scholarly journals Equity in healthcare utilisation and cost of treatment in Western India

2021 ◽  
Author(s):  
Anil Gumber
Keyword(s):  
Urban Areas ◽  
Healthcare Utilisation ◽  
Morbidity Rate ◽  
Western India ◽  
Health Seeking ◽  
Public Provision ◽  
Cost Of Treatment ◽  
Public And Private ◽  
Burden Of Treatment ◽  
The Poor

AbstractThe paper compares the morbidity and healthcare utilisation scenario prevalent in Gujarat and Maharashtra as well as for all − India over the last 35 years by exploring the National Sample Surveys data for 1980–81, 1986–87, 1995–96, 2004, and 2014. The differentials and trends in morbidity rate, health seeking behaviour, use of public and private providers for inpatient and outpatient care and associated cost, and burden of treatment are analysed by population groups. Changes in people’s demand for health services are correlated with the supply factors i.e. expansion of public and private health infrastructure. Rising cost and burden of treatment on the poor are examined through receipt of free inpatient and outpatient services as well as the extent of financial protection under the health insurance schemes received by them. Overtime, morbidity rates have gone up, with several folds increase in select states; the reliance on public provision has gone down substantially despite being cheaper than the private sector; and cost of treatment at constant prices increased considerably even for the poor. Hospitalisation costs were higher among insured than the non-insured households in several states irrespective of whether resident in rural or urban areas (Haryana, Maharashtra, Himachal Pradesh, and Assam have reported that insured households ended-up paying almost double the hospitalisation expenses in 2014). Leaving aside Kerala (where insured households have paid just a half of the cost of the non-insured), this clearly reflects the widespread prevalence of moral hazard and insurance collusion in India.

scholarly journals Effectiveness of health voucher scheme and micro-health insurance scheme to support the poor and extreme poor in selected urban areas of Bangladesh: An assessment using a mixed-method approach

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0256067
Author(s):  
Sayem Ahmed ◽  
Md. Zahid Hasan ◽  
Nausad Ali ◽  
Mohammad Wahid Ahmed ◽  
Emranul Haq ◽  
...  
Keyword(s):  
Health Insurance ◽  
Urban Areas ◽  
Healthcare Utilisation ◽  
Access To Healthcare ◽  
Health Coverage ◽  
Voucher Scheme ◽  
Micro Health Insurance ◽  
The Poor ◽  
The Cost ◽  
Benefits Package

Background National healthcare financing strategy recommends tax-based equity funds and insurance schemes for the poor and extreme poor living in urban slums and pavements as the majority of these population utilise informal providers resulting in adverse health effects and financial hardship. We assessed the effect of a health voucher scheme (HVS) and micro-health insurance (MHI) scheme on healthcare utilisation and out-of-pocket (OOP) payments and the cost of implementing such schemes. Methods HVS and MHI schemes were implemented by Concern Worldwide through selected NGO health centres, referral hospitals, and private healthcare facilities in three City Corporations of Bangladesh from December 2016 to March 2020. A household survey with 1,294 enrolees, key-informant interviews, focus group discussions, consultative meetings, and document reviews were conducted for extracting data on healthcare utilisation, OOP payments, views of enrolees, and suggestions of implementers, and costs of services at the point of care. Results Healthcare utilisation including maternal, neonatal and child health (MNCH) services, particularly from medically trained providers, was higher and OOP payments were lower among the scheme enrolees compared to corresponding population groups in general. The beneficiaries were happy with their access to healthcare, especially for MNCH services, and their perceived quality of care was fair enough. They, however, suggested expanding the benefits package, supported by an additional workforce. The cost per beneficiary household for providing services per year was €32 in HVS and €15 in MHI scheme. Conclusion HVS and MHI schemes enabled higher healthcare utilisation at lower OOP payments among the enrolees, who were happy with their access to healthcare, particularly for MNCH services. However, they suggested a larger benefits package in future. The provider’s costs of the schemes were reasonable; however, there are potentials of cost containment by purchasing the health services for their beneficiaries in a competitive basis from the market. Scaling up such schemes addressing the drawback would contribute to achieving universal health coverage.

