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

Privatisation of Health Care in India5Utilisation of Private Health ServicesThe structure of provisioning of health services will largelydetermine the patterns of utilisation and the expendituresincurred at the household level. Based on the 42 nd and 52 ndrounds of the NSS, the household survey conducted bythe National Council of Applied Economic Research(NCAER) and the NFHS, trends in utilisation of healthservices in the three states have been analysed. The analysishas been disaggregated for outpatient and inpatient care,states, rural/urban and income levels depending on theavailability of the data.5.1. Utilisation of Health Care forOutpatient ServicesAnalysis of the 42 nd round of the NSS data, pertaining to1985-86 period shows that in both rural and urban areasat the all India level, more than 50 percent of outpatientservices were provided by private doctors. In rural areasonly 18 percent of the cases requiring outpatient care soughttreatment in a public hospital, five percent at a primaryhealth centre (PHC) and a mere three percent in publicdispensaries. In urban areas, the proportion of those whoused public hospitals was higher than in rural areas. InMaharashtra, 49.94 percent used private doctors and 23percent used private hospitals for outpatient care in urbanareas. Only 19 percent of the households had used publichospitals and the remaining had used a public dispensaryor primary health centre (PHC). In rural areas, 51 percentof the households had opted for private doctors and 19.5percent for private hospitals. Only 14 percent had usedpublic hospitals, 10.4 percent had used PHCs and a mereone percent had used the public dispensaries.In Karnataka, 43 percent of outpatients had used the privatedoctors and 22 percent private hospitals for outpatientcare in urban areas. Moreover, 27 percent had usedpublic hospitals and mere 1.71 and 1.23 percent used PHCsand public dispensaries respectively.In rural areas, 41.5 percent had used private doctors and 18.5percent private hospitals. 25 percent of the households hadused public hospitals, 8.5 percent PHCs and a mere 1.2 percenthad used public dispensaries.Orissa shows a different trend from Karnataka andMaharashtra. In urban areas 38.7 percent used private doctorsand only four percent used private hospitals. Nearly 42percent of the households had used public hospitals whileonly one percent had used a PHC and 3.5 percent had usedpublic dispensaries for treatment. In rural areas, 31 percentused private doctors and there was no reported utilisation ofprivate hospitals at all. 34 percent of the population used thepublic hospitals, nearly 12 percent PHCs and six percent thepublic dispensaries (Tables 5 and 6).The 52 nd round of the NSS data pertaining to the 1995 to1996 period shows that there has been an increase in theutilisation of private sources for inpatient and outpatient careacross both the rural and urban areas. At the all India level, 64percent of rural and 72 percent of urban outpatient care wassought through the private sector. In Maharashtra, 73 percentin rural areas and 77 percent in urban areas had opted for theprivate sector. In Karnataka, 51 percent in rural and 74 percentin urban areas opted for the private sector for care. InOrissa, 31 percent in rural and 53 percent in urban areas hadopted for the private sector for outpatient care (Duggal, 2001).16