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Article
Publication date: 17 June 2020

Samuel Ampaw, Edward Nketiah-Amponsah, Frank Agyire-Tettey and Bernardin Senadza

Equity in access to and use of healthcare resources is a global development agenda. Policymakers’ knowledge of the sources of differences in household healthcare spending…

Abstract

Purpose

Equity in access to and use of healthcare resources is a global development agenda. Policymakers’ knowledge of the sources of differences in household healthcare spending is crucial for effective policy. This paper aims to investigate the differences in the determinants of household healthcare expenditure across space and along selected quantiles of healthcare expenditure in Ghana. The determinants of rural-urban healthcare expenditure gap are also explored.

Design/methodology/approach

Data was obtained from the sixth round of the Ghana Living Standards Survey (GLSS 6) conducted in 2013. An unconditional quantile regression (UQR) and a decomposition technique based on UQR, adjusted for sample selection bias, were applied.

Findings

The results indicate that differences in the determinants of household healthcare expenditure across space and along quantiles are driven by individual-level variables. Besides, the rural-urban health expenditure gap is greatest among households in the lower quantiles and this gap is largely driven by differences in household income per capita and percentage of household members enrolled on health insurance policies.

Originality/value

The findings show that there are differences in the determinants of household health expenditure along with the income distribution, as well as between rural and urban localities, which would call for targeted policies to address these inequalities.

Details

International Journal of Development Issues, vol. 19 no. 3
Type: Research Article
ISSN: 1446-8956

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Article
Publication date: 16 March 2012

David J. Forbes

Changing healthcare provision need not be sudden or damaging. If changes are made then many valuable services may be lost. This article aims to consider dramatic change…

Abstract

Purpose

Changing healthcare provision need not be sudden or damaging. If changes are made then many valuable services may be lost. This article aims to consider dramatic change and its negative effects on Indian rural healthcare provision.

Design/methodology/approach

A case study is used to evaluate rural India's developing private health insurance, combined with evidence from other micro health insurance effectiveness studies.

Findings

Rural health insurance schemes are financially and culturally precarious. Enthusiastically importing these ventures into rural scenarios fragments vulnerable healthcare systems that have served and survived many other threats. The new services may fail if not subsidised and the experiment might undermine what was already in place. Is it improvement or just change?

Research limitations/implications

Missing rural health providers from the dataset means that data are not regularly available.

Practical implications

As more Western healthcare concepts are parachuted into developing areas, understanding and appreciating what already exists is necessary. New healthcare schemes must be critically evaluated, including the damage they could do to other healthcare provision.

Originality/value

Unlike other published research on private health insurance introduced in India and Africa, this study critically reviews the effect in rural areas from vital hospital services' perspective.

Details

International Journal of Health Care Quality Assurance, vol. 25 no. 3
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 11 May 2010

H. Holly Wang, Shaomin Huang, Linxiu Zhang, Scott Rozelle and Yuanyuan Yan

Since 1999, China has undergone reform of its healthcare system. City‐based social health insurance (SHI) is the primary form of current health insurance, supplemented by…

Abstract

Purpose

Since 1999, China has undergone reform of its healthcare system. City‐based social health insurance (SHI) is the primary form of current health insurance, supplemented by various commercial health insurance programs. The rural new cooperative medical system (NCMS) was introduced in 1993 and extended to cover the whole of rural China in 2003.

Design/methodology/approach

The paper developed a theoretical model for consumer demand of medical services and health insurance based on an expected utility framework with a two‐stage decision under uncertainty. The model is then applied to current health insurance systems in China for urban citizens and rural residents separately. Least square and logistic regressions are employed.

Findings

The major results are that although the factors driving the decisions on health insurance participation are basically the same for rural and urban citizens, the participation levels are quite different. The major difference is that urban SHI has higher coverage and urban citizens have higher income, resulting in a much larger urban medical expenditure.

Practical implications

The empirical analysis reveals that health insurance programs have played an important role in the healthcare expenditure for urban residents, while the NCMS has not made a significant impact towards increasing the ability of rural residents to seek more medical services, based on data at 2004.

Originality/value

This is the first paper employing a health production theory on China's new urban and rural healthcare programs.

Details

China Agricultural Economic Review, vol. 2 no. 2
Type: Research Article
ISSN: 1756-137X

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Article
Publication date: 3 August 2012

Mark Esposito, Amit Kapoor and Sandeep Goyal

The access to high quality, a reliable and affordable basic healthcare service is one of the key challenges facing the rural and semi‐urban population lying at base of the

Abstract

Purpose

The access to high quality, a reliable and affordable basic healthcare service is one of the key challenges facing the rural and semi‐urban population lying at base of the pyramid (BoP) in India. Realizing this as a social challenge and an economic opportunity (shared value), there has been an emergence of healthcare service providers who have bundled entrepreneurial attitude and passion with available scarce resources to design and implement cost‐effective, reliable and scalable market solutions for the BoP. The purpose of this research paper is to understand the underlying operating principles of these self‐sustainable business models aimed at providing healthcare services to the BoP segment in India.

