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Privatisation of Health Care in IndiaMaharashtra indicate that the middle and better off sectionsin these communities use the services of both qualifiedand unqualified private practitioners. The really poorare unable to afford the doctor’s charges and hence, eitheropt for government hospitals or often go without care(Bisht, 1993; Soman, 1992; Vijaya, 1997; Kakade, 1998).Chemist shops and pharmaceutical representatives influencethe prescription patterns of both qualified and unqualifiedpractitioners. In addition, the former also dispensemedicines for a variety of ailments and act as providers ofprimary level care. Studies by Phadke and Greenhalgh inMaharashtra have amply demonstrated the nexus betweenthe pharmaceutical industry’s marketing network and prescriptionpatterns of doctors, both qualified and unqualified(Greenhalgh, 1987; Phadke, 1998; Shah, 1997). Phadke’sstudy on the supply and use of pharmaceuticals in Sataradistrict of Maharashtra shows that a high proportion ofprescriptions are irrational and often very expensive. Theinfluence of pharmaceutical representatives is significant andthey are the single most important source of continuingmedical education of doctors (Phadke, 1998). While examiningthe utilisation of health services in the Kandhamal districtof Orissa, it was seen that women utilise the pharmacist’sservices in both rural and urban areas without consultinghealth professionals (Samantaray, 2000).Given the poor knowledge base of these practitioners, itis not surprising that their treatment of even common ailmentsis often irrational, ineffective and sometimes harmful.Studies that have analysed provider behaviour withrespect to specific diseases like tuberculosis and diarrhoeain Maharashtra, Delhi slums and Tamil Nadu support thefindings from elsewhere (Uplekar and Shepherd, 1991;Bhandari,1992; Balambal et al, 1997).4.2. Characteristics of PrivateProviders at the Secondary andTerertiartiary Levels of CareA few studies on the secondary level of care show that itconsists of institutions with five to over 100 beds that provideboth outpatient and inpatient services. These studiesprovide an insight into the heterogeneity of these institutionsin terms of scale of operation, services offered, technologyemployed and the social background of patientsusing these facilities (Bhat, 1993; Jesani and Anantharam,1993; Nanda and Baru, 1993; Baru, 1998; Muraleedharan,1999). They have further shown that single owners or partners,who are mostly doctors, usually promote these institutions.Typically, these institutions are located in towns andcities, but in some states like Andhra Pradesh, Maharashtra,Gujarat and parts of Karnataka and Tamil Nadu, they havespread to urban peripheries and rural areas especially thosewhich are economically well developed. Given the variabilityin the size and characteristics of the institutions at thislevel of care there is much plurality in type, quality and costof services provided by such institutions.Nandraj and others have explored the variability in the physicalinfrastructure, qualifications of personnel and their practicesat the secondary level of care in Mumbai. The studies fromDelhi, Chennai and Hyderabad show similar trends and thislack of basic and uniform standards for service provisioninghas implications for the quality of care provided (Baru,1998; Muraleedharan, 1999). It is important to point outhere that there is a dearth of studies, which examine thequality of the private sector in some detail.The tertiary level forms only three to five percent of thetotal private sector and is located in larger cities. Typicallythese are promoted as trusts, public or private limited enterprisesand most are located in the southern cities of Chennai,Bangalore and Hyderabad. These hospitals have a strongNRI link and provide a range of super specialist care.4.3. Regional Variations in theGrowth of Private Health CareThe growth of the private sector is related to the level ofeconomic and infrastructure development. As mentionedin the earlier section, the primary level of care consistingof private practitioners is widespread in both rural/urbanareas and across states. However, when it comes to secondaryand tertiary levels of care there is a distinct variationacross states. A study across developed and backward12
