Publication: India : Equity Effects of Quality Improvements on Health Service Utilization and Patient Satisfaction in Uttar Pradesh State
Loading...
Published
2004-10
ISSN
Date
2013-06-05
Author(s)
Editor(s)
Abstract
This study investigates the impact of a health systems development project in Uttar Pradesh, India, on utilization of health services and patient satisfaction for the poor and lower caste members. The project began in July 2000, and introduced a range of reforms including management training, new staffing and service patterns, provision of essential drugs, and repair of equipment and facilities. The study uses a quasi-experimental design to compare changes in new outpatient visits and patient satisfaction at project and non-project health facilities. All public health facilities were scored according to health and economic conditions of the population and physical conditions of the facility, with the poorest scoring facilities selected for the project. A survey of service utilization, user perceptions, and economic status was conducted in 1999 at project facilities and an equal number of randomly selected control sites, stratified by level of facility: district and women's hospitals, community health centers (CHCs) and primary health centers (PHCs). A subsequent survey conducted in 2003 assessed changes in a systematically selected subset of the baseline sites. There was a consistent increase in mean monthly outpatient visits at all levels of project sites compared to controls, indicating that the project has improved overall utilization levels. Although patients from the poorest 40 percent of the population increased utilization at all types of facilities except the women's hospitals, the wealthiest 40 percent had larger increases at each level of facility. Lower caste members gained at all facilities relative to higher caste members. The project had a significantly positive impact on patient satisfaction at lower levels of facilities (CHCs and PHCs), but not for patients from the poorest 40 percent.
Link to Data Set
Citation
“Peters, David; Rao, Krishna; Ramana, G.N.V.. 2004. India : Equity Effects of Quality Improvements on Health Service Utilization and Patient Satisfaction in Uttar Pradesh State. HNP Discussion Paper;. © World Bank. http://hdl.handle.net/10986/13792 License: CC BY 3.0 IGO.”
Digital Object Identifier
Associated URLs
Associated content
Other publications in this report series
Journal
Journal Volume
Journal Issue
Related items
Showing items related by metadata.
Publication Building on Early Gains in Afghanistan's Health, Nutrition, and Population Sector : Challenges and Options(World Bank, 2010)A number of development partners, including the World Bank, have been actively supporting the health sector in Afghanistan since 2003-04 (1382 AC). Collectively, they invested more than $820 million between 2003 (1382 AC) and 2008-09 (1387 AC) and played key roles in supporting the government in reshaping the country's health sector. This support continues, with all partners starting new projects aimed at further strengthening the sector and building on the successes that have been achieved. The book is organized as follows. Chapters one-four tell a coherent story about the achievements of the sector between 2002 and 2008 (1381-87AC), the financial resources used to achieve the results, and the contribution the private sector has made to the achievements. Chapters five-eight) look forward. They identify the challenges the sector is facing in meeting human resource needs, expanding the coverage of the basic package of health services (BPHS), and increasing the institutional capacity of the Ministry of Public Health (MoPH). Chapter eight summarizes the lessons learned and provides options for moving forward.Publication Tajikistan - Feasibility Study for Results-Based Financing (RBF) In the Health Sector(World Bank, 2010-03-31)The purpose of this study is to examine the feasibility of introducing Results-Based Financing (RBF) in Tajikistan's health sector. Several countries have experience with RBF in low-income settings, and lessons learned can be interesting for Tajikistan. Technically, RBF is a retrospective provider payment that can be designed to reimburse providers for contractually defined services and specific compliance targets, including for efficiency and quality targets. In Tajikistan RBF will be linked to ongoing provider payment reforms. Therefore, the chapter also provides a brief overview on provider payment mechanisms and experience with provider payment reforms and treatment patterns from middle- and higher-income countries. The objective of this feasibility study is to propose a sustainable RBF pilot program for two oblasts (Khatlon and Sughd), to cost-effectively improve maternal and child health (MCH) outcomes. The study aims to inform the health sector strategy and help the Government and partners to effectively design and use RBF mechanisms at three potential levels. First, the fiscal transfer from the central government to oblasts (regions) and rayons (districts) could be adjusted to include a bonus payment based on specific