Health Systems Reform and Ethics: Private Practitioners in Poor Urban Neighbourhoods in India, Indonesia and Thailand
This project studied health care provided by private practitioners to inhabitants of selected poor urban neighbourhoods in India, Indonesia and Thailand. In India, the project observed wide variation in types and qualifications of providers, but only small differences in services rendered. It was found that the pharmaceutical industry used the widespread prevalence of providers irrespective of formal qualifications to promote higher sales of drugs than medically necessary, thereby depleting resources in poor households. At the same time, in some areas, the medical association fought the existence of providers without formal qualifications while not replacing these providers with better alternatives. The project recommendations included steps to train unqualified providers and steps to improve regulation of the pharmaceutical market. In Indonesia, the project described the complex plurality of health care providers from a patients’ perspective through emic concepts such as ‘cocok’, meaning degree of mutual fit between e.g. provider and patient, or medicine and patient. The local perception of the functioning of medicines was seen to match with current developments of ‘individualised therapy’ or tailor-made drugs. The project also explored various health financing schemes and practices as they worked in the local ecology of a poor neighbourhood and questioned the mechanisms used to determine which households are eligible to participate in pro-poor health financing schemes. In Thailand, the project confirmed that the universal insurance scheme (formerly the 30 Baht scheme) had had a substantial impact on health care consumption, providing free or almost free access to public health goods, including at primary care level. The project also focused on the issue of internal migration and problems of access to free health care services for migrating populations. For more information, please see www.hum.au.dk/hsre.