Privatisation of Health Care in India - Indian Institute of Public ...

3Private Health Services in India:An OverviewviewThe following section traces the evolution of the privatesector and explores its characteristics for India and the specificstates under study. It is well known that India’s privatesector in health care is characterised by plurality in termsof systems of medicine and the forms of practice. Evenbefore Independence, the single largest category of providersconsisted of private practitioners across allopathic,ayurveda, unani, siddha and homeopathy (Baru, 1993). Individualpractitioners dominate the private sector in all thesesystems but from the seventies the growth of nursinghomes and hospitals was largely confined to the allopathicsystem of medicine. Other indigenous systems of medicinedid not witness a similar kind of growth at the secondaryand tertiary levels of health care. Clearly the growthof the private secondary and tertiary levels of care wereconfined largely to urban areas and rural areas where therewas agrarian prosperity. The relationship between economicdevelopment and the growth of private services is obviousand this has been empirically shown in a study comparingthe poorer and richer districts in Andhra Pradesh(Baru, 1993). This study showed that the number of privateinstitutions at the secondary level of care was skewedin favour of the developed districts as compared to thepoorer ones. This trend has been observed across states,supported by the data on the growth of private institutionsfrom the mid 1980s. The better developed states haveseen a growth of private institutions at the secondary andtertiary levels (Table 1).The three states under study represent varying levels ofdevelopment, private medical care and public health services.Maharashtra represents a developed state, Karnataka,a middle level and Orissa a poorly developed state. Giventhese variations, one would like to examine the growth ofthe public and private sectors in these states. Given thepaucity of data on the private sector, we are relying onpublished sources to discern the broad trends for the secondaryand tertiary levels of care. The data on primarylevel care is not available, but we have made use of publishedand unpublished studies that give us some insightinto the numbers and characteristics of the providers inthe private sector at this level. Utilisation of services forboth outpatient and inpatient care is examined in the contextof the structures of provisioning. This analysis willstudy the variations across selected states, across incomegroups and also the vulnerable social groups, namely, thescheduled castes and scheduled tribes. Since NSS (NationalSample Survey) data is available for the mid-eighties andthe nineties, it is possible to study if there has been any shiftin utilisation patterns. All these three states have opted forreforming health systems as a part of the World Bank financedproject, which is part of the ‘soft loans’ that severalstates have opted for.If one examines the trends in crude death and infant mortalityrates (IMR) for these three states one finds that thelatter reflects the level of development. In 1995,Maharashtra had an infant mortality rate of 55 per 10005