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

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Privatisation of Health Care in IndiaAnalysis of the 52 nd round of the NSS data shows that theexpenditure on both inpatient and outpatient care increasedbetween 1986 and 1996. Between 1986 and 1996 costs ofmedical care in both the public and private sectors rosesharply. The costs in the public sector rose by 549 percent inrural areas and 470 percent in urban areas while for the privatesector it rose by 486 percent in rural areas and 343percent in urban areas. The major reason for the rise in costsof medical care in the public sector has been the increasedprices of drugs. This rise in cost of medical care is bound toaffect both the accessibility and utilisation of health services,which would result in those requiring care, not getting it.This would also explain why the rates of untreated diseasesare very high among the poorer groups and why, when theydo seek care, they have to borrow to pay for it (Sen et al,2002). The 52 nd round estimates that 45 percent of thecountry’s poor had to borrow money or sell their assets tomeet the increasing cost of medical care.26
6ConclusionThis study has explored the evolution of the private sectorand its characteristics for India and also across states, morespecifically in Maharashtra, Karnataka and Orissa. The threestates under study represent varying levels of socio-economicdevelopment and this is reflected in the health outcomes,as well as the growth of the private sector. In termsof health outcomes, Maharashtra has lower infant mortalityrates than either Karnataka or Orissa. The available dataclearly shows that Orissa has the poorest health indicatorsamong the three states. The private sector is a heterogeneousstructure consisting of a substantial number of individualpractitioners who have been either formally or informallytrained. They are distributed across rural and urbanareas and offer primary level curative care. The secondarylevel of care consists of institutions, which deliverboth inpatient and outpatient care. There is great variationin the size of operations at this level and it is mostly anurban phenomenon. The tertiary level of care is an urbanphenomenon and there is a substantial presence of thesehospitals in cities like Delhi, Hyderabad, Mumbai, Chennaiand Bangalore.In terms of provisioning, Maharashtra has both a strongpublic and private presence, followed by Karnataka andthen Orissa. These structures of provisioning get reflectedin the patterns of utilisation. In general, available data suggeststhat the utilisation of private services is higher inMaharashtra and Karnataka compared to Orissa and thisholds true for the vulnerable groups as well.The patterns of private utilisation of health services havebeen quite different for outpatient and inpatient care. Acrossall the three states, there is a greater dependency on theprivate practitioners for outpatient care. However, when itcomes to hospitalisation there is variation in utilisation patternsacross the three states. This variation needs to be explainedwith respect to the structures of provisioning. Thestates that have experienced higher private sector growthare the ones, which are economically better off. There is ahigher utilisation of the private sector for hospitalisation inMaharashtra and Karnataka. In these states, it is the upperand middle-income groups that use these services, whereasin Orissa, the percentage of those using the private sectoramong the middle and upper middle-income groups isvery low (Krishnan, 1999).The NSS, NCAER and NFHS data show that there arevariations in the patterns of utilisation of the private sectoracross states, income groups and vulnerable social groups.The 52 nd round of the NSS data has shown a tremendousincrease in the costs of medical care in both the public andprivate sectors. For outpatient care, all the three states haveshown an increased use of the private sector. Of the threestates, urban Orissa has shown the highest increase from42.4 percent in the mid eighties to 53 percent in the midnineties (Table 12). For inpatient care there has been agreater increase in urban areas as compared to rural areas.Maharashtra and Karnataka show similar trends in increaseduse of the private sector whereas Orissa shows only a small27
Page 3 and 4: Table of Contents123456Introduction
Page 5 and 6: Chhattisgarh Infrastructure ReportL
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Page 13 and 14: 3Private Health Services in India:A
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Page 19 and 20: 4Structure and Characteristics of P
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Page 37 and 38: ReferencesAcharya, A.; Baru, R. and
Page 39 and 40: ReferencesShah, G. 1997. Public Hea

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