Design/methodology/approach

The empirical context involves the use of case study research methodology, where the source of data is published case studies and the company websites of four healthcare organizations who have made a socio‐economic difference in the lives of the rural and semi‐urban population lying at the BoP in India.

Findings

The analysis and findings reflect the key operating principles for sustainable healthcare business ventures at the BoP. These include focus on 4A's (accessible, affordable, acceptable and awareness), local engagement, local skills building, learning by experiment, flexible organizational structure, dynamic leadership, technology integration and scalability.

Research limitations/implications

This research study has focused mainly on the published case studies as source of data.

Originality/value

The intent is to understand and bring forth the learning and guiding principles, which act as a catalyst for the future researchers and business ventures engaged in BoP context.

Details

Corporate Governance: The international journal of business in society, vol. 12 no. 4
Type: Research Article
ISSN: 1472-0701

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Article
Publication date: 21 November 2018

Martha R. Crowther, Cassandra D. Ford, Latrice D. Vinson, Chao-Hui Huang, Ernest Wayde and Susan Guin

Older adults are at risk for developing metabolic syndrome (MSX). Given the growing rural older adult population and the unknown prevalence rate of MSX in rural

Abstract

Purpose

Older adults are at risk for developing metabolic syndrome (MSX). Given the growing rural older adult population and the unknown prevalence rate of MSX in rural communities, the purpose of this paper is to assess the risk factors for MSX among rural elders.

Design/methodology/approach

Individuals aged 55+ from four West Alabama rural communities were assessed by an interdisciplinary healthcare team via a mobile unit (n=216). Descriptive analyses and analysis of variances (ANOVA) were conducted to assess the effect of gender, race and community on the number of risk factors of MSX among rural elders.

Findings

Results of a three-way ANOVA revealed a significant interaction between gender, age and community on the number of MSX risk factors [F (16,193)= 2.41, p <0.01]. Rural communities with lower social economic status (SES) and predominantly African American residents were at higher risk for developing MSX compared to communities with higher SES [F(3, 68) = 7.42, p<0.05].

Practical implications

Findings suggest low SES rural communities are at risk of developing MSX. Innovative approaches such as mobile healthcare delivery are crucial to providing quality healthcare and preventive health screens to underserved rural older adult communities.

Originality/value

Limited research is available on assessing rural midlife and older adults at risk for metabolic syndrome largely due to lack of communication or transportation infrastructure and their history of negative experiences with public institutions. This research demonstrates that these barriers can be addressed.

Details

Quality in Ageing and Older Adults, vol. 19 no. 4
Type: Research Article
ISSN: 1471-7794

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Book part
Publication date: 20 October 2014

Valentina Bodrug-Lungu and Erin Kostina-Ritchey

The purpose of this paper is to provide an overview of post-Soviet and demographic challenges faced by the government in Moldova that have posed as challenges to reform of…

Abstract

Purpose

The purpose of this paper is to provide an overview of post-Soviet and demographic challenges faced by the government in Moldova that have posed as challenges to reform of the healthcare system. Since independence from the Soviet Union in 1991, Moldova has undergone significant challenges and reforms throughout the society. Healthcare has been no exception. Changes in family structures due to migration, a decreased birthrate, and an aging population have placed strain on the healthcare system which is working to both modernize and provide specialized care. Legislation has helped to streamline and reform the healthcare system but systemic challenges are still faced by at-risk populations including the elderly, women, and rural populations.

Design

Information presented in this paper is based on a review of independent research, United Nations and government reports.

Findings

Findings show that progress has been made through legislative reform, new government programming, and most recently volunteer/nonprofit involvement in healthcare reform. Currently, the government is working to establish holistic patient centered care and to bridge the healthcare divide between rural and urban populations. Healthcare reforms include basic universal health care services and family support programming. Additionally, there has been a renewed emphasis on how environmental factors, like housing and nutrition, interact with health quality.

Value

Moldova faces an increasing challenge of caring for elderly populations at the family and societal level due to the increased number of elderly, shifts in family structures, and international migration for employment. A discussion of the developing role of nonprofit and nongovernment organizations is included.

Details

Family and Health: Evolving Needs, Responsibilities, and Experiences
Type: Book
ISBN: 978-1-78441-126-8

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Article
Publication date: 13 August 2018

Dinesh Kumar

The purpose of this paper is to identify factors related to rural healthcare services and establish a hierarchical model for the effective rural healthcare management in India.

Abstract

Purpose

The purpose of this paper is to identify factors related to rural healthcare services and establish a hierarchical model for the effective rural healthcare management in India.

