亚洲转型国家疾病与健康网

Research strategy
POVILL focuses on risks associated with major illness. Most field data collection is in a few local administrative units (counties or districts) in Cambodia, Lao PDR and Hubei and Sichuan Provinces of China. In each location, the approach is that of in-depth case studies addressing the following questions:
What is the impact of different types of illness on different kinds of households?How effective are the various coping strategies that these households adopt and what are the consequences for household members?
Have innovative schemes in the study countries reduced the impoverishing impact of major illness and what factors have influenced their performance?
Has inappropriate provider performance regarding drug use and hospital in-patient care increased the cost of care for the poor and what measures can government take to reduce unnecessary costs?
What considerations influenced government action to meet health-related needs of the poor and how have local institutional arrangements affected implementation of health safety nets and drug regulation? The research is organised as four integrated sub-studies that provide different approaches for understanding the effects of illness on households and of arrangements to mitigate their impact (figure 1). The data collection exercises take into account the needs of all four sub-studies. One major challenge has been to refine current definitions of “major illness” and focus the study on illness events most relevant for policy purposes.

Figure 1.The four areas of study within the project

1. Household
This sub-study looks at how different types of major illness affect livelihoods, explores how different types of households adapt to cope with health-related shocks and assesses the extent to which they are supported by formal or informal support networks.
2. Health assistance schemes
This sub-study focuses on government interventions specifically aimed at reducing financial barriers to access to care and the impoverishing impact of major illness. It assesses the performance of these schemes in terms of efficiency of targeting, access by the poor, protection against catastrophic healthcare expenditure and efficient use of public resources.
3. Providers
This sub-study focuses on providers of medical care. A central strategy for coping with major illness is to seek treatment to reduce suffering and speed up a return to normal health. The performance of health service providers greatly affects the efficacy of this coping strategy. This study will explore the performance of providers for different types of health problem in terms of the course of illness (acute or chronic), the type of provider used (hospital or ambulatory care) and the type of person affected (age, sex and other relevant characteristics). The intention is to deepen our knowledge of whether the kinds of services that poor people are offered for different types of health problems put unnecessary financial burdens on them.
4. Government and institutional environment
This sub-study explores the growing awareness of the problems for households in managing risks associated with the transition to a market economy. It studies the factors behind the rising government concern about the impoverishing impact of major illness, the broad policy context within which specific interventions have been designed and the factors that influence the implementation of these interventions.