results achieved. Second, the provider payment method from oblast health fund pools to hospitals and outpatient facilities could reward providers based on results indicators. Third, a performance payment could be added to salaries paid to staff working in health facilities. It is expected that such a three-pronged approach could reinforce the financial incentive set through RBF to staff working in the administration and provision of care. If the staff responds to these incentives, then this could lead to better management in oblast and rayons, improved availability of financial resources and medical material in health facilities, and better treatment of patients. Combined, these behavioral changes will ultimately lead to better health results, including improved quality of care and in the longer-run improved health status.Publication Health Policy Research in South Asia : Building Capacity for Reform(Washington, DC: World Bank, 2003-08)The richness of the research papers in this volume makes it difficult to quickly capture the main themes and implications of their research. But three repeated themes can be highlighted: equality of public spending, the role of the private sector, and the role of consumers. On the theme of equality in public expenditures, research in Bangladesh, India, Nepal, and Sri Lanka shows that in some parts of South Asia-such as south India and Sri Lanka-governments do a much better job of distributing subsidies in the health sector than other regions. The research overwhelmingly documents the dominance of the private sector in Bangladesh and India and finds a very strong private sector in Sri Lanka. The research also highlights different policy instruments available to the government for working with the private sector to achieve health sector outcomes. A third general theme is the role of consumers and the mechanisms available to them to influence health services delivery. The authors in this volume have supported the belief that individuals and households can make a difference in how health services are delivered. While the three themes summarized above cut across several of the chapters in this volume, a more basic theme underlies all the chapters and is the main motivation for conducting health policy research. That theme is that empirical research can and should challenge basic assumptions about the health sector and will provide policymakers some of the tools needed to improve and monitor the performance of the sector.Publication Universal Health Coverage for Inclusive and Sustainable Development(World Bank, Washington, DC, 2014-08)A low-income country, Ethiopia has made impressive progress in improving health outcomes. The Inter-agency Group for Child Mortality Estimation reported that Ethiopia has achieved Millennium Development Goal (MDG) 4, three years ahead of target, with under-5 mortality at 68 per 1,000 live births in 2012. Significant challenges remain, however, with the maternal mortality ratio at 420 out of 100,000 live births. The government has introduced a three-tier public health care delivery system to deliver essential health services and ensure referral linkages, with level three as specialized hospitals (one per 3.5 million 5 million population), level two as general hospitals (one per 1 million 1.5 million), level one as primary hospitals (one per 60,000 100,000) with satellite health centers (one per 15,000 25,000) and health posts (one per 3,000 5,000). One initiative contributing greatly toward universal health coverage (UHC) is the Health Extension Program (HEP) that provides free primary care services at health posts and communities. The country is at its early stage initiating insurance schemes to provide financial protection for its citizens: Social Health Insurance (SHI) for formal sector employees and Community-Based Health Insurance (CBHI) for rural residents and informal sector employees. Public facilities are expected to provide exempted services for free, and there is a fee-waiver system for the poor.Publication A Roadmap to Achieve Social Justice in Health Care in Egypt(Washington, DC, 2015)This paper lays out a roadmap to achieve social justice in healthcare by prioritizing areas related to service delivery, financial protection, and quality of care. The aim is to assist the Government of Egypt (GoE) in realizing the principle of social justice in the provision of healthcare. In doing so, the roadmap aims to prioritize key areas of focus for Egypt, including describing which existing programs to continue supporting and which new programs to consider for development, all under an integrated and interdependent structure. It is a focused assessment of how the overarching aim of social justice can be achieved in the healthcare sector through an emphasis on improving services for the most disadvantaged groups. This roadmap suggests recommendations that will result in incremental improvements in Egypt’s healthcare system in the short to medium term with a focus on disadvantaged groups. Achievement of these results should situate Egypt on the path to achieving social justice in healthcare in the long term.
