India : Equity Effects of Quality Improvements on Health Service Utilization and Patient Satisfaction in Uttar Pradesh State
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 ra...
| Main Authors: | , , |
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| Format: | Working Paper |
| Language: | English en_US |
| Published: |
World Bank, Washington, DC
2013
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| Subjects: | |
| Online Access: | http://documents.worldbank.org/curated/en/2004/10/5371195/india-equity-effects-quality-improvements-health-service-utilization-patient-satisfaction-uttar-pradesh-state http://hdl.handle.net/10986/13792 |
| Summary: | 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. |
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