Urban Transport

2018 ◽  
Author(s):  
José van
Keyword(s):  
Urban Areas ◽  
Urban Transport ◽  
Transport Sector ◽  
Public And Private ◽  
Transport Services ◽  
Ride Sharing ◽  
The World ◽  
Private And Public ◽  
Selection Mechanisms

Platformization affects the entire urban transport sector, effectively blurring the division between private and public transport modalities; existing public–private arrangements have started to shift as a result. This chapter analyzes and discusses the emergence of a platform ecology for urban transport, focusing on two central public values: the quality of urban transport and the organization of labor and workers’ rights. Using the prism of platform mechanisms, it analyzes how the sector of urban transport is changing societal organization in various urban areas across the world. Datafication has allowed numerous new actors to offer their bike-, car-, or ride-sharing services online; selection mechanisms help match old and new complementors with passengers. Similarly, new connective platforms are emerging, most prominently transport network companies such as Uber and Lyft that offer public and private transport options, as well as new platforms offering integrated transport services, often referred to as “mobility as a service.”

scholarly journals Cost of Management of Diabetes Mellitus: A Pan India Study

2021 ◽  
pp. 097275312199849
Author(s):  
Raghuram Nagarathna ◽  
M Madhava ◽  
Suchitra S Patil ◽  
Amit Singh ◽  
K. Perumal ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Urban Areas ◽  
Noncommunicable Disease ◽  
Cost Of Treatment ◽  
Rural And Urban Areas ◽  
Cost Of Disease ◽  
Rural And Urban ◽  
Significant Difference ◽  
The Cost ◽  
Prevalence Of Diabetes Mellitus

Background: Diabetes mellitus is a major noncommunicable disease. While mortality rates are increasing, the costs of managing the disease are also increasing. The all-India average monthly expenditure per person (pppm) is reported to be ₹ 1,098.25, which translates to an annual expenditure of ₹13,179 per person. Purpose: While a number of studies have gone into the aspect of the cost of disease management, we do not find any study which has pan-India reach. We also do not find studies that focus on differences (if any) between rural and urban areas, age or on the basis of gender. We planned to report the cost of illness (COI) in diabetes individuals as compared to others from the data of a pan-India trial. Methods: Government of India commissioned the Indian Yoga Association to study the prevalence of diabetes mellitus in India in 2017. As part of the questionnaire, the cost of treatment was also captured. Data collected from 25 states and union territories were analyzed using the analysis of covriance (ANCOVA) test on SPSS version 21. Results: There was a significant difference ( P < .05) between the average expenses per person per month (pppm) of individuals with self-reported known diabetes (₹1,357.65 pppm) and others (unknown and/or nondiabetes individuals–₹ 999.91 pppm). Similarly, there was a significant difference between rural (₹2,893 pppm) and urban (₹4,162 pppm) participants and between those below (₹1,996 pppm) and above 40 years (₹5,059 pppm) of age. Conclusion: This preliminary report has shown that the COI because of diabetes is significantly higher than others pointing to an urgent need to promote disease-preventive measures.

Public Provision for Pauper Idiois and Imbeciles in England and Wales

1895 ◽  
Vol 41 (175) ◽  
pp. 640-645
Author(s):  
G. E. Shuttleworth
Keyword(s):  
Local Government ◽  
Annual Report ◽  
Public Provision ◽  
England And Wales ◽  
Number Of Children ◽  
Special Training ◽  
The Poor ◽  
Epileptic Children ◽  
Similar Character ◽  
Lunatic Asylums

