Comprehensive Assessment of Health System Performance in Odisha, India

Yip, Winnie; Kalita, Anuska; Bose, Bijetri; Cooper, Jan; Haakenstad, Annie; Hsiao, William C.; Woskie, Liana; Reich, Michael R.

doi:10.1080/23288604.2022.2132366

Cited by 8 publications

(11 citation statements)

References 28 publications

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“…Other studies suggest that limited staffed hours at public sector facilities mean that most of the low-income working population might have to forgo their daily wages to access care 62 66. Our findings on low drug stocks at public primary-care facilities indicate that even when people visit them, medicines might not always be available and have to be accessed through multiple visits, requiring even more loss of wages or, as we report elsewhere, these drugs are purchased from private pharmacies 46 47. These link to our findings that even though total OOP expenditure is similar for pharmacies and public primary-care facilities, expenses on drugs for the latter were significantly higher.…”

Section: Discussionmentioning

confidence: 69%

“…However, poor clinical quality is not unique to private pharmacies, and may be endemic to the Indian health system35 83 86 87 and needs to be improved across the board. Our research from this same project, reported eslewhere, find concerning levels of poor clinical quality among public- and private-sector providers 47. Another set of associated concerns is that private pharmacies are used disproportionately by disadvantaged populations,44 70 If the hypothesis that private pharmacies provide worse clinical quality of care than public primary-care facilities in India is true, then this may lead to increasing disparities in health outcomes.…”

Section: Discussionmentioning

confidence: 84%

“…For example, in India, training pharmacy staff on correct diagnosis and recommended referral patterns have been effective for tuberculosis 32. While most attention in India has been on whether pharmacies have a qualified pharmacist, evidence, including our own analysis published elsewhere,47 shows that formal qualification is not necessarily a significant predictor of clinical effectiveness among Indian providers 87 92. Further, a substantial number of pharmacies are unregistered, and they provide a similar range of services irrespective of registration status.…”

Section: Discussionmentioning

confidence: 97%

“…It includes a range of providers—super-specialty hospitals with highly-skilled doctors, charitable hospitals and clinics, doctors with small individual practices (or solo providers), traditional healers and private pharmacies. Data suggests that between 40–56% of the outpatient care in Odisha is provided by the private sector, with the majority being hospitals and private pharmacies 4 5 18 46 47…”

Section: Methodsmentioning

confidence: 99%

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Private pharmacies as healthcare providers in Odisha, India: analysis and implications for universal health coverage

Kalita,

Bose,

Woskie

et al. 2023

BMJ Glob Health

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IntroductionIn India, as in many low-income and middle-income countries, the private sector provides a large share of health care. Pharmacies represent a major share of private care, yet there are few studies on their role as healthcare providers. Our study examines: (1) What are the characteristics of and services provided by private pharmacies and how do these compare with other outpatient care providers? (2) What are the characteristics of patients who opted to use private pharmacies? (3) What are the reasons why people seek healthcare from private pharmacies? (4) What are the quality of services and cost of care for these patients? Based on our findings, we discuss some policy implications for universal health coverage in the Indian context.MethodsWe analyse data from four surveys in Odisha, one of India’s poorest states: a household survey on health-seeking behaviours and reasons for healthcare choices (N=7567), a survey of private pharmacies (N=1021), a survey of public sector primary care facilities (N=358), and a survey of private-sector solo-providers (N=684).Results17% of the households seek outpatient care from private pharmacies (similar to rates for public primary-care facilities). 25% of the pharmacies were not registered appropriately under Indian regulations, 90% reported providing medical advice, and 26% reported substituting prescribed drugs. Private pharmacies had longer staffed hours and better stocks of essential drugs than public primary-care facilities. Patients reported choosing private pharmacies because of convenience and better drug stocks; reported higher satisfaction and lower out-of-pocket expenditure with private pharmacies than with other providers.ConclusionThis is the first large-scale study of private pharmacies in India, with a comparison to other healthcare providers and users’ perceptions and experiences of their services. To move towards universal health coverage, India, a country with a pluralistic health system, needs a comprehensive health systems approach that incorporates both the public and private sectors, including private pharmacies.

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Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 97%

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Private pharmacies as healthcare providers in Odisha, India: analysis and implications for universal health coverage

Kalita,

Bose,

Woskie

et al. 2023

BMJ Glob Health

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“…Public satisfaction with the health system is the degree to which the population, in general, report satisfaction with the health system [ 9 ]. Public satisfaction is a broader concept than patient satisfaction, reflecting the general population’s interaction and experience with the health system and the extent to which the system meets their expectations [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Public satisfaction with health system after healthcare reform in China

Kang,

Zhang,

Xian

et al. 2023

Health Res Policy Sys

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Background The Chinese central government launched the third phase of health system reforms in 2009. After a decade since the initiation of the reform, the health system has witnessed noteworthy gains. However, there is no concurrent improvement in public satisfaction with the health system. This study analysed various factors that influence public satisfaction with the system and examined whether perceived quality of care affects public satisfaction. Methods A longitudinal nationally representative survey was used for this study. We used five waves of China Family Panel Studies (CFPS) survey data. The final sample consisted of 145 843 observations. A two-way fixed-effects ordered logistic model was used for the analysis. Results The results indicate that perceived good quality of care was positively associated with public satisfaction in health system regardless of rural–urban residence. Older adults and individuals with more than 3 years of college education were less likely to be satisfied with the system in rural areas. Personal income and the density of medical professionals in the geographic area tend to improve public satisfaction in rural areas. Having medical insurance coverage and fair or good self-rated health improved the probability of reporting public satisfaction in urban areas. Married people and individuals who lived in the West region were less likely to be satisfied with the health system in urban areas. Conclusions Knowledge and skills of healthcare providers or physical quality of facilities are not sufficient in improving public satisfaction in the health system. Policymakers need to identify options to influence the important factors that affect public perception of the system. This analysis identified several policy-amenable factors to improve public perception of the health system in rural and urban China.

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