Human Development in India - NCAER

health and medical care 109Sixty nine per cent of the long-term ill went to privatepractitioners (similar to the 71 per cent of the short-term ill),23 per cent went to government facilities (somewhat higherthan the 17 per cent of the short-term ill), only 5 per centwent to pharmacists or some other medical care (only halfof the 10 per cent for those with a short-term illness), and9 per cent reported not seeking any medical treatment.The proportion seeking no treatment in the past year maybe an underestimate resulting from our focus on diagnosedillnesses. Polio (58 per cent), mental illness (76 per cent), andcataracts (79 per cent) have especially low rates of medicaltreatment.The pattern of private and public service usage for longtermillnesses is much the same as that discussed above forshort-term illnesses. There are only small differences betweenmen and women, and between the elderly and the workingage population (see Table A.7.2a). Educational and socialgroup differences in treatment options are also minor.Again, the major determinants of public and privatemedical care are regional. More than half the long-termpatients were treated at public health facilities in HimachalPradesh and Delhi (see Table A.7.2b). On the other hand, thesame states with low rates of public medical service usage forcoughs, fevers, and diarrhoea, also have low usage of publicservices for more serious diseases. Bihar, at 4 per cent, isagain the lowest. Metropolitan cities show the greatest usageof government services (27 per cent), while less developedvillages document the lowest usage (20 per cent), reflectingthe greater availability of high quality training hospitals inmetropolitan areas.Treatments occur outside the village or neighbourhoodmore often for major illnesses (62 per cent) than for minorillnesses (42 per cent). Among major illnesses, chronicconditions like hypertension (51 per cent) and diabetes (54per cent) are less often treated outside the area than othermajor illnesses (see Table 7.1).The young, although less likely to suffer from a majorillness, travel farther for treatment (Table A.7.2a). Butgenders, income levels, and social groups differ little inwhere they are treated. Residential location is the primarydeterminant of local treatment of long-term illnesses, as itis for short-term illnesses. The sick in metropolitan cities arefar more likely to be treated locally (71 per cent) than arethose in the least developed villages (25 per cent). States alsodiffer in how often long-term illnesses are treated locally;travelling for treatment of major illnesses is much morelikely in Himachal Pradesh (81 per cent), Uttar Pradesh(77 per cent), or Bihar (77 per cent), than in West Bengal(44 per cent) or Kerala (52 per cent).Patients with major illnesses were hospitalized moreoften (25 per cent) and for longer periods than were thosewith short-term illnesses (3 per cent). The average hospitalstay was seven days, although 10 per cent of the patientsstayed for a month or more. Hospitalization stays were theshortest for cataracts, with a median of four days, but weretypically 7–12 days for each of the other diseases. Becauseof the ‘Others’ (Table 7.1) category’s high prevalence, abouthalf of the hospital days are accounted for by the ‘Others’category, which is composed primarily of accidents.Hospitalization rates vary little by income, education, orsocial group (Table A.7.2a). However, states differ substantiallyin their hospitalization rates (Table A.7.2b). Himachal,Haryana, Gujarat, and Maharashtra had high rates of hospitalization.Punjab, Delhi, West Bengal, and Orissa had lowrates, as did Andhra Pradesh and Chhattisgarh.Maternal Medical CareAbout half of all recent births were attended by trainedmedical personnel. As shown in Figure 7.11, 43 per cent ofbabies were delivered by a physician. Another 11 per cent weredelivered by a nurse or other trained medical personnel.Major social, geographic, and demographic differences,separate the half of babies delivered by medical personnelfrom the other half who were attended only by traditionalmidwives, family, or friends. Poor, illiterate mothers havingtheir sixth child in rural Bihar are almost never attendedby medical personnel. Affluent, college educated mothershaving their first child in Chennai almost always are.Deliveries are the most visible part of a larger systemof maternal care, whose parts are closely related. Prenatalcheckups, blood and urine tests, sonograms, tetanus injections,iron supplements, and postnatal checkups have widelyvarying levels of acceptance across India (Figure 7.11), buta mother who has any one of these is more likely to havethe others as well. For example, 82 per cent of mothers whohad a physician-assisted birth had had a prenatal blood test.Only 34 per cent of other mothers had that test. Moreover,the personal, social, and geographic factors, that affect anyone of these, are the same as the factors that affect the others.To avoid repetition, this report will concentrate on physicianassisted deliveries, but the reader should realize that what isfound for deliveries applies as well to the other elements ofthe maternal health complex.The mother’s education and her household’s income arestrong determinants of what kind of medical care she receivesduring delivery (Table A.7.2a). Ninety-one per cent of collegegraduated women delivered their babies with a physicianattending. Only 24 per cent of uneducated women receivedthat level of attention. Similarly, only 27 per cent of womenin the poorest income quintile had a physician attendeddelivery, compared to 69 per cent of women in the mostaffluent quintile. This suggests that delivery care for womenis far more dependent on the household socioeconomic statusthan is care for illnesses that afflict both men and women.