Health systems
India: equity effects of quality improvements on health service utilization and patient satisfaction in Uttar Pradesh State
Health systems in Uttar Pradesh
Authors:
D. Peters; K. Rao; G.N.V Ramana
Publisher:
Health, Nutrition and Population Division, Human Development Department, World Bank, 2004
Uttar Pradesh, with 170 million people is India’s most populous state. Socioeconomic inequalities in health outcomes are large within India overall, but more pronounced in Uttar Pradesh and neighbouring states. This study by the Health, Nutrition, and Population (HNP) Family of the World Bank's Human Development Network, investigates the impact of a health systems development project in Uttar Pradesh, on utilisation 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 finds that 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 utilisation levels. Although patients from the poorest 40 precent of the population increased utilisation 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 but not for patients from the poorest 40 percent. The authors find that patient satisfaction overall improved only at lower level project facilities, not hospitals. The wealthiest group showed gains in satisfaction with every type of facility, and with significantly higher improvements than the poorest group.
