
Mixes in the Delivery of Tuberculosis Care 59
4.1 Selected Health Status Outcomes in India and
Major Indian States, Selected Years, 1992 99 87
Contents • vii
4.2 Selected Health Service Outcomes in Major
Indian States and India Overall, Selected Years,
1995 99 88
4.3 Categorization of Major Indian States by
Characteristics Influencing Fundamental Health
System Choices 89
4.4 Local Factors to Consider at State Level when
Prioritizing Health Systems Choices 91
4.5 Major Health System Choices Facing Indian
States, by Stage of the Health Transition, and
the Central Government 97
4.6 Pros and Cons of Actions for Improving
Oversight 100
4.7 Pros and Cons of Actions for Improving Public
Health Services 102
4.8 Pros and Cons of Actions for Improving
Ambulatory Curative Care 107
4.9 Pros and Cons of Actions for Improving
Inpatient Care and Health Insurance 110
4.10 Allocation of Critical Health System Functions
for Maternal Care between the Public and
Private Sectors, by Type of Vision for
Public Private Partnerships 115
4.11 Recommendations for Government Action
on Critical Functions of India s
Health System 121
4A.1 Key Gaps in Knowledge about and Experience
in India s Health System, and Potential Uses
of the Needed Information 126
6.1 Alternative Private Practitioners Receiving
Informal Payments, Andhra Pradesh and
Uttar Pradesh 161
6.2 Participation in National Health Programs by
Private Practitioners, Andhra Pradesh and
Uttar Pradesh 170
viii • Better Health Systems for India s Poor
6.3 Performance Indicators of Private Hospitals,
Andhra Pradesh and Uttar Pradesh, 2000 180
6.4 Quality Assurance Standards in Hospitals,
Andhra Pradesh and Uttar Pradesh 181
6.5 Private Hospitals Whose Managers Favor
Various Procedures for Improving Hospital
Quality, 2000 182
6.6 Proportion of Patients Satisfied or Very Satisfied
with Overall Quality of Care at Public and
Private Health Facilities, Andhra Pradesh, by
Type of Facility and Wealth of Patient 183
6.7 Private Hospitals Offering Concessions to the
Poor, Andhra Pradesh and Uttar Pradesh 183
6.8 Proportion of Private Hospitals that Have
Received Public Benefits, Andhra Pradesh and
Uttar Pradesh 185
6.9 Participation in National Health Programs by
Private Hospitals, Andhra Pradesh and
Uttar Pradesh 186
6A. 1 Distribution of Main Reasons Given by
Alternative Private Practitioners in Andhra
Pradesh and Uttar Pradesh for Becoming a
Medical Practitioner 187
6A.2 Clinical Conditions Treated by Alternative
Private Practitioners over Two Days,
Andhra Pradesh and Uttar Pradesh 188
6A.3 Patient Fees for an Outpatient Consultation in
the Private Sector, Alternative Practitioners
Compared with Qualified Allopaths,
Andhra Pradesh and Uttar Pradesh 189
6A.4 Allopathic Therapies Offered at Clinics of
Alternative Private Practitioners, Andhra Pradesh
and Uttar Pradesh 190
6A.5 Concessions Offered to the Poor by Alternative
Private Practitioners, Andhra Pradesh and
Uttar Pradesh 190
Contents • ix
6A.6 Alternative Private Practitioners Who Rate
Government Health Programs as Good or
Very Good, Andhra Pradesh and Uttar Pradesh 191
6A.7 Private Hospitals Experiencing Moderate or
Severe Obstacles to Credit, Andhra Pradesh
and Uttar Pradesh 191
6A.8 Private Hospitals Making or Planning Capital
Investments, Andhra Pradesh and Uttar Pradesh,
by Source of Funds 192
6A.9 Revenue Issues Affecting Private Hospitals,
Andhra Pradesh and Uttar Pradesh 192
6A.10 Labor Issues in Private Hospitals, Andhra
Pradesh and Uttar Pradesh 193
6A. 11 Public Infrastructure Issues Affecting Private
Hospitals, Andhra Pradesh and Uttar Pradesh 193
6A.12 Regulatory Issues Affecting Hospital Managers,
Andhra Pradesh and Uttar Pradesh 194
6A. 13 Ideal Job Characteristics Reported by Public
and Private Sector Health Workers,
Andhra Pradesh and Uttar Pradesh 195
6A.14 Presence in Current Job of Ideal Job
Characteristics, as Reported by Public and
Private Health Sector Workers, Andhra Pradesh
and Uttar Pradesh 196
6A.15 Presence of Ideal Job Characteristics in Andhra
Pradesh: Differences in Ratings between Public
and Private Sector, by Characteristic of Health
Worker 197
6A.16 Average Number of Full Time and Part Time
Nurses and Private and Government Doctors
Working in Private Hospitals, Andhra Pradesh
and Uttar Pradesh 198
7.1 Deaths and DALYs Lost Associated with
Conditions Covered by National Health
Programs, India, 1990 and 1998 206
x • Better Health Systems for India s Poor
7.2 Deaths and DALYs Lost Associated with Major
