印度县级全民医保监测。

IF 8.4 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Bulletin of the World Health Organization Pub Date : 2024-09-01 Epub Date: 2024-06-25 DOI:10.2471/BLT.23.290854
Arnab Mukherji, Megha Rao, Sapna Desai, S V Subramanian, Gagandeep Kang, Vikram Patel
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引用次数: 0

摘要

目标:制定衡量印度县级全民健康保险(UHC)的框架和指数,并评估各县在实现全民健康保险方面取得的进展:制定衡量印度县级全民健康覆盖率(UHC)的框架和指数,并评估各县在实现全民健康覆盖率方面取得的进展:我们对世界卫生组织和世界银行的框架进行了调整,以制定地区级全民健康覆盖指数(UHC d)。我们利用在印度例行收集的健康调查和计划数据,从生殖、孕产妇、新生儿和儿童健康、传染病、非传染性疾病、服务能力和获取途径以及金融风险保护这五个示踪领域的 24 个示踪指标的几何平均数中,计算出 687 个县的全民健康覆盖指数 d。全民健康覆盖率 d 采用 0% 到 100% 的评分标准,分数越高,表示表现越好。我们还使用 14 个跟踪指标子集评估了地区内的不平等程度。弱势分组基于四个不平等维度:财富五分位数、城乡位置、宗教和社会群体:全民保健覆盖率的中位数为 43.9%(范围:26.4 至 69.4)。存在很大的地域差异,南部各邦地区的全民健康覆盖率 d 值高于印度其他地区。除非传染性疾病以及服务能力和获取途径外,服务覆盖率指标水平均超过 60%。医疗保险覆盖面有限,约 10%的人口面临灾难性和贫困化的医疗支出。各地区在全民健康保险方面存在巨大的贫富差距:我们的研究表明,全民健康计划可以在地方层面进行衡量,并通过确定医疗服务提供情况以及全民健康计划进展有限的地理热点地区,帮助国家和国家以下各级政府制定优先事项框架。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
District-level monitoring of universal health coverage, India.

Objective: To develop a framework and index for measuring universal health coverage (UHC) at the district level in India and to assess progress towards UHC in the districts.

Methods: We adapted the framework of the World Health Organization and World Bank to develop a district-level UHC index (UHC d ). We used routinely collected health survey and programme data in India to calculate UHC d for 687 districts from geometric means of 24 tracer indicators in five tracer domains: reproductive, maternal, newborn and child health; infectious diseases; noncommunicable diseases; service capacity and access; and financial risk protection. UHC d is on a scale of 0% to 100%, with higher scores indicating better performance. We also assessed the degree of inequality within districts using a subset of 14 tracer indicators. The disadvantaged subgroups were based on four inequality dimensions: wealth quintile, urban-rural location, religion and social group.

Findings: The median UHC d was 43.9% (range: 26.4 to 69.4). Substantial geographical differences existed, with districts in southern states having higher UHC d than elsewhere in India. Service coverage indicator levels were greater than 60%, except for noncommunicable diseases and for service capacity and access. Health insurance coverage was limited, with about 10% of the population facing catastrophic and impoverishing health expenditure. Substantial wealth-based disparities in UHC were seen within districts.

Conclusion: Our study shows that UHC can be measured at the local level and can help national and subnational government develop prioritization frameworks by identifying health-care delivery and geographic hotspots where limited progress towards UHC is being made.

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来源期刊
Bulletin of the World Health Organization
Bulletin of the World Health Organization 医学-公共卫生、环境卫生与职业卫生
CiteScore
11.50
自引率
0.90%
发文量
317
审稿时长
3 months
期刊介绍: The Bulletin of the World Health Organization Journal Overview: Leading public health journal Peer-reviewed monthly journal Special focus on developing countries Global scope and authority Top public and environmental health journal Impact factor of 6.818 (2018), according to Web of Science ranking Audience: Essential reading for public health decision-makers and researchers Provides blend of research, well-informed opinion, and news
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