Monitoring and Evaluating Progress towards Universal Health Coverage in India

Devadasan, Narayanan; Ghosh, Soumitra; Nandraj, Sunil; Sundararaman, T

doi:10.1371/journal.pmed.1001697

Cited by 18 publications

(19 citation statements)

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“…One of the most ambitious plans in Indian healthcare reform has been a call for 'universal healthcare for all by 2020' (Reddy et al 2011b), now extended to year 2022 (Devadasan et al 2014). Reaching this goal would include implementing universal health insurance, which been seen as a potential way of reducing health disparities and OOP health expenditure (Bennett, Ozawa, and Rao 2010;Reddy et al 2011b;Reddy 2012).…”

Section: Introductionmentioning

confidence: 99%

Health insurance in India: what do we know and why is ethnographic research needed

Ahlin

Nichter

Pillai

2016

Anthropology & Medicine

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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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Section: Introductionmentioning

confidence: 99%

Health insurance in India: what do we know and why is ethnographic research needed

Ahlin

Nichter

Pillai

2016

Anthropology & Medicine

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“…[ 10 ] There are reports which reveal that <20% of population are covered under any health-care insurance scheme. [ 10 19 ] Over the past two decades, advancements in techniques and technologies in neurosurgery have changed the outlook of treatments and results of neurological diseases, but unfortunately, these are quite expensive and available at only few public sector hospitals or institutes. [ 5 6 ] If we see the neurosurgical services in particular, approximately ninety government medical colleges have functional neurosurgical departments.…”

Section: Discussionmentioning

confidence: 99%

“…Innovations in the field of technologies and equipment are failing the test of financial challenges, which is being faced by most of the developing countries due to poor budgetary allocation, deficiency in health-care infrastructure, and human resource. [ 8 9 10 19 23 24 ] Need of the hour is maximal utilization of the available resources at public sector hospitals/institutes and low-cost innovations which may be made available at maximum centers. Tertiary care public sector hospitals having advanced neurosurgical facilities are overloaded with the patients and cannot match the demand due to limitations in infrastructure and human resource.…”

Section: Discussionmentioning

confidence: 99%

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Endoscopic treatment of hydrocephalus with minimal resources: Resource utilization and indigenous innovation in developing countries like India

et al. 2018

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Context: Neuroendoscopic surgeries need specialized equipments, unavailable in neurosurgical departments of majority of public healthcare institutions of India. Aims: Neuroendoscopic treatment of hydrocephalus in the setting of minimal resources using utilization of available resources, inter-departmental co-ordination and indigenous innovations. Methods: Study was carried out at a public sector institute of India with scarce resources. Senior author (DKJ) used indigenously designed stainless steel working sheath along with equipments of 'awake endoscopic intubation system' of department of neuroanesthesia and 18 cm, 4 mm, 0° rigid telescope for neuroendoscopic surgeries for various intraventricular pathologies. Results: Thirty-four neuroendoscopic surgeries in 32 patients were done over last 3 years. There were 18 males and 14 females with average age of 23 years. It included hydrocephalus due to tubercular meningitis (n = 19), neurocysticercosis (NCC) (n = 4), intra-ventricular (n = 2) and para-ventricular (n = 2) space occupying lesions, aqueduct stenosis with (n = 2) or without (n = 1) shunt malfunction and one case each of pyogenic meningitis and right cerebellar infarction. Endoscopic third ventriculostomy (ETV) (n = 28), septostomy (n = 6), removals of cystic lesions (n = 3) and biopsies of intraventricular lesions (n = 2) were done in a total of 34 neuroendoscopic surgeries. Overall there were four failures of ETVs, which were managed by ventriculo-peritoneal shunts. Two mortalities in the study group were unrelated to the surgical procedures. Conclusion: Indigenous innovations and interdisciplinary co-ordination are the way ahead to tackle resource scarcity in public sector healthcare institutions of India in the scenario of plenty of neuroendoscopic trainings opportunities for young neurosurgeons and paucity of equipments required.

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“…Lowering medicine cost or providing medicines as a part of a universal health coverage strategy can improve treatment adherence, outcomes and improve quality of life. 11 35 …”

Section: Introductionmentioning

confidence: 99%

Perceptions of the quality of generic medicines: implications for trust in public services within the local health system in Tumkur, India

et al. 2018

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IntroductionGeneric medicines are an important policy option to reduce out-of-pocket expenditure on medicines. However, negative perceptions of their quality affect utilisation and raise issues of confidence and trust in medicines and health services. The aim of the study was to test the quality of generic and branded medicines and explain negative perceptions towards generic medicines.MethodsThe study was part of a larger study on access to medicines. Information on various quality parameters was collected for branded medicines and branded and unbranded generic versions of the same medicines from government and private pharmacies in Karnataka in Southern India. To assess perceptions related to quality and drivers of preferred point of care (public vs private), focus group discussions were conducted with diabetes and hypertension patients, health workers and private pharmacists. The results of the quality tests were assessed and thematic analysis was conducted on the qualitative data to develop a conceptual framework to explain perceptions of medicine and care quality in the local health system.ResultsThe generic and branded variants of the medicines tested were of comparable quality. Contrary to the quality test results, patients’ and health workers’ perceptions of quality were largely in favour of branded medicines. Negative perceptions of medicine quality along with other drivers contribute towards choosing more expensive medicines in the private sector. Trust in the health system emerged as an underlying central theme that explained and drove choice of medicines and providers within the local health system.ConclusionNegative perceptions of generic medicines and preferential promotion of branded medicines over generics by pharmaceutical companies could influence prescriber behaviour and affect trust in healthcare provided in public services. To succeed, access to medicines programmes need to systematically invest in information on quality of medicines and develop strategies to build trust in healthcare offered in government health services.

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Monitoring and Evaluating Progress towards Universal Health Coverage in India

Abstract: This paper is a country case study for the Universal Health Coverage Collection, organized by WHO. N. Devadasan and colleagues illustrate progress towards UHC and its monitoring and evaluation in India. Please see later in the article for the Editors' Summary

Cited by 18 publications

References 1 publication

Health insurance in India: what do we know and why is ethnographic research needed

Health insurance in India: what do we know and why is ethnographic research needed

Endoscopic treatment of hydrocephalus with minimal resources: Resource utilization and indigenous innovation in developing countries like India

Perceptions of the quality of generic medicines: implications for trust in public services within the local health system in Tumkur, India

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