PDF(Pubmed)
Abstract：
BACKGROUND: Kerala has initiated many Universal Health Coverage (UHC) reforms in the last decade. The Aardram Mission launched in 2017 stands out owing to its scope, objectives, and commitments for strengthening Primary Health Care (PHC) in the State. The current study proposes to explore access and financial protection through the lens of equity in Kerala especially in the context of major UHC reforms carried out during the last decade. This paper will also highlight the key lessons from Kerala\'s approach towards UHC and health systems strengthening through a political economy approach.
METHODS: Data from the Kerala state sample of 75th Round (2017-18) National Sample Survey is used for this study. Comparison is also drawn from the 71st Round Sample Survey, 2014, to measure the state\'s progress in terms of access and financial protection. Logistic regression was used for the calculation. The findings were further explored through a political economy approach.
RESULTS: The share of public facilities for outpatient care is 47.5%, which is a significant increase from 34.0% (in 2014) in the state. The share of public sector for out-patient care has increased for the lower socio-economic population in the state. The share of public sector for in-patient care has also increased to 37.3% in 2017-18 from 33.9% in 2014, but not to the extent as the increase shown in outpatient care. The average out-of-pocket-expenditure during hospitalization has increased more in private facilities as compared to public for both outpatient care and hospitalization.
CONCLUSIONS: Overall increase in the share of public facilities for both outpatient care and hospitalization is indicative of the enhanced trust among the people at large of the public healthcare delivery system in Kerala, post the launch of UHC reforms in the State. The insurance linked UHC reforms would be insufficient for the State to progress further towards UHC. Kerala with a long and successful history in \'public provisioning\' should focus more on strengthening PHC through Aardram Mission in its journey towards pursuit of UHC.
METHODS: Data from the Kerala state sample of 75th Round (2017-18) National Sample Survey is used for this study. Comparison is also drawn from the 71st Round Sample Survey, 2014, to measure the state\'s progress in terms of access and financial protection. Logistic regression was used for the calculation. The findings were further explored through a political economy approach.
RESULTS: The share of public facilities for outpatient care is 47.5%, which is a significant increase from 34.0% (in 2014) in the state. The share of public sector for out-patient care has increased for the lower socio-economic population in the state. The share of public sector for in-patient care has also increased to 37.3% in 2017-18 from 33.9% in 2014, but not to the extent as the increase shown in outpatient care. The average out-of-pocket-expenditure during hospitalization has increased more in private facilities as compared to public for both outpatient care and hospitalization.
CONCLUSIONS: Overall increase in the share of public facilities for both outpatient care and hospitalization is indicative of the enhanced trust among the people at large of the public healthcare delivery system in Kerala, post the launch of UHC reforms in the State. The insurance linked UHC reforms would be insufficient for the State to progress further towards UHC. Kerala with a long and successful history in \'public provisioning\' should focus more on strengthening PHC through Aardram Mission in its journey towards pursuit of UHC.
摘要：
背景：喀拉拉邦在过去十年中发起了许多全民健康覆盖（UHC）改革。2017年启动的Aardram任务因其范围而脱颖而出，目标,以及加强国家初级卫生保健（PHC）的承诺。当前的研究建议通过喀拉拉邦的公平视角探索获取和财务保护，特别是在过去十年中进行的大规模UHC改革的背景下。本文还将重点介绍喀拉拉邦通过政治经济方法加强UHC和卫生系统的方法的关键教训。
方法：来自第75轮（2017-18）全国抽样调查的喀拉拉邦样本的数据用于本研究。还从第71轮抽样调查中进行了比较，2014年，衡量国家在准入和财政保护方面的进展。使用Logistic回归进行计算。通过政治经济学方法进一步探讨了这些发现。
结果：门诊医疗公共设施的比例为47.5%，与该州的34.0%(2014年)相比有显著增长。对于该州较低的社会经济人口，公共部门在门诊护理方面的份额有所增加。公共部门在住院护理中的份额也从2014年的33.9%增加到2017-18年的37.3%，但没有达到门诊护理增长的程度。与门诊和住院的公共机构相比，私人机构住院期间的平均自付支出增加更多。
结论：门诊和住院的公共设施所占份额的总体增加表明，喀拉拉邦的公共医疗保健提供系统的广大人民之间的信任增强，在该州启动UHC改革后。与保险相关的UHC改革不足以使国家进一步朝着UHC迈进。喀拉拉邦在“公共供应”方面有着悠久而成功的历史，在追求UHC的过程中，应该更多地关注通过AardramMission加强PHC。
方法：来自第75轮（2017-18）全国抽样调查的喀拉拉邦样本的数据用于本研究。还从第71轮抽样调查中进行了比较，2014年，衡量国家在准入和财政保护方面的进展。使用Logistic回归进行计算。通过政治经济学方法进一步探讨了这些发现。
结果：门诊医疗公共设施的比例为47.5%，与该州的34.0%(2014年)相比有显著增长。对于该州较低的社会经济人口，公共部门在门诊护理方面的份额有所增加。公共部门在住院护理中的份额也从2014年的33.9%增加到2017-18年的37.3%，但没有达到门诊护理增长的程度。与门诊和住院的公共机构相比，私人机构住院期间的平均自付支出增加更多。
结论：门诊和住院的公共设施所占份额的总体增加表明，喀拉拉邦的公共医疗保健提供系统的广大人民之间的信任增强，在该州启动UHC改革后。与保险相关的UHC改革不足以使国家进一步朝着UHC迈进。喀拉拉邦在“公共供应”方面有着悠久而成功的历史，在追求UHC的过程中，应该更多地关注通过AardramMission加强PHC。
