Gopukrishnan Pillai | Universiteit Leiden (original) (raw)
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Papers by Gopukrishnan Pillai
Anthropology & Medicine, 2016
The percentage of India's national budget allocated to the health sector remains one of the lowes... more The percentage of India's national budget allocated to the health sector remains one of the lowest in the world, and healthcare expenditures are largely out-of-pocket (OOP). Currently, efforts are being made to expand health insurance coverage as one means of addressing health disparity and reducing catastrophic health costs. In this review, we document reasons for rising interest in health insurance and summarize the country's history of insurance projects to date. We note that most of these projects focus on in-patient hospital costs, not the larger burden of outpatient costs. We briefly highlight some of the more popular forms that government, private, and community-based insurance schemes have taken and the results of quantitative research conducted to assess their reach and cost-effectiveness. We argue that ethnographic case studies could add much to existing health service and policy research, and provide a better understanding of the life cycle and impact of insurance programs on both insurance holders and healthcare providers. Drawing on preliminary fieldwork in South India and recognizing the need for a broad-based implementation science perspective (studying up, down and sideways), we identify six key topics demanding more in-depth research, among others: (1) public awareness and understanding of insurance; (2) misunderstanding of insurance and how this influences health care utilization; (3) differences in behavior patterns in cash and cashless insurance systems; (4) impact of insurance on quality of care and doctor-patient relations; (5) (mis)trust in health insurance schemes; and (6) health insurance coverage of chronic illnesses, rehabilitation and OOP expenses.
The percentage of India's national budget allocated to the health sector remains one of the lowes... more The percentage of India's national budget allocated to the health sector remains one of the lowest in the world, and healthcare expenditures are largely out-of-pocket (OOP). Currently, efforts are being made to expand health insurance coverage as one means of addressing health disparity and reducing catastrophic health costs. In this review, we document reasons for rising interest in health insurance and summarize the country's history of insurance projects to date. We note that most of these projects focus on in-patient hospital costs, not the larger burden of out-patient costs. We briefly highlight some of the more popular forms that government, private, and community-based insurance schemes have taken and the results of quantitative research conducted to assess their reach and cost-effectiveness. We argue that ethnographic case studies could add much to existing health service and policy research, and provide a better understanding of the life cycle and impact of insurance programs on both insurance holders and healthcare providers. Drawing on preliminary fieldwork in South India and recognizing the need for a broad-based implementation science perspective (studying up, down and sideways), we identify six key topics demanding more in-depth research, among others: (1) public awareness and understanding of insurance; (2) misunderstanding of insurance and how this influences health care utilization; (3) differences in behavior patterns in cash and cashless insurance systems; (4) impact of insurance on quality of care and doctor-patient relations; (5) (mis)trust in health insurance schemes; and (6) health insurance coverage of chronic illnesses, rehabilitation and OOP expenses.
Identifying factors that contribute the most towards meeting the healthcare needs of the populati... more Identifying factors that contribute the most towards meeting the healthcare needs of the population is of particular importance
in a developing country such as India. Good governance in health should lead to provision of healthcare of acceptable quality
that is physically and socially accessible to all segments of the population. It should moreover be delivered in culturally
acceptable forms, without injuring basic human dignity or otherwise offending local customs. Allocation of scarce economic
resouces between different groups and for different purposes is often the negotiated outcome of a complicated political
process. Quality of public health is ultimately contingent on the quality of governance in a country. Recent changes in
allocation of resources for health bring this fact to plain light. This study is an attempt to compile the grassroots perspective
on health systems performance and the role of local self governements in improving the same.
The study was performed in different regions on Rajasthan using mixed methodology approach. The methods included
multi-state holder discussions, focus group discussion and surveys. This study highlights the multiplicity of factors that could
raise barriers to healthcare access. These range from such obvious ones as lack of infrastructure or large distances, to such
elements as information barriers, cultural outlooks etc that tend to be overlooked in many cases. The study findings reiterates
the inter-connectedness of the numerous medical and non-medical determinants. Managing the multiplicity of factors and
their numerous interactions will have to be streamlined by an appropriate program that combines the local context with the
national scene.
Home-based healthcare is gaining in popularity as an alternative to conventional care for elderly... more Home-based healthcare is gaining in popularity as an alternative to conventional care for elderly in many countries. However there is lack of clarity regarding benefits to elderly living in the community with chronic diseases from home-based healthcare intervention (HBI) programs. This review aimed to assess the benefits if any from HBI compared to usual care for mortality, functional status and admission to long term care facility. Specific program components were identified that gave the best outcomes across different interventions.
Government of India (GoI) needs to urgently prioritize increasing the availability of community n... more Government of India (GoI) needs to urgently prioritize increasing the availability of community nursing services through the public health system. Community nursing care reduces the work-load of hospitals, is based on a 'population-near' approach and has been shown to achieve better health outcomes at lower costs when combined with regular hospitalbased care. The elderly and those living with disabilities are unable to access government-run hospitals which are few and far in between, whereas the private sector in healthcare is not affordable to a large segment of the population. Moreover, the latter does not have the financial incentive to invest in home-based services to all but a small segment of the urban population. As such, the majority of those who need nursing care at home have to rely on what is provided by a few organisations in the not-for-profit sector. In the backdrop of the rapidly increasing numbers of the elderly, the current gap between demand and supply of affordable community nursing care is set to widen further in the near future. GoI should directly establish community nursing services as part of the public health system, in addition to establishing a favourable policy environment that will encourage the private sector to invest in delivering community-based services.
