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health care

How and why do countries vary so much in their use of health services?

Adam Wagstaff's picture

I’ve been struck recently by how little we (or at least I) seem to know about variations in use of health services across the world, and what drives them. Do people in, say, India or Mali use doctors “a lot” or “a little”. Even harder: do they “overuse” or “underuse” doctors? At least we could say whether doctor utilization rates in these countries are low or high compared to the rate for the developing world as a whole. But typically we don’t actually make such comparisons – we don’t have the numbers at our fingertips. Or at least I don’t.

I’m also struck by how strongly people feel about the factors that shape people’s use of services and what the consequences are. There are some who argue that the health problems in the developing world stem from people not getting care, and that people don’t get care because of shortages of doctors and infrastructure. There are others who argue that doctors are in fact quite plentiful – in principle; the problem is that in practice doctors are often absent from their clinic and people don’t get care at the right moment. There are others who argue that doctors are plentiful even in practice and people do get care; the problem is that the quality of the care is shockingly bad. Who’s right?

Law and Development from the Ground Up: Bridging Health Care by the Sewa River

Margaux Hall's picture

In Sierra Leone's rainy season, the Sewa River, feared by many locals for its powerful currents, floods over its banks separating entire villages from basic services.  Konta health clinic in Kenema district operates near the shores of the Sewa, and during the six-month rainy season, five of Konta’s 17 dependent villages cannot access the clinic.  If women in those villages give birth during the rains, they entrust care to traditional birth attendants; if children fall ill, they turn to traditional medicine, stockpiled drugs, and, often, prayer.  As one woman explained during a recent community meeting in Konta, these are the only options, even if the all-too-frequent consequence is death.  Hearing her account, it’s difficult not to feel a strong sense of injustice, even in an incredibly resource-constrained country like Sierra Leone.  But is there a role for the law in remedying this situation?

Poverty measurement, electricity generation, emissions, universal health care, greenhouse issues and financial literacy

Merrell Tuck-Primdahl's picture

This week, amidst fireworks and stultifying Washington heat, five Policy Research Working Papers were published. They cover weakly relative poverty measures, PPPs in electricity generation, carbon emissions, universal health care, financial literacy, and economic analysis of projects in a greenhouse world.

    Do Informed Citizens Receive More, or Pay More?

    Philip Keefer's picture

    One widely-accepted political economy research finding is that informed citizens receive greater benefits from government transfer programs. The evidence for the impact of information comes from particular contexts—disaster relief in India and welfare payments in the USA during the Great Depression.  Do other contexts yield similar results?  New research on the distribution of anti-malaria bed nets in Benin suggests:  “No.”  Instead, local health officials charged more informed households for bed nets that they could have given them for free.

    The Benin context differs in three ways.  First, the policy is not the distribution of cash, but of health benefits.  Households’ access to information then influences not only their knowledge of government programs to distribute such benefits, but also the value they place on them. 

    Second, the political context also differs.  In younger democracies, like Benin’s, citizens are more likely to confront additional obstacles, besides a lack of information, in their efforts to extract promised benefits from government.

    Beyond Universal Coverage Part II

    Adam Wagstaff's picture

    Quantity inequalities may be dwarfed by quality inequalities

    In my last post on UC I argued that UC is best thought of as a means to achieving lower inequalities and improved financial protection in the health sector, but that in practice UC is unlikely to be sufficient – and may not even be necessary – for us to achieve these goals.

    In this post, I argue that our focus on narrowing inequalities in the quantity of care is leading us to ignore another and potentially more important type of inequality in the health sector: inequality in the quality of care.

    Beyond Universal Coverage Part I

    Adam Wagstaff's picture

    Health sector inequalities and financial protection – is UC enough?

    Since the publication of the 2010 World Health Report “Health Systems Financing: The Path to Universal Coverage”, the “universal coverage” (UC) agenda has accelerated worldwide.

    In this post, I ask how far UC is likely to narrow health sector inequalities and improve financial protection. In the next two I pick up a couple of other themes: the need to look beyond the quantity of care to the quality of care; and how far we should try to incorporate the cost of forgone care into a measure of financial protection.

    Health System Innovation in India Part III

    Adam Wagstaff's picture

    Taking high-quality affordable primary care to the rural poor with the help of handheld computers, telemedicine, and P4P.

    In our first post in this series, we showed how illness in India causes financial hardship and leaves Indians—especially poor ones—with limited access to affordable good-quality health care that can actually make them better. In our last post, we outlined the Aarogyasri scheme—a novel government-sponsored health insurance program in the state of Andhra Pradesh that has the potential not just to reduce financial impoverishment but also raise quality standards in hospital care. In this post, we discuss an innovative private-sector approach to delivering and financing primary health care in rural Andhra Pradesh.

    Health System Innovation in India Part II: Aarogyasri

    Adam Wagstaff's picture

    More than health insurance for the poor

    In our last post, we showed how illness in India causes financial hardship and leaves Indians—especially poor ones—with limited access to affordable good-quality health care that can actually make them better. In this post, we outline a novel government-sponsored health insurance program in the state of Andhra Pradesh (AP)—a program that has the potential not just to reduce financial impoverishment but also raise quality standards in hospital care.

    a) “Actors”, and their rights and responsibilities

    Initiated by the then chief minister of AP, the medical doctor YSR Reddy, the Rajiv Aarogyasri scheme started in 2007 and is targeted at the below-poverty line (BPL) population. The scheme focuses on life-saving procedures that aren’t covered elsewhere in India’s patchwork of health programs, for which treatment protocols are available, and for which specialist doctors and equipment are required. Currently 938 tertiary care procedures are covered. The scheme revolves around five key “actors”, one unique to Aarogyasri and all with interesting rights and responsibilities.

    Health System Innovation in India Part I: India’s health system challenges

    Adam Wagstaff's picture

    India’s health system faces some major challenges. In some respects, the hill India’s health system has to climb is steeper than that facing other developing countries. The good news is that the innovation that India is famous for in other sectors, as well as in health technology, is now starting to make itself felt in the health system. Not only may these ideas benefit India’s poor; they may also provide food for thought for other countries.

    In this post, we sketch out the challenges facing India’s health system. In the next two, we outline two innovative approaches—one government, one private—in the state of Andhra Pradesh.