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

Privatisation of Health Care in India5.2. Utilisation of Inpatient ServicesWhen it comes to inpatient services the picture is somewhatdifferent. An analysis of the 42 nd round of the NSSdata at the all India level reveals that only around 36 percentof the hospitalisations were in private hospitals in urbanareas and around 35 percent in rural areas. InMaharashtra, around 48 percent of the households hadused a private hospital in urban areas while in rural areasthe figure was around 54 percent. In Karnataka, around50 percent in urban areas and around 38 percent in ruralareas had used private sources for treatment. In Orissa,around 15 percent in urban and seven percent in rural areashad been treated in a private hospital (Tables 9 and 10).The 52 nd round of the NSS data shows that at the all Indialevel 54.7 percent of households in rural areas and 56.9percent in urban areas had utilised private hospitals forhospitalisation. There has definitely been an increase in theproportion of persons utilising the private sector betweenthe 42 nd and 52 nd rounds of the NSS, which is roughlyover a decade.In Maharashtra, 68.8 percent in rural areas and 68.2 in urbanareas had utilised private sources. In Karnataka, 54.2percent in rural areas and 70.2 in urban areas had utilisedprivate sources. In Orissa, 9.4 percent in rural areas and 19percent in urban areas had utilised private sources. Apartfrom the inter-state differences in the utilisation of the privatesector there is also a difference between the poorestand richest quintiles. An analysis of the 52 nd round of theNSS shows an interesting picture that at the all India level39 percent of the poorest quintile were using the privatesector for hospitalisation while 77 percent of the richestquintile were utilising the private sector. Among the threestates, the poorest in Orissa relied more on the public sectorthan either Karnataka or Maharashtra. In many states,the middle and lower middle income groups have startedusing the private sector while the poor still continue to relyon public hospitals. Therefore, there is a clear indicationthat the utilisation of the private sector increases as theincome gradient increases. As far as the vulnerable sectionsviz. SCs and STs are concerned, utilisation by STs is verylow in both the public and private sectors while in the caseof SCs it is marginally higher and the dependence is greateron the public than the private sector.The NCAER survey on the utilisation of inpatient careshows that 38 percent of people in rural areas and 40 percentin urban areas opt for private sources at the all Indialevel. In Maharashtra, 69.5 percent of people in rural areasand 41.2 percent in urban areas opted for private sources.In Karnataka, 38.9 percent and 42.2 percent opted for privatesources in rural and urban areas respectively. In Orissa,a mere 1.9 percent of people in rural areas and 31.3 inurban areas opted for private sources (Sunder, 1992).While there is some variation between the findings of NSSand NCAER surveys across the three states, it also broadlyreflects the structures of provisioning in terms of privateand public sectors in these three states. Maharashtra has ahigher proportion of private beds, followed by Karnatakaand lastly Orissa, which is clearly reflected in the utilisationpatterns as well. The important issue to be underscored isthat in all three states there is dependence on the publicsector, especially for inpatient care, but the degree of dependencevaries across these states.The NFHS also provides data on the proportion of deliveriestaking place in institutions. Invariably, they are quitelow among the vulnerable sections. At the all India level,10.9 percent of the SCs used public hospitals while a mere5.1 percent used a private hospital. Among the STs, 6.7percent used public hospitals and 2.4 percent private hospitals.Among the category of ‘others’ 16.3 percent usedthe public sector while 12.9 percent used the private sector.Non-institutional or home deliveries formed a highproportion with 82.7 percent, 89.6 percent and 69.9 percentof SCs, STs and ‘others’ respectively (Table 11). InKarnataka, the proportion of SCs accessing private facilitieswas only 4.4 percent while for STs it was 4.5 percent. In Orissa,a mere 0.7 percent of SCs and 1.3 percent of STs were usingprivate facilities. However in Maharashtra, 16.6 percent of SCsand 6.1 percent of STs were using private facilities for deliveries.The proportion of home deliveries is high in Orissa with86.1 percent for SCs, 92.4 percent for STs and 80.6 percentfor others. In Karnataka, 77.8 percent of SCs, 73.2 percent ofSTs and 58.2 percent of others had deliveries at home. InMaharashtra, 55.2 percent of SCs, 82.2 percent and 51.7 percentof others had home deliveries (Table 11).20