Q: How can medical diagnostic instruments like X-ray machine, USG machine, CT scan machine, ECG machine etc. be better utilised in hospitals and other analytical labs and made more accessible to the poor?

A:The issue you raise is a complex one and there are no simple answers to it as there are many factors, which come into play. Financial factors may encourage or inhibit patients’ use of services, and may also encourage or discourage the provision of services. Planning the availability of services is another important aspect that involves rationing, resource allocation, service configuration and organisational change. There are organisational barriers that determine the timeliness and acceptability of care. They result from lack of capacity and inefficient use of existing capacity as services are seldom designed from the patient’s perspective. There is also the issue of fairness in access as it is well known that there are substantial inequalities in health and health care utilisation in the country. Inequity in access may be due to place of residence, socioeconomic status, ethnic group, age and gender. A number of studies have shown that there is a significant mismatch between professional expectations, patients’ needs and patterns of uptake of services. For example, some groups have low uptake of preventive services, many delay in accessing care for serious conditions, or there is over-utilisation of emergency services for what may be termed trivial conditions. It is difficult to change people’s behaviour and it may be better to provide appropriate service, which addresses the concerns of the users. Facilitating access is concerned with helping people to utilise appropriate health care resources and there are several aspects to it: a) an adequate supply of services - if services are available then a population may have access to health care; b) The extent to which population gains access to health care also depends on financial, organisational and social/cultural barriers that limit utilisation. Thus utilisation is dependent on the affordability, physical accessibility and acceptability of services and not merely the adequacy or availability of supply; c) The services available must be relevant and effective if the population is to gain access to it; and d) The availability of services and barriers to utilisation have to be evaluated in the context of the differing perspectives, health needs and the socioeconomic/cultural settings of diverse groups in society.