Waiting time at health facilities and social class: Evidence from the Indian caste system

Shaikh, Mujaheed; Miraldo, Marisa; Renner, Anna-Theresa

doi:10.1371/journal.pone.0205641

Cited by 30 publications

(19 citation statements)

References 37 publications

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“…This includes socio-economic status or the caste system which is highly relevant in the Indian context. Lower social caste has been significantly associated with longer waiting times ( p < 0.0001) in private facilities [134]. Studies on TB providers’ perspectives in India suggest that they may treat patients differently, providing poor and less educated patients with less information and agency as they question their ability to understand medical information and perceive them as irrational when prioritizing life concerns over adherence [126,127,135].…”

Section: Discussionmentioning

confidence: 99%

User-experience and patient satisfaction with quality of tuberculosis care in India: A mixed-methods literature review

Bhatnagar

2019

Journal of Clinical Tuberculosis and Other Mycobacterial Diseas

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BackgroundTuberculosis affected 2.7 million people in India in 2017. The Revised National TB Control Programme has achieved milestones in coverage, however quality of TB care remains highly variable and often poor, with significant gaps in provider knowledge, practices, and patients consistently lost to follow-up. These quality gaps are largely informed by studies on provider practices or objective chart abstractions and case data. Per the knowledge of the author, no review has been conducted on first-hand patient perspectives on the quality of TB care they receive. This mixed-methods literature review aims to synthesize evidence on user-experience and patient satisfaction with TB care in India and inform areas for service quality improvement.MethodsFive medical databases, including PubMed, EMBASE, Global Health (Ovid), Web of Science, and CINAHL were searched for empirical studies on patient perspectives on TB health services published between January 1st, 2000 to December 31st, 2017. Studies in English with adult patients with any form of TB in the public or private health system were included. Studies prior to entering the health system, on distance to health facilities and cost were excluded. Seven Indian journals were hand searched and a grey literature search was conducted in GoogleScholar. Studies were assessed for methodological quality and thematic analysis was conducted by categorizing data using NVivo 12.ResultsA total of 498 studies were screened, of which 23 met the inclusion criteria. 16 supplementary studies were identified from Indian journals and grey literature. Of the 39 total studies included most were quantitative (29; 74%), based in South India (17; 44%) and focused on drug-sensitive TB patients (19; 49%) within the public health system (25; 64%). Data collection methods were highly heterogenous which limited synthesis and comparisons across population demographics, health sectors, or regions. Overall quantitative patient satisfaction measured in seven studies was high. Two major themes identified were provider-related factors (n = 26 studies) and convenience (n = 25), and six minor themes were supplies and equipment availability (n = 12), confidence (n = 10), information and communication (n = 10), waiting time (n = 8), stigma (n = 4), and confidentiality (n = 4). Each reported positive and negative user-experiences. Most significantly, DOTS did not fit the daily needs and obligations of many patients, particularly due to conflicts with employment and frequency of visits; while positive provider support, information, and flexibility helped patients adhere to treatment.ConclusionAlthough quantitative patient satisfaction was found to be high, data were not collected using robust, validated tools. Qualitative and quantitative user-experiences in each theme were variable, making them both barriers and facilitators of good quality TB care. Poor user-experiences were often responsible for patients interrupting treatment or dropping out of TB care. Patient-centeredness, or user-friendliness of TB ...

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Section: Discussionmentioning

confidence: 99%

User-experience and patient satisfaction with quality of tuberculosis care in India: A mixed-methods literature review

Bhatnagar

2019

Journal of Clinical Tuberculosis and Other Mycobacterial Diseas

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“…Caste in India is a strong determinant for social exclusion and exploitation which is seen in many social science research papers. In a study, it is seen that waiting time at non-emergency healthcare services has proven the presence of social class and strong casteism [10].…”

Section: Caste-based Discrimination In Healthcare Servicesmentioning

confidence: 99%

“…are also linked with waiting time at healthcare services. They have proved that lower social caste has longer waiting times at non-emergency healthcare services [10]. Surprisingly this caste-based discrimination is seen only in private healthcare services.…”