Structure and Characteristics of Private Health Care Providers in Indiadistricts in Andhra Pradesh amply demonstrated this. Thebed strength of the private sector was much higher in thebetter-developed districts than the backward ones (Jesaniand Anantharam, 1993; Baru, 1993). This pattern is seenacross states as well. There is a paucity of data on individualpractitioners since the only source of informationavailable is the registration data from the various medicalcouncils. This data is limited because not all practitionersare registered with these councils and there is also a greatdeal of cross practice across systems of medicine (Baru,1993; Duggal, 2001). Duggal estimates that there are approximately12 lakh practitioners in the country and theyare concentrated in states like Maharashtra, Gujarat andthe southern states. The allopathic doctors constitute about45 percent of the total registered practitioners and are locatedmostly in urban areas, whereas non-allopathic practitionersare mostly located in the smaller towns and ruralareas (Duggal, 2001).At the secondary level of care, which consists of nursinghomes, the economically developed states like Maharashtra,Punjab, Tamil Nadu and Gujarat have a higher proportionof beds in the private sector compared to the public sector(Table 4). Relatively poorer states such as Orissa, MadhyaPradesh, Uttar Pradesh and Rajasthan have low privatesector growth. The growth of corporate hospitals is largelya phenomenon in those states, which have agrarian prosperityand also have strong NRI links. For the three statesunder study the trends are clear: Maharashtra is the highprivate sector growth state, Karnataka falls in the middlerange and Orissa is a poor state with very little privatesector growth. The trend in the growth of private bedsrelative to public beds, from the seventies to the nineties,indicates that the number of private beds has doubled overthe twenty-year period in Karnataka. In Maharashtra, privatebeds have increased four and a half times during thesame period, while for Orissa there has been no growth–in fact there has been a decrease in the number of privatebeds during this period (Table 4).A survey done by the Karnataka government in 1996 onnon- government facilities shows that there are a large numberof institutions in this sector at the secondary and tertiarylevels of care. 89 percent of these institutions weregeneral hospitals with total a bed strength of 36,042, followedby those that provided only maternal and child healthservices (10.04 %) and the remaining provided specialistservices like ophthalmology and oncology (Governmentof Karnataka, 2001, pp.29-30). In terms of ownership83.38 percent of these institutions were promoted by individuals,7.49 percent were partnerships, 3.98 percent werecharitable trusts 2.46 percent were registered societies, 1.58percent were religious missions and 1.11 percent were limitedcompanies. Nearly 52 percent of the total beds werein the category of institutions promoted by individuals.This data does not provide information on the distributionof these institutions within Karnataka, but the general patternis that they are mostly located in urban and its peripheries..Karnataka does have a sizeable private sector, but thereis no system for registration. Hence, there is an incompletepicture of the private sector. In recent years there has beenan increase in the number of nursing homes and corporatehospitals especially in urban areas (Government of Karnataka,2001). In terms of accessibility of services there are considerableregional variations in both the private and public sectors.North Karnataka has poor infrastructure in terms ofroads, communications and transport facilities, while southernKarnataka has better infrastructure facilities, which hasan impact on accessibility and utilisation.In Maharashtra, a few studies have focussed on the publicsector and the regional variations in terms of its distribution.The more developed regions of Marathwada andKonkan have better facilities and access as compared tothe poorer region of Vidarbha (Budhkar, 1996). Budhkarobserves that there has been a strong tradition of localbodies in the provisioning of health services in Maharashtra.During the late seventies those regions that experiencedagrarian prosperity viz. Marathwada and parts of Konkan,also witnessed a spurt in the growth of the private sectorat the secondary level of care. She also shows that dispensariesand small nursing homes, which are skewed in favourof urban areas, dominate the private sector. This trendwas observed in a study of the distribution of NGOs inMaharashtra, where there was a greater concentration in13
Page 3 and 4: Table of Contents123456Introduction
Page 5 and 6: Chhattisgarh Infrastructure ReportL
Page 7 and 8: Table of Contents123456Introduction
Page 9 and 10: Privatisation of Health Care in Ind
Page 11 and 12: Globalisation and Health Services:
Page 13 and 14: 3Private Health Services in India:A
Page 15 and 16: Private Health Services in India: A
Page 17 and 18: Private Health Services in India: A
Page 19: 4Structure and Characteristics of P
Page 23 and 24: Structure and Characteristics of Pr
Page 25 and 26: Utilisation of Private Health Servi
Page 35 and 36: 6ConclusionThis study has explored
Page 37 and 38: ReferencesAcharya, A.; Baru, R. and
Page 39 and 40: ReferencesShah, G. 1997. Public Hea

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