In this Essay, I argue for flexibility in retirement options to favour vitality and healthy ageing
Drafts by Gopukrishnan Pillai
Anthropology & Medicine, 2016
The percentage of India's national budget allocated to the health sector remains one of the lowes... more The percentage of India's national budget allocated to the health sector remains one of the lowest in the world, and healthcare expenditures are largely out-of-pocket (OOP). Currently, efforts are being made to expand health insurance coverage as one means of addressing health disparity and reducing catastrophic health costs. In this review, we document reasons for rising interest in health insurance and summarize the country's history of insurance projects to date. We note that most of these projects focus on in-patient hospital costs, not the larger burden of outpatient costs. We briefly highlight some of the more popular forms that government, private, and community-based insurance schemes have taken and the results of quantitative research conducted to assess their reach and cost-effectiveness. We argue that ethnographic case studies could add much to existing health service and policy research, and provide a better understanding of the life cycle and impact of insurance programs on both insurance holders and healthcare providers. Drawing on preliminary fieldwork in South India and recognizing the need for a broad-based implementation science perspective (studying up, down and sideways), we identify six key topics demanding more in-depth research, among others: (1) public awareness and understanding of insurance; (2) misunderstanding of insurance and how this influences health care utilization; (3) differences in behavior patterns in cash and cashless insurance systems; (4) impact of insurance on quality of care and doctor-patient relations; (5) (mis)trust in health insurance schemes; and (6) health insurance coverage of chronic illnesses, rehabilitation and OOP expenses.
The percentage of India's national budget allocated to the health sector remains one of the lowes... more The percentage of India's national budget allocated to the health sector remains one of the lowest in the world, and healthcare expenditures are largely out-of-pocket (OOP). Currently, efforts are being made to expand health insurance coverage as one means of addressing health disparity and reducing catastrophic health costs. In this review, we document reasons for rising interest in health insurance and summarize the country's history of insurance projects to date. We note that most of these projects focus on in-patient hospital costs, not the larger burden of out-patient costs. We briefly highlight some of the more popular forms that government, private, and community-based insurance schemes have taken and the results of quantitative research conducted to assess their reach and cost-effectiveness. We argue that ethnographic case studies could add much to existing health service and policy research, and provide a better understanding of the life cycle and impact of insurance programs on both insurance holders and healthcare providers. Drawing on preliminary fieldwork in South India and recognizing the need for a broad-based implementation science perspective (studying up, down and sideways), we identify six key topics demanding more in-depth research, among others: (1) public awareness and understanding of insurance; (2) misunderstanding of insurance and how this influences health care utilization; (3) differences in behavior patterns in cash and cashless insurance systems; (4) impact of insurance on quality of care and doctor-patient relations; (5) (mis)trust in health insurance schemes; and (6) health insurance coverage of chronic illnesses, rehabilitation and OOP expenses.
Identifying factors that contribute the most towards meeting the healthcare needs of the populati... more Identifying factors that contribute the most towards meeting the healthcare needs of the population is of particular importance
in a developing country such as India. Good governance in health should lead to provision of healthcare of acceptable quality
that is physically and socially accessible to all segments of the population. It should moreover be delivered in culturally
acceptable forms, without injuring basic human dignity or otherwise offending local customs. Allocation of scarce economic
resouces between different groups and for different purposes is often the negotiated outcome of a complicated political
process. Quality of public health is ultimately contingent on the quality of governance in a country. Recent changes in
allocation of resources for health bring this fact to plain light. This study is an attempt to compile the grassroots perspective
on health systems performance and the role of local self governements in improving the same.
The study was performed in different regions on Rajasthan using mixed methodology approach. The methods included
multi-state holder discussions, focus group discussion and surveys. This study highlights the multiplicity of factors that could
raise barriers to healthcare access. These range from such obvious ones as lack of infrastructure or large distances, to such
elements as information barriers, cultural outlooks etc that tend to be overlooked in many cases. The study findings reiterates
the inter-connectedness of the numerous medical and non-medical determinants. Managing the multiplicity of factors and
their numerous interactions will have to be streamlined by an appropriate program that combines the local context with the
national scene.
Home-based healthcare is gaining in popularity as an alternative to conventional care for elderly... more Home-based healthcare is gaining in popularity as an alternative to conventional care for elderly in many countries. However there is lack of clarity regarding benefits to elderly living in the community with chronic diseases from home-based healthcare intervention (HBI) programs. This review aimed to assess the benefits if any from HBI compared to usual care for mortality, functional status and admission to long term care facility. Specific program components were identified that gave the best outcomes across different interventions.
Government of India (GoI) needs to urgently prioritize increasing the availability of community n... more Government of India (GoI) needs to urgently prioritize increasing the availability of community nursing services through the public health system. Community nursing care reduces the work-load of hospitals, is based on a 'population-near' approach and has been shown to achieve better health outcomes at lower costs when combined with regular hospitalbased care. The elderly and those living with disabilities are unable to access government-run hospitals which are few and far in between, whereas the private sector in healthcare is not affordable to a large segment of the population. Moreover, the latter does not have the financial incentive to invest in home-based services to all but a small segment of the urban population. As such, the majority of those who need nursing care at home have to rely on what is provided by a few organisations in the not-for-profit sector. In the backdrop of the rapidly increasing numbers of the elderly, the current gap between demand and supply of affordable community nursing care is set to widen further in the near future. GoI should directly establish community nursing services as part of the public health system, in addition to establishing a favourable policy environment that will encourage the private sector to invest in delivering community-based services.
In this Essay, I argue for flexibility in retirement options to favour vitality and healthy ageing