Users also downloaded
Showing related downloaded files
Publication Digital Africa(Washington, DC: World Bank, 2023-03-13)All African countries need better and more jobs for their growing populations. "Digital Africa: Technological Transformation for Jobs" shows that broader use of productivity-enhancing, digital technologies by enterprises and households is imperative to generate such jobs, including for lower-skilled people. At the same time, it can support not only countries’ short-term objective of postpandemic economic recovery but also their vision of economic transformation with more inclusive growth. These outcomes are not automatic, however. Mobile internet availability has increased throughout the continent in recent years, but Africa’s uptake gap is the highest in the world. Areas with at least 3G mobile internet service now cover 84 percent of Africa’s population, but only 22 percent uses such services. And the average African business lags in the use of smartphones and computers as well as more sophisticated digital technologies that catalyze further productivity gains. Two issues explain the usage gap: affordability of these new technologies and willingness to use them. For the 40 percent of Africans below the extreme poverty line, mobile data plans alone would cost one-third of their incomes—in addition to the price of access devices, apps, and electricity. Data plans for small- and medium-size businesses are also more expensive than in other regions. Moreover, shortcomings in the quality of internet services—and in the supply of attractive, skills-appropriate apps that promote entrepreneurship and raise earnings—dampen people’s willingness to use them. For those countries already using these technologies, the development payoffs are significant. New empirical studies for this report add to the rapidly growing evidence that mobile internet availability directly raises enterprise productivity, increases jobs, and reduces poverty throughout Africa. To realize these and other benefits more widely, Africa’s countries must implement complementary and mutually reinforcing policies to strengthen both consumers’ ability to pay and willingness to use digital technologies. These interventions must prioritize productive use to generate large numbers of inclusive jobs in a region poised to benefit from a massive, youthful workforce—one projected to become the world’s largest by the end of this century.Publication Global Economic Prospects, June 2024(Washington, DC: World Bank, 2024-06-11)After several years of negative shocks, global growth is expected to hold steady in 2024 and then edge up in the next couple of years, in part aided by cautious monetary policy easing as inflation gradually declines. However, economic prospects are envisaged to remain tepid, especially in the most vulnerable countries. Risks to the outlook, while more balanced, are still tilted to the downside, including the possibility of escalating geopolitical tensions, further trade fragmentation, and higher-for-longer interest rates. Natural disasters related to climate change could also hinder activity. Subdued growth prospects across many emerging market and developing economies and continued risks underscore the need for decisive policy action at the global and national levels. Global Economic Prospects is a World Bank Group Flagship Report that examines global economic developments and prospects, with a special focus on emerging market and developing economies, on a semiannual basis (in January and June). Each edition includes analytical pieces on topical policy challenges faced by these economies.Publication Argentina Country Climate and Development Report(World Bank, Washington, DC, 2022-11)The Argentina Country Climate and Development Report (CCDR) explores opportunities and identifies trade-offs for aligning Argentina’s growth and poverty reduction policies with its commitments on, and its ability to withstand, climate change. It assesses how the country can: reduce its vulnerability to climate shocks through targeted public and private investments and adequation of social protection. The report also shows how Argentina can seize the benefits of a global decarbonization path to sustain a more robust economic growth through further development of Argentina’s potential for renewable energy, energy efficiency actions, the lithium value chain, as well as climate-smart agriculture (and land use) options. Given Argentina’s context, this CCDR focuses on win-win policies and investments, which have large co-benefits or can contribute to raising the country’s growth while helping to adapt the economy, also considering how human capital actions can accompany a just transition.Publication Classroom Assessment to Support Foundational Literacy(Washington, DC: World Bank, 2025-03-21)This document focuses primarily on how classroom assessment activities can measure students’ literacy skills as they progress along a learning trajectory towards reading fluently and with comprehension by the end of primary school grades. The document addresses considerations regarding the design and implementation of early grade reading classroom assessment, provides examples of assessment activities from a variety of countries and contexts, and discusses the importance of incorporating classroom assessment practices into teacher training and professional development opportunities for teachers. The structure of the document is as follows. The first section presents definitions and addresses basic questions on classroom assessment. Section 2 covers the intersection between assessment and early grade reading by discussing how learning assessment can measure early grade reading skills following the reading learning trajectory. Section 3 compares some of the most common early grade literacy assessment tools with respect to the early grade reading skills and developmental phases. Section 4 of the document addresses teacher training considerations in developing, scoring, and using early grade reading assessment. Additional issues in assessing reading skills in the classroom and using assessment results to improve teaching and learning are reviewed in section 5. Throughout the document, country cases are presented to demonstrate how assessment activities can be implemented in the classroom in different contexts.Publication World Development Report 2006(Washington, DC, 2005)This year’s Word Development Report (WDR), the twenty-eighth, looks at the role of equity in the development process. It defines equity in terms of two basic principles. The first is equal opportunities: that a person’s chances in life should be determined by his or her talents and efforts, rather than by pre-determined circumstances such as race, gender, social or family background. The second principle is the avoidance of extreme deprivation in outcomes, particularly in health, education and consumption levels. This principle thus includes the objective of poverty reduction. The report’s main message is that, in the long run, the pursuit of equity and the pursuit of economic prosperity are complementary. In addition to detailed chapters exploring these and related issues, the Report contains selected data from the World Development Indicators 2005‹an appendix of economic and social data for over 200 countries. This Report offers practical insights for policymakers, executives, scholars, and all those with an interest in economic development.