Risk-sharing in rural health care.

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1992-12-09
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Kasturba Hospital in Sevagram India has helped to initiate an outreach health program for nearby villages A health insurance scheme has evolved where the community contributes sorghum for a fund and participates in decision making and the supervision of village health workers Contributors are entitled to free primary care and subsidized referral care Only villages where at least 75 of the poor community agreed to enroll in the health insurance scheme were adopted by the hospital The hospital offers insured persons free inpatient treatment for unexpected illness and a 75 subsidy for care during normal pregnancy or with cataract and hernia operations The mobile health team comprising auxiliary nurse midwife social worker and village health worker provides maternal and child health services in the localities The village health workers provide symptomatic drug treatment exercise a preventive role with the help of visiting health team members and refer patients to hospital The auxiliary nurse midwife and social workers organize visits for vaccination and provide maternal and child health care The doctor in charge treats patients in the hospital and trains village health workers More than 75 of the villages in the area have enrolled in the scheme over the last 10 years No vaccine preventable illness measles poliomyelitis diphtheria whooping cough tetanus was reported in children or mothers after mass immunization was instituted no maternal deaths have occurred during the past 10 years and perinatal mortality has fallen steeply The village health teams are now regarded as counselors on health related matters among them drinking water supplies irrigation and programs for income generation It is necessary to regulate the private health sector including professionals the drug industry and investors If outpatient services are opened up to the private sector a system of universal medical insurance financed by local government should operate
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