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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
Utilisation of Private Health ServicesTable 5: Distribution of Outpatient Treatment Over Sources of Treatment for States/U.T. (Urban)States/UTs Public Primary Public Private Nursing Charit- ESI Private Other AllHospital Health Dispen- Hospital Home able Doctor DoctorCentre sary HospitalAndhra Pradesh 18.42 0.66 1.43 41 3.23 1.05 1.45 26.62 6.1 100Assam 26.03 2.09 1.48 6.58 0.81 0.03 - 51.07 11.97 100Bihar 15.62 1.2 0.81 20.95 0.66 0.18 0.37 56.45 3.76 100Gujarat 14 0.45 1.41 39.28 - 1.05 2.7 38.13 2.98 100Haryana 11.3 2.18 3.52 6.12 2.05 0.31 4.69 68.6 1.23 100Himachal Pradesh 40.77 4.69 2.25 2.07 - - - 50.22 - 100Jammu & Kashmir 40.39 4.3 2.35 0.81 - 2.86 0.38 44.84 4.07 100Karnataka 27 1.71 1.23 22.07 1.01 0.24 1.36 43.19 2.09 100Kerala 32.83 2.43 0.43 40.21 0.66 0.12 0.63 19.87 2.82 100Madhya Pradesh 28.77 1.01 0.63 12.48 0.34 0.72 1.59 51.65 2.81 100Maharashtra 19.39 1.66 3.1 23.01 0.3 0.92 0.87 49.94 0.81 100Manipur 40.1 18.16 3.18 9.83 - - - 17.8 10.93 100Meghalaya 23.42 0.06 1.54 6.07 - - 2.75 49.23 15.95 100Nagaland 30.6 - - 1 - - - 68.25 - 100Orissa 41.8 1.11 3.54 4.07 0.67 1.05 1.42 38.78 7.56 100Punjab 8.72 0.84 0.59 9.14 0.25 0.4 0.77 79 0.29 100Rajasthan 51.36 3.54 2.31 12.15 0.33 0.24 0.3 24.3 5.45 100Sikkim 83.3 3.9 - - 0.84 - - 11.96 - 100Tamil Nadu 29.94 1.11 1.52 17.28 3.94 0.49 2.5 40.91 2.31 100Tripura 17.72 6018 1.28 - - - - 50.9 23.92 100Uttar Pradesh 13.63 0.82 1.48 6.32 0.66 1 0.27 73.93 1.92 100West Bengal 19.52 0.58 0.74 1.95 0.34 2.03 2.39 69.6 2.85 100Chandigarh 20.9 - 3 1.59 - - 3.94 70 0.57 100Delhi 32.14 0.29 6.95 7.3 1.41 0.89 3.28 45026 2.48 100Goa, Daman & Diu 42.12 - 10.6 21.18 - - - 23.93 5.17 100Mizoram 63.85 3.13 5.24 7.12 - - - 14.67 5.99 100Pondicherry 67.6 1.42 - 2.16 - - - 26.52 2.3 100Andaman & Nicobar 74.81 1.41 3.96 7.23 - - - 7.4 5.19 100Lakshadweep 73.01 19.78 - 3.97 2.44 - - 0.8 - 100INDIA 22.6 1.19 1.75 16.18 1.15 0.81 1.61 51.83 2.88 100Note: Percentages may not add up to 100 due to rounding off figures.Source : Morbidity and Utilisation of Medical Services, Report 364, 42 nd Round, National Sample Survey, Central Statistical Organisation, Government of India (1989),cited in Baru (1998).The NCAER survey of 1993 shows that around 55 percentof the households had sought outpatient care withprivate doctors in rural areas while around 64 percent hadgone to private sources in urban areas. In Maharashtra,around 53 percent are using private sources in rural areasand around 66 percent are using private sources in urbanareas. In Karnataka the corresponding figures are 40 percentand around 50 percent . While in Orissa the figuresare 17 percent are and 55 percent respectively(Sunder, 1992).Analysis of the NFHS of 1993 has provided informationon the utilisation of maternal health services and alsoutilisation of health services for certain diseases sufferedby children. This data has been analysed for scheduled17
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 and 20: 4Structure and Characteristics of P
Page 21 and 22: Structure and Characteristics of Pr
Page 23: Structure and Characteristics of Pr
Page 27 and 28: 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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