Section: Caste-based Discrimination In Healthcare Servicesmentioning

confidence: 99%

Casteism Among Indian Doctors: A Critical Review

Pol¹

2020

WJPH

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In India, caste-based differentiation is directly related to the socio-economic and socio-cultural status of an individual. In the past studies have shown that people's health outcomes are related to their social group and position in the social gradient. India has witnessed the suicide of promising doctors who were alleged to bullying because of their caste. The social evil called casteism is spreading its branches in every level and sector. But the disappointing fact is that no policy or norms or planning or agenda can uproot it. As it is embedded in the subconscious mind of civilians and is carried over generation after generation. The present review tries to point out in detail the presence of casteism among the Indian healthcare system. Moreover, this study also discussed if this caste-based system also discriminates patients from getting the healthcare facility. In this review all the past and present literature were searched extensively and then the finding of all the studies were discussed in a comprehensive manner. The result of the study showed that at present Indian health service system is not at all equipped with the addressing the casteism among doctors and other healthcare sevice providers. An important option could be increasing the number of dalits in the different level of healthcare sector. Weather implication of this option in practical scenario is possible that needs further evaluation. Making policies that ensures the adequate representation of members of excluded communities in healthcare can certainly reduce the cultural discrimination and prejudice.

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“…The long waiting time problem often occurs in public healthcare services more than in private healthcare services [ 8 ]. Especially in developing countries such as India, Nigeria, and Vietnam, people are facing the patient overload problem in public hospitals [ 9 , 10 ]. Also, in Thailand, the long waiting time is the main problem in the public hospital.…”

Section: Introductionmentioning

confidence: 99%

Resource management framework using simulation modeling and multi-objective optimization: a case study of a front-end department of a public hospital in Thailand

Tanantong

Pannakkong

Chemkomnerd

2022

BMC Med Inform Decis Mak

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Background The overcrowded patients, which cause the long waiting time in public hospitals, become significant problems that affect patient satisfaction toward the hospital. Particularly, the bottleneck usually happens at front-end departments (e.g., the triage and medical record department) as every patient is firstly required to visit these departments. The problem is mainly caused by ineffective resource management. In order to support decision making in the resource management at front-end departments, this paper proposes a framework using simulation and multi-objective optimization techniques considering both operating cost and patient satisfaction. Methods To develop the framework, first, the timestamp of patient arrival time at each station was collected at the triage and medical record department of Thammasat University Hospital in Thailand. A patient satisfaction assessment method was used to convert the time spend into a satisfaction score. Then, the simulation model was built from the current situation of the hospital and was applied scenario analyses for the model improvement. The models were verified and validated. The weighted max–min for fuzzy multi-objective optimization was done by minimizing the operating cost and maximizing the patient satisfaction score. The operating costs and patient satisfaction scores from various scenarios were statistically compared. Finally, a decision-making guideline was proposed to support suitable resource management at the front-end departments of the hospital. Result The three scenarios of the simulation model were built (i.e., a real situation, a one-stop service, and partially shared resources) and ensured to be verified and valid. The optimized results were compared and grouped into three situations which are (1) remain the same satisfaction score but decrease the cost (cost decreased by 2.8%) (2) remain the same satisfaction score but increase the cost (cost increased up to 80%) and (3) decrease the satisfaction score and decrease the cost (satisfaction decreased up to 82% and cost decreased up to 59%). According to the guideline, the situations 1 and 3 were recommended to use in the improvement and the situation 2 was rejected. Conclusion This research demonstrates the resource management framework for the front-end department of the hospital. The experimental results imply that the framework can be used to support the decision making in resource management and used to reduce the risk of applying a non-improvement model in a real situation.

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Waiting time at health facilities and social class: Evidence from the Indian caste system

Cited by 30 publications

References 37 publications

User-experience and patient satisfaction with quality of tuberculosis care in India: A mixed-methods literature review

User-experience and patient satisfaction with quality of tuberculosis care in India: A mixed-methods literature review

Casteism Among Indian Doctors: A Critical Review

Resource management framework using simulation modeling and multi-objective optimization: a case study of a front-end department of a public hospital in Thailand

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