My apology for bringing forward this subject at the present time is that considerable interest with regard to it has recently been evidenced by correspondence and comments in the medical journals, as well as by inquiries set on foot by the Lunacy Commissioners and the Local Government Board. The former have published in their 49th Annual Report, just issued, a “Return showing the Number of Pauper Idiot, Imbecile, and Epileptic Children in the Asylums, etc., on 1st September, 1894,”† and a return of similar character as to such children in workhouses has been issued by the latter. The upshot of the whole matter is that, according to these returns, there are in lunatic asylums 525 children of this class (335 males, 190 females), and in workhouses 485 (281 males, 204 females). The latter number includes, however, 93 children returned as “epileptic only,” so that of idiots and imbeciles in workhouses under 16 years of age there are but 392. Adding together those in lunatic asylums and in workhouses we find that a total of 917 youthful idiots and imbeciles are provided for by the Poor Law in these institutions. The Local Government Board return, however, gives us no information as to the large number of such children living with poor parents who receive on their behalf some parochial relief. In the Commissioners' return the children are classified as idiots and imbeciles respectively, 399 in the former, 126 in the latter class; and 154 are said to be in the opinion of the medical officers likely to be improved by special training. In the Local Government Board return the children are classified as “imbecile only,” “epileptic only,” and “both imbecile and epileptic;” and the number of children who, in the opinion of their medical officers, would be likely to be improved by special training is set down as 178. Consequently if we are guided solely by these returns we should be led to the conclusion that in England and Wales—excluding the Metropolitan district, for which separate arrangements exist—there are no more than 332 improvable pauper idiots and imbeciles under 16 years of age remaining to be provided for in addition to the 225 paupers already accommodated in voluntary institutions for the training of imbecile children. Indeed, deducting 52 now resident in the special idiot block of the Northampton County Asylum, there remain but 280, a number insufficient to fill a decent-sized special institution!

Start-up motives and challenges facing female entrepreneurs in Tanzania

2019 ◽  
Vol 11 (2) ◽  
pp. 102-119 ◽  
Author(s):  
Nsubili Isaga
Keyword(s):  
Urban Areas ◽  
Developed Countries ◽  
Access To Finance ◽  
Female Entrepreneurs ◽  
Public And Private ◽  
Developed Country ◽  
Content Type ◽  
The Government ◽  
Survey Responses ◽  
Practical Implications

Purpose Research on women-owned business is more extensive in developed countries than in developing countries and such one cannot compare the results. This paper aims to examine the motives of women in Tanzania (a less developed country) to start their own businesses and the challenges they faced in running their businesses. Design/methodology/approach Based on 400 response to a semi-structured questionnaire and in-depth interview with 20 female entrepreneurs. Subsequently, descriptive and factors analysis were performed to analyze the data Findings Based on survey responses, the primary reason for starting a business was to create employment for the woman herself. Other motives include supplementing income and enabling women to be able to do the kind of work they wanted to do. According to the factor analysis, female entrepreneurs are driven more by push factors than pull factors. The most serious problems faced by female entrepreneurs are lack of access to finance, gender-related problems and social and cultural commitments. Research limitations/implications The sample was selected from urban areas of only three regions, out of 26 regions in Tanzania. Researchers may extend the study to other regions; also, the non-probability sampling method used in this study essentially means that there is a limitation to the extent to which the research findings can be generalized to the rest of the population of female entrepreneurs in Tanzania. Practical implications Policy makers, financial institutions and all organization that have a stake on development on female entrepreneurs in Tanzania should design policies and programs that encourage and promote the creation and growth of businesses. Collective efforts from the government, public and private institutions and NGOs are needed to eliminate the challenges, especially gender-related problems. Practical implications By studying female owner-managers’ motivations and constraints, the author suggests that to a greater extent, gender-related problems, social and cultural commitments and access to finance and networks are the constraints faced by female entrepreneurs. Originality/value The research on female entrepreneurs in the context of Tanzania is scarce, this study responds to a need of better understanding women motivations and constraints. By studying these factors, this study shows that startup motives and constraints faced by female entrepreneurs are unique to different contexts.

scholarly journals Oral health seeking behaviors of adults in Nebbi District, Uganda: a community-based survey

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Juliet Ocwia ◽  
Ronald Olum ◽  
Pamela Atim ◽  
Florence Laker ◽  
Jerom Okot ◽  
...  
Keyword(s):  
Oral Health ◽  
Dental Health ◽  
Oral Disease ◽  
Tooth Decay ◽  
Oral Diseases ◽  
Health Seeking ◽  
Dental Clinic ◽  
Community Based ◽  
Cost Of Treatment ◽  
Cross Sectional