Conditions Not Covered by National Health
Programs, India, 1990 and 1998 207
7.3 Income Bias in Public Spending on Curative
Care in India and Selected States 224
7A. 1 Infant and Child Mortality among Indian States:
Effects of Public Hospitalization, Equity, and
Other Factors, 1995 96 230
8.1 Market Failures, Consequences, and Responses
in Financing Health Care 249
8A.1 Health Expenditures and Cost Recovery in the
Public Sector of Selected States, 1996 257
8A.2 Salient Features of Some Insurance Schemes
in India 258
8A.3 Questions for Policymakers to Ask when
Deciding on Resource Allocations
and Purchasing 260
9.1 India s Share of the World s Health Problems 270
9.2 Top 10 Specific Causes of Death in India, 1998 271
9.3 Top 10 Specific Causes of DALYs Lost
in India, 1998 272
9.4 Under Five Mortality Rates in Indian States and
in the World 280
9.5 Health Outcomes among Scheduled Castes,
Tribes, and Rest of Population in India,
1998 99 283
9.6 Health Status Indicators—Comparison between
the Poorest and Richest Quintiles of the Indian
Population, 1992 93 284
9.7 Health Outcomes by Standard of Living,
1998 99 285
9.8 Indians Reporting an Illness within a 15 Day
Period Who Did Not Seek Care, and
Distribution of Reasons for Inaction,
by Income Quintile, 1995 96 292
Contents • xi
9.9 Presence of Mechanisms of Consumer Redress
at Public Health Facilities and Private Hospitals 294
9.10 Patients Satisfied or Very Satisfied with Health
Services in Public and Private Facilities in
Andhra Pradesh, by Sex and Income Level 297
9.11 Quality of Care Reported by Women after Their
Most Recent Visit to a Health Facility, Public or
Private, 1998 99 298
9A. 1 Distribution of DALYs Lost in World, India,
and Countries Grouped by Income, by
Condition, 1998 300
9A.2 Distribution of Deaths in World, India, and
Countries Grouped by Income, by Cause, 1998 308
9A.3 Comparison of India and Other Countries on
Selected Healm Related Indicators, Selected
Years, 1992 99 316
9A.4 Causes of DALYs Lost in India, 1990 and 1998 317
9A.5 Infant Mortality and Total Fertility Rates in
India and Major Indian States, 1981 97 318
9A.6 Underweight Children under Three Years of
Age in Major States of India, 1998 99 319
9A.7 Reduction in Rates of Severe and Total
Malnutrition (Weight for Age) among Children
in India and Major States in India between
1992 93 and 1998 99 320
9A.8 Comparison of Female and Male Health
Outcomes in India, 1998 99 321
Figures
0.1 Distribution of Public Expenditures in India
on Curative Care, by Income Quintile,
1995 96 4
O.2 Percent of Hospitalized Indians Falling into
Poverty from Medical Costs, 1995 96 5
xii • Better Health Systems for India s Poor
O.3 Public and Private Sector Shares of Delivery of
Selected Health Care Services in India, by
Income Status of Patients, 1995 96 7
3.1 Range of Interventions to Involve Private
Practitioners 58
5.1 Descriptive Framework of the Health System 137
5.2 Decision Points for Government Financing
and Provision in the Health Sector 143
5.3 Measurability and Contestability of Health
Services (Product Markets) 145
5.4 Measurability and Contestability of Inputs
(Factor Markets) in the Health Sector 146
5.5 Make or Buy Decisions, and Inform Regulate
Options to Increase Contestability and
Measurability 147
6.1 Public and Private Sector Shares in Service
Delivery across India, 1995 96 158
6.2 Types of Assistance Favored by Alternative
Private Practitioners in Andhra Pradesh and
Uttar Pradesh 171
6.3 Average Number of Beds per Full Time
Equivalent Doctor and Nurse in Private
Hospitals, Andhra Pradesh and Uttar Pradesh 179
7.1 Prevalence of Alcohol and Tobacco Use in India,
by Income Quintile, 1995 96 210
7.2 Public and Private Sector Shares of
Hospitalization, by Income Quintile of the
Population 214
7.3 Public and Private Sector Shares of Inpatient
Bed Days of Patients below the Poverty Line 217
7.4 Public Expenditures on Curative Care, by Income
Quintile 219
7.5 Income Bias of Public Spending on Hospital
and Primary Health Care Facilities 221
7.6 Income Bias of Public Spending on
Immunizations 222
Contents • xiii
8.1 Public Sector Spending on Health in India,
1985 2000 236
8.2 Public Expenditures on Health in Selected States
in India, Grouped by State and Distributed by
Government Level, 1995 96 237
8.3 Private Spending on Health Services at Private
and Public Facilities, 1995 96 238
8.4 Comparison of State Public and Private per
Capita Health Spending, 1995 96 240
8A.1 Structure of Heakh Care Sources and Uses 261
