The health inequities remain high in India with government and private health expenditures clearly favoring the rich, urban population and organized sector workers and the Out Of Pocket (OOP) spending as high as 80%, ...The health inequities remain high in India with government and private health expenditures clearly favoring the rich, urban population and organized sector workers and the Out Of Pocket (OOP) spending as high as 80%, afflicting the poor in the worst manner. The focus of the paper is to examine the potential Community Based Health Insurance (CBHI) offers to improve the healthcare access to rural, low-income population and the people in unorganized sector. This is done by drawing empirical evidence from various countries on their experiences of implementing CBHI schemes and its potential for applications to India, problems and challenges faced and the policy and management lessons that may be applicable to India. It can be concluded that CBHI schemes have proved to be effective in reducing the Catastrophic Health Expenditure (CHE) of people. But success of such schemes depends on its design, benefit package it offers, its management, economic and non-economic benefits perceived by enrollees and solidarity among community members. Collaboration of government, NGO’s and donor agencies is very crucial in extending coverage;similarly overcoming the mistrust that people have from such schemes and subsidizing the insurance for the many who cannot pay the premiums are important factors for success of CBHI in India. One of the biggest challenges for the health system is to address the piecemeal approach of CBHI schemes in extending health insurance and inability of such schemes to cover a large number of poor and the unorganized sector workers. Also, there is a need for a stronger policy research to demonstrate: 1) how such schemes can create a larger risk pool, 2) how such schemes can enroll a large number of people in the unorganized sector, 3) the interaction of CBHI schemes with other financing schemes and its link to the health system.展开更多
Organisational Climate (OC) has been an important topic of research in Organisational Development. There are several frameworks and approaches to study OC. One such framework focuses on the effect of OC on motivation....Organisational Climate (OC) has been an important topic of research in Organisational Development. There are several frameworks and approaches to study OC. One such framework focuses on the effect of OC on motivation. Although studying OC from viewpoint of motivetion is an important one, there is very limited research in Indian public health system on assessing OC from the view point of motivation. The present study uses a comprehensive framework that focuses on assessing OC from the view point of motivation in a government district hospital. The overall objective of the study was to assess the OC of a District Hospital (DH) from the view point of motivation. A total of 66 staff (all from the same district hospital) participated in the study that included 12 Class I doctor specialists;14 Class II doctors and 40 Class III staff The data was collected using a validated instrument called Motivational Analysis of Climate (MAO-C). The instrument included six needs or motives and twelve dimensions of organisational climate that were ranked by individuals according to their perception. Based on the ranks, final scores were calculated that reflected the dominant climate (highest score for a particular motive) and backup climates (second highest score for a particular motive). Also a combination of the two motives, dominant and back up motives or climates indicated a particular OC. According to the study, the dominant climate in the organisation was that for Dependency motive while the backup climate for the organisation was for Control motive. According to the literature, both Dependency and Control motives are dysfunctional climates. A high dependency motive indicates that the overall organisational climate is characterized by no initiatives by the people and the employees always look for approval from their seniors;assistance of others in developing oneself;a need to check with others who are more knowledgeable. Similarly high score for control motive indicates that order is maintained in organisation;indicates display of personal power;a desire to stay informed and an urge to monitor events and to take corrective action when needed. When the two motives are combined, the study indicates a dependency-control climate profile which means that the organisational practices are similar to government offices, where subordinates have no say in decision making and they have to follow the established rules of the organisation. Such organisations have clearly laid communication channels controlled from higher authority indicating typical characteristics of a beaurocratic organisation.展开更多
文摘The health inequities remain high in India with government and private health expenditures clearly favoring the rich, urban population and organized sector workers and the Out Of Pocket (OOP) spending as high as 80%, afflicting the poor in the worst manner. The focus of the paper is to examine the potential Community Based Health Insurance (CBHI) offers to improve the healthcare access to rural, low-income population and the people in unorganized sector. This is done by drawing empirical evidence from various countries on their experiences of implementing CBHI schemes and its potential for applications to India, problems and challenges faced and the policy and management lessons that may be applicable to India. It can be concluded that CBHI schemes have proved to be effective in reducing the Catastrophic Health Expenditure (CHE) of people. But success of such schemes depends on its design, benefit package it offers, its management, economic and non-economic benefits perceived by enrollees and solidarity among community members. Collaboration of government, NGO’s and donor agencies is very crucial in extending coverage;similarly overcoming the mistrust that people have from such schemes and subsidizing the insurance for the many who cannot pay the premiums are important factors for success of CBHI in India. One of the biggest challenges for the health system is to address the piecemeal approach of CBHI schemes in extending health insurance and inability of such schemes to cover a large number of poor and the unorganized sector workers. Also, there is a need for a stronger policy research to demonstrate: 1) how such schemes can create a larger risk pool, 2) how such schemes can enroll a large number of people in the unorganized sector, 3) the interaction of CBHI schemes with other financing schemes and its link to the health system.
文摘Organisational Climate (OC) has been an important topic of research in Organisational Development. There are several frameworks and approaches to study OC. One such framework focuses on the effect of OC on motivation. Although studying OC from viewpoint of motivetion is an important one, there is very limited research in Indian public health system on assessing OC from the view point of motivation. The present study uses a comprehensive framework that focuses on assessing OC from the view point of motivation in a government district hospital. The overall objective of the study was to assess the OC of a District Hospital (DH) from the view point of motivation. A total of 66 staff (all from the same district hospital) participated in the study that included 12 Class I doctor specialists;14 Class II doctors and 40 Class III staff The data was collected using a validated instrument called Motivational Analysis of Climate (MAO-C). The instrument included six needs or motives and twelve dimensions of organisational climate that were ranked by individuals according to their perception. Based on the ranks, final scores were calculated that reflected the dominant climate (highest score for a particular motive) and backup climates (second highest score for a particular motive). Also a combination of the two motives, dominant and back up motives or climates indicated a particular OC. According to the study, the dominant climate in the organisation was that for Dependency motive while the backup climate for the organisation was for Control motive. According to the literature, both Dependency and Control motives are dysfunctional climates. A high dependency motive indicates that the overall organisational climate is characterized by no initiatives by the people and the employees always look for approval from their seniors;assistance of others in developing oneself;a need to check with others who are more knowledgeable. Similarly high score for control motive indicates that order is maintained in organisation;indicates display of personal power;a desire to stay informed and an urge to monitor events and to take corrective action when needed. When the two motives are combined, the study indicates a dependency-control climate profile which means that the organisational practices are similar to government offices, where subordinates have no say in decision making and they have to follow the established rules of the organisation. Such organisations have clearly laid communication channels controlled from higher authority indicating typical characteristics of a beaurocratic organisation.