Abstract Background Dental health is often neglected by the majority of the population and has contributed to the global burden of oral diseases. We assessed awareness, utilization and barriers to seeking oral health care among adults in Nebbi District, Uganda. Methods A community-based, cross sectional study was conducted in the central division, Nebbi District in Uganda among adults between the age of 18 years or older. An interviewer-administered, semi-structured questionnaire was used for data collection on socio-demographic characteristics, oral health awareness, oral health utilization, associated factors and barriers. Results A total of 400 adults with a median age of 32 years (interquartile range 24–43) years were enrolled. More than half (57.5%, n = 230) of the participants were female. Participants identified smoking (42.8%, n = 171) and consumption of sugary foodstuffs (29.0%, n = 116) as risk factors for oral disease. Not brushing was also identified by 260 participants (65.0%) as the cause of tooth decay and 95.8% (n = 383) believed brushing one’s teeth could prevent tooth decay. Of the 51.5% (n = 206) who had experienced a toothache or discomfort 12 months prior to the study but only about half (52%, n = 106) had sought healthcare from a dental clinic or facility. About 89.5% (n = 94) of the participants were able to see a dentist during their last visits. Dental carries (76.6%, n = 70) and gum bleeding (14.9%, n = 14) were the most frequent reasons for visiting a dental clinic, and 73.7% (n = 70) had their tooth extracted. Barriers to seeking oral healthcare were cost of treatment (47.5%, n = 190), and long waiting time (18.5%, n = 74). The odds of seeking oral healthcare was 2.8-fold higher in participants who were being married (Odds ratio (OR): 2.8, 95% CI 1.3–6.3, p = 0.011) and 3.5-fold higher among housewives (COR: 3.5, 95% CI 1.1–11.4, p = 0.040). Conclusion About half of the participants had sought healthcare following a dental condition. Cost of treatment seems to be an important factor affecting utilization of oral health services. Optimization of costs, and creating awareness regarding benefits of utilizing preventive dental services are recommended.

scholarly journals Tangible Cultural Heritage Re-Appropriation Towards A New Urban Centrality. A Critical Crossroad In Semi-Peripheral Eastern Riverside Lisbon

2020 ◽  
Vol 13 (3) ◽  
pp. 139-146
Author(s):  
Joao C. Martins
Keyword(s):  
Cultural Heritage ◽  
Urban Areas ◽  
Urban Regeneration ◽  
Ground Level ◽  
Ground Field ◽  
Public And Private ◽  
Positive Effects ◽  
The Creation ◽  
Tangible Culture ◽  
Private Investors

. The transformation of decayed semi-peripheral riverside areas and its Tangible Culture Heritage is presented today as a contributing factor in urban regeneration by several public preservation bodies and agendas, as well as privately led investment. These practices demand the economic and symbolic valorization of abandoned Tangible Cultural Heritage, where the social coexistence of residents, workers and visitors is seen as a smoother urban integration of these deprived territories and their communities into the surrounding contemporary cities.We’ll focus our approach on socio-spatial changes occurring in Marvila and Beato, presented today as new urban areas in which to financially invest after the 2011 economic crisis occurred in Portugal, discussing public and private re- appropriation of Old Palaces, Convents and Farms and Reconverted Warehouses (industrial and commercial); towards the creation of a new urban centrality in Lisbon. In this case, public ground-field intervention established a culture led regeneration process, with the creation of a municipal library, a crucial point in the cultural use of this space, community participation and gathering. Dealing with private investors, despite the positive effects, such as a reduction in unemployment, economic diversification and re-use of urban voids, there is always the possibility of undesired consequences. This paper argues, and the research experiments in many European cities show us that the ambition to improve the image of these deprived areas, despite somGonzalex encouraging ground level achievements, has unwanted or unexpected outcomes, starting as urban regeneration practices, often sliding towards gentrification, where local public powers have a determinant role.

scholarly journals GAP FILLERS OR PIONEERS: INFORMAL WATER SUPPLIERS IN PERI-URBAN AREAS OF THE TECHIMAN MUNICIPALITY OF GHANA