Design/methodology/approach

A questionnaire survey identified and correlated numerous factors related to the Uttarakhand rural healthcare systems. Experts opinion were translated into a reachability matrix and an interpretive structural model. A fuzzy matriced impacts croises-multiplication applique and classment (FMICMAC) analysis arranged the factors as hierarchical stages using their driving power.

Findings

The interpretive structural and FMICMAC hierarchical models suggest four key driving factors: diseases, climatic conditions, population growth and political pressure.

Practical implications

Despite numerous issues, rural healthcare services can be improved by considering key driving factors that could be used as a prediction tool for policy makers.

Originality/value

Results demonstrate that population control, coordinating services with local bodies and rural health center annual maintenance can be game changers toward better healthcare services.

Details

International Journal of Health Care Quality Assurance, vol. 31 no. 7
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 5 August 2014

Dane M. Lee and Tommy Nichols

The purpose of this paper is to identify the challenges when recruiting and retaining rural physicians and to ascertain methods that make rural physician recruitment and…

Abstract

Purpose

The purpose of this paper is to identify the challenges when recruiting and retaining rural physicians and to ascertain methods that make rural physician recruitment and retention successful. There are studies that suggest rural roots is an important factor in recruiting rural physicians, while others look at rural health exposure in medical school curricula, self-actualization, community sense and spousal perspectives in the decision to practice rural medicine.

Design/methodology/approach

An extensive literature review was performed using Academic Search Complete, PubMed and The Cochrane Collaboration. Key words were rural, rural health, community hospital(s), healthcare, physicians, recruitment, recruiting, retention, retaining, physician(s) and primary care physician(s). Inclusion criteria were peer-reviewed full-text articles written in English, published from 1997 and those limited to USA and Canada. Articles from foreign countries were excluded owing to their unique healthcare systems.

Findings

While there are numerous articles that call for special measures to recruit and retain physicians in rural areas, there is an overall dearth. This review identifies several articles that suggest recruitment and retention techniques. There is a need for a research agenda that includes valid, reliable and rigorous analysis regarding formulating and implementing these strategies.

Originality/value

Rural Americans are under-represented when it comes to healthcare and what research there is to assist recruitment and retention is difficult to find. This paper identify the relevant research and highlights key strategies.

Details

International Journal of Health Care Quality Assurance, vol. 27 no. 7
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 8 October 2018

Dinesh Kumar and D. Kumar

The purpose of this paper is to eliminate the medicine stock-out problem by building an optimum medicine stock in rural healthcare centers in India.

Abstract

Purpose

The purpose of this paper is to eliminate the medicine stock-out problem by building an optimum medicine stock in rural healthcare centers in India.

Design/methodology/approach

Data associated with inflow and outflow of a specific medicine (folic acid tablets) arer collected from all consecutive supply chain stages during the survey. While conducting the survey, it is found that several medicines are out of stock owing to uncertain lead time and demand. Integrating with quantity discount and min–max (s, S) inventory policy, two models are developed using system dynamics: one is Model 1 with constant lead time and uncertain demand, and the other is Model 2 with both uncertain lead time and demand.

Findings

Both models are simulated for a period of one year on Stella 9.1 platform. The results are compared with actual data, and the comparison shows significant improvement of the medicine stock at all downstream stages, while maintaining a certain safety stock. Further, Model 2 suggests a larger stock than Model 1 at each point of time.

Practical implications

Despite numerous issues, the stocks of medicine in rural healthcare systems can be improved as suggested by the models. The models depict the behavior of inventory stock at each stage of the supply chain and act as a function of time that could be used in the form of a prediction tool for the policymakers.

Originality/value

This paper is one of the first papers that had developed the model of the medicine supply chain in rural parts of a developing country. It provides a generic framework for the stock assessment and improvement throughout the supply chain.

Details

International Journal of Health Care Quality Assurance, vol. 31 no. 8
Type: Research Article
ISSN: 0952-6862

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Case study
Publication date: 14 November 2011

Harit Palan, Anand Kumar Jaiswal, Jagdip Singh and Garima Sharma

Prayas is a unique healthcare initiative, launched in India by Sanofi-Aventis, a French multinational pharmaceutical company, with the objectives of updating the medical…

Abstract

Prayas is a unique healthcare initiative, launched in India by Sanofi-Aventis, a French multinational pharmaceutical company, with the objectives of updating the medical knowledge of doctors in semi-urban and rural areas, bridging the gap between diagnosis and treatment, and making available quality medicines at affordable prices. This case discusses the evolution of the Prayas model from its inception to its current state, and the company's business strategies around it. Cognizant of the success of Prayas, many competitors of Sanofi-Aventis are actively developing and implementing similar models. The company's top management team has to respond to the competitive threat.

Details

Indian Institute of Management Ahmedabad, vol. no.
Type: Case Study
ISSN: 2633-3260
Published by: Indian Institute of Management Ahmedabad

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