8A.2 Out of Pocket Payments and Household Income,
1995 96 262
8A.3 Out of Pocket Payments by Socioeconomic
Group, 1995 96 263
9.1 Infant Mortality Rate in India, 1980 2000 273
9.2 Distribution of Total Out of Pocket Health
Expenditures in India as a Proportion of
Nonfood Expenditures, 1995 96 287
9.3 Sources of Financing for Private Expenditures
on Hospitalization in India, by Income
Quintile, 1995 96 289
9.4 Hospital Patients below the Poverty Line
Who Financed Their Care in Public and
Private Hospitals from Borrowing or
Sale of Assets by State, 1995 96 290
9.5 Reasons for Using the Private Health Sector,
by Poverty Status 296
Boxes
1.1 Lessons on Health Reform in Wealthy
Countries 34
2.1 A Proactive Public Health Provider 51
3.1 A Quality Assurance Initiative in Mumbai 60
xiv • Better Health Systems for India s Poor
3.2 Oversight Constraints and Opportunities:
Reform of the Drug Control System
in Uttar Pradesh 61
3.3 Effective Technologies to Combat
Communicable Diseases 65
3.4 International Approaches to Spreading Risks
and Subsidizing the Poor 75
3.5 Health Insurance for the Informal Sector:
The SEWA Experience in Gujarat 79
4.1 Keys to Success 105
5.1 How Chronic Illness Makes People Poor 134
6.1 Empirical Findings and Policy Challenges 152
6.2 Working with Untrained Private Providers:
The Janani Experience 168
7.1 Empirical Findings and Policy Challenges 202
7.2 Responding to Violence against Women 209
7.3 Equity of Public Spending on Health:
International Experience 224
7.4 Adjusting Public Sector Hospitalization Rates
for Income Bias, 1995 96 226
8.1 Empirical Findings and Policy Challenges 234
8.2 How Hospitalization Can Devastate 243
8.3 Innovative Health Insurance Schemes in India 247
8.4 International Experience with Health Insurance
for the Informal Sector 250
8.5 Conclusions of the National Seminar on
Health Insurance 252
8.6 Contracting Out Nonclinical Hospital Services
to the Private Sector: Experiences from
Karnataka 254
9.1 Empirical Findings and Policy Challenges 266
9.2 Achievement Means Doing Well for
Everyone—Not Just the Better Off 276
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| spelling | Better health systems for India's poor findings, analysis, and options David H. Peters ... [et al.] Washington, D.C. World Bank 2002 XXVI, 347 S. Ill. : 23 cm txt rdacontent n rdamedia nc rdacarrier Health, nutrition, and population series Includes bibliographical references (p. 337-347) Armen (personen) gtt Beleidsplannen gtt Gezondheidszorg gtt Gesundheitswesen Delivery of Health Care India Health Care Reform India Health Services Accessibility India Health services accessibility India Poor Medical care India Indien Peters, David H. Sonstige oth HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=009892179&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Better health systems for India's poor findings, analysis, and options Armen (personen) gtt Beleidsplannen gtt Gezondheidszorg gtt Gesundheitswesen Delivery of Health Care India Health Care Reform India Health Services Accessibility India Health services accessibility India Poor Medical care India |
| title | Better health systems for India's poor findings, analysis, and options |
| title_auth | Better health systems for India's poor findings, analysis, and options |
| title_exact_search | Better health systems for India's poor findings, analysis, and options |
| title_full | Better health systems for India's poor findings, analysis, and options David H. Peters ... [et al.] |
| title_fullStr | Better health systems for India's poor findings, analysis, and options David H. Peters ... [et al.] |
| title_full_unstemmed | Better health systems for India's poor findings, analysis, and options David H. Peters ... [et al.] |
| title_short | Better health systems for India's poor |
| title_sort | better health systems for india s poor findings analysis and options |
| title_sub | findings, analysis, and options |
| topic | Armen (personen) gtt Beleidsplannen gtt Gezondheidszorg gtt Gesundheitswesen Delivery of Health Care India Health Care Reform India Health Services Accessibility India Health services accessibility India Poor Medical care India |
| topic_facet | Armen (personen) Beleidsplannen Gezondheidszorg Gesundheitswesen Delivery of Health Care India Health Care Reform India Health Services Accessibility India Health services accessibility India Poor Medical care India Indien |
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