دورية أكاديمية
أعرض في EDS

"I go I die, I stay I die, better to stay and die in my house": understanding the barriers to accessing health care in Timor-Leste.

التفاصيل البيبلوغرافية
العنوان: "I go I die, I stay I die, better to stay and die in my house": understanding the barriers to accessing health care in Timor-Leste.
المؤلفون: Price JA; School of Public Health and Community Medicine, University of New South Wales, Botany Street, Sydney, Australia. jenniferprice.unsw@gmail.com., Soares AI; Ministry of Health, Edifcio dos Servisos Centrais do Ministrio da Saude, Rua de Caicoli, Caixa Postal 374, Dili, Timor-Leste., Asante AD; School of Public Health and Community Medicine, University of New South Wales, Botany Street, Sydney, Australia., Martins JS; Faculty of Medicine and Health Sciences, National University of East Timor, Rua Jacinto Candido, Dili, Timor-Leste., Williams K; Liga Inan mHealth program, Catalpa International, Rua Quinze de Outubro Culuhun, Dili, Timor-Leste., Wiseman VL; School of Public Health and Community Medicine, University of New South Wales, Botany Street, Sydney, Australia.; Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK.
المصدر: BMC health services research [BMC Health Serv Res] 2016 Sep 30; Vol. 16 (1), pp. 535. Date of Electronic Publication: 2016 Sep 30.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: BioMed Central Country of Publication: England NLM ID: 101088677 Publication Model: Electronic Cited Medium: Internet ISSN: 1472-6963 (Electronic) Linking ISSN: 14726963 NLM ISO Abbreviation: BMC Health Serv Res Subsets: MEDLINE
أسماء مطبوعة: Original Publication: London : BioMed Central, [2001-
مواضيع طبية MeSH: Health Expenditures*, Health Services Accessibility/*standards , Hospitalization/*statistics & numerical data , Patient Acceptance of Health Care/*statistics & numerical data, Adult ; Aged ; Community Health Centers/statistics & numerical data ; Female ; Focus Groups ; Health Services/economics ; Health Services/statistics & numerical data ; Health Services Accessibility/economics ; Healthcare Disparities/economics ; Hospitalization/economics ; Humans ; Male ; Medicine, Traditional/statistics & numerical data ; Middle Aged ; Primary Health Care/statistics & numerical data ; Qualitative Research ; Referral and Consultation ; Residence Characteristics ; Rural Health ; Timor-Leste ; Travel/economics ; Travel/statistics & numerical data ; Universal Health Insurance/economics ; Universal Health Insurance/statistics & numerical data ; Urban Health ; Young Adult
مستخلص: Background: Despite public health care being free at the point of delivery in Timor-Leste, wealthier patients access hospital care at nearly twice the rate of poorer patients. This study seeks to understand the barriers driving inequitable utilisation of hospital services in Timor-Leste from the perspective of community members and health care managers.
Methods: This multisite qualitative study in Timor-Leste conducted gender segregated focus groups (n = 8) in eight districts, with 59 adults in urban and rural settings, and in-depth interviews (n = 8) with the Director of community health centres. Communication was in the local language, Tetum, using a pre-tested interview schedule. Approval was obtained from community and national stakeholders, with written consent from participants.
Results: Lack of patient transport is the critical cross-cutting issue preventing access to hospital care. Without it, many communities resort to carrying patients by porters or on horseback, walking or paying for (unaffordable) private arrangements to reach hospital, or opt for home-based care. Other significant out-of-pocket expenses for hospital visits were blood supplies from private suppliers; accommodation and food for the patient and family members; and repatriation of the deceased. Entrenched nepotism and hospital staff denigrating patients' hygiene and personal circumstances were also widely reported. Consequently, some respondents asserted they would never return to hospital, others delayed seeking treatment or interrupted their treatment to return home. Most considered traditional medicine provided an affordable, accessible and acceptable substitute to hospital care. Obtaining a referral for higher level care was not a significant barrier to gaining access to hospital care.
Conclusions: Onerous physical, financial and socio-cultural barriers are preventing or discouraging people from accessing hospital care in Timor-Leste. Improving access to quality primary health care at the frontline is a key strategy for ensuring universal access to health care, pursued alongside initiatives to overcome the multi-faceted barriers to hospital care experienced by the vulnerable. Improving the availability and functioning of patient transport services, provision of travel subsidies to patients and their families and training hospital staff in standards of professional care are some options available to government and donors seeking faster progress towards universal health coverage in Timor-Leste.
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فهرسة مساهمة: Keywords: Barriers; Demand-side; Determinants; Hospital services; Out-of-pocket payments; Referrals; Supply-side; Timor-Leste; Traditional medicine; Universal access
تواريخ الأحداث: Date Created: 20161008 Date Completed: 20171016 Latest Revision: 20220330
رمز التحديث: 20240628
مُعرف محوري في PubMed: PMC5045628
DOI: 10.1186/s12913-016-1762-2
PMID: 27716190
قاعدة البيانات: MEDLINE
الوصف
تدمد:1472-6963
DOI:10.1186/s12913-016-1762-2