2021 ◽  
Vol 8 (1) ◽  
pp. 525-539
Author(s):  
Lydia Kwoyiga
Keyword(s):  
Urban Areas ◽  
Water Distribution ◽  
Water Source ◽  
Water Quality Monitoring ◽  
Distribution Networks ◽  
Sub Saharan Africa ◽  
Formal Sector ◽  
Public Provision ◽  
Sub Saharan ◽  
Municipal Assembly

There is continuous expansion and growth of urban and peri urban areas in Sub-Saharan Africa with projections indicating that this will double. Some peri-urban areas such as those in the Techiman municipality of Ghana are experiencing this trend. Nonetheless, the spate of growth of these areas outstrips the supply of utilities by municipal water distribution networks. As a result, some areas have little or no public provision. In order to address the water supply challenge, places with favourable hydrological settings are witnessing the emergence of informal water suppliers as “gap fillers” or “pioneers”, providing water services. Noteworthy, however, existing studies about informal water suppliers in peri-urban areas in Ghana lump them together, without considering the water source. This study differs in that it specifically examines the evolution and the features of informal water suppliers who privately and independently abstract and supply groundwater. Additionally, it attempts to understand the nature of informality of the suppliers and the possibility of formalisation. The paper is an exploratory study using the case of private mechanised borehole operators who supply water in their respective areas. The findings showed that in some peri-urban areas in the Techiman municipality, some dwellers constructed and operated mechanised boreholes, which provide in-situ water and utilities to others. They are mostly pioneer water suppliers in some of the areas. Their services are informal by nature because they are largely independent of the formal sector and apply informal arrangements in rendering their services. Seen also as business enterprises, they are not licenced. However, the boreholes are registered with the Municipal Assembly, which indicated some level of formalisation. The study recommended that efforts to formalise them further should focus on improving water quality monitoring for consumption and promoting sustainable abstraction.

scholarly journals MASS PATTERNS OF HIGHER EDUCATION IN TAMIL NADU

2016 ◽  
Vol 4 (9(SE)) ◽  
pp. 57-62
Author(s):  
Rajendran ◽  
Udaya Kumar
Keyword(s):  
Economic Development ◽  
Urban Areas ◽  
Tamil Nadu ◽  
New Technology ◽  
Vital Role ◽  
Educational Service ◽  
Public And Private ◽  
The Public ◽  
Rural And Urban Areas ◽  
Rural And Urban

Education plays a vital role for economic development of any nation. It reduces social and economic disparities in society. This study explores the public and private higher educational institutions and literacy level of Tamil Nadu. The literacy rate indicates educational level of total population. Education makes and ushers knowledge economy of a country. The importance of educational service is forever growing in the public and private sectors. Education facilitates the acquisition of new technology, skills and knowledge that ultimately increases productivity in rural and urban areas of India. Public and Private partnership institutions play an important role in delivering educational service in the society and itsrole for delivering general and technical educationfor achieving economic development and its producing skill and knowledge of  human resource.

Letter To The Editor

PEDIATRICS ◽  
1970 ◽  
Vol 45 (2) ◽  
pp. 340-341
Author(s):  
Alfred Yankauer
Keyword(s):  
Health Care ◽  
New England ◽  
Private Practice ◽  
Urban Areas ◽  
Young Men ◽  
Government Programs ◽  
Large Cities ◽  
The Poor ◽  
Letter To The Editor ◽  
The Rich

Dr. Yankauer wrote: Dr. Marks' point is moot. It has been raised previously in a Pediatrics Commentary. At about the same time a New England practitioner complained that private practice was being ignored in government programs. The question of whether young men finishing their residencies will "go where they are needed" can only be answered by time. The problem is that they are needed just about everywhere (by the rich as well as the poor) because of mounting manpower shortages.3 It is worth mentioning that in urban areas outside of the large cities, where money does not lead to such sharply segregated residential districts and hospital out-patient departments are underdeveloped, practicing pediatricians are virtually the only source of health care.

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