In India, as in many developing countries, outpatient health care is provided largely by the private sector. Indian women favour outpatient care in the private sector as the Quality of care is superior to that in the public health service. Under these circumstances, should reforms prioritise improvements in the public sector or encourage better performance by private providers?

Outpatient care in India has been dominated by the private sector for several decades. Many more doctors work privately than for the government. The Indian Institute of Management, together with the London School of Hygiene and Tropical Medicine, carried out a study in Karnataka State to compare the two sectors. 18 private doctors and 25 public sector doctors were observed over a period of five days.  The private doctors worked in the rural Kolar District while the public sector practitioners were based in Mysore District.  All of the doctors were qualified and around half of the consultations were carried out by a female doctor.  The study found that:

• Consultations in the private sector lasted more than twice as long as in the public sector.  A patient spent on average less than three minutes seeing a public sector doctor. Private patients spent almost seven minutes with the doctor.
• The private doctors were more likely to undertake a physical examination of the patient. 
• They were also more likely to explain their diagnosis to the patient, to give advice on diet and to ask the patient to return.
• One third of public sector patients received an injection compared with two thirds of private patients.
• The average cost of drugs in the public sector was half that of the private sector: 37 as opposed to 74 rupees.

The quality of care appears to be much higher in the private sector both in terms of the thoroughness of the examination and communication between the doctor and the patient. However, private doctors may be over-prescribing drugs.

Huge improvements in public health care are necessary if women are going to choose to use it in preference to the private sector.  The Task Force on Health and Family Welfare, established in 2001, planned extensive reform for the Indian health service.  It included steps to reduce corruption, increase public-private partnership and consider public health issues such as nutrition, clean water, sanitation and decent housing.  Results from this study suggest that, when considering reform:

• greater regulation is often ineffective
• the advantages of continuing medical education are mixed
• communities, patients and providers of health care must work together in order to bring about improved quality of health care in the public sector.

It is often assumed that the quality of private health care is lower than that in the public sector.  However, in the Indian State of Karnataka the reverse appears to be true.  In areas where health care is largely private, some people see the role of the state as simply overseeing the quality of this private care.

Source(s):
'Health care of female outpatients in south-central India: comparing public and private sector provision', Health Policy and Planning 19(6): 402-409, by J. Bhatia and J. Cleland, 2004
HINARI subscribers can access the full-text article here. Full document.

Funded by: UK Department for International Development

id21 Research Highlight: 11 March 2005

Further Information:
John Cleland
Centre for Population Studies
London School of Hygiene and Tropical Medicine
49-51 Bedford Square
London WC1B 3DP
UK

Tel: +44 (0) 20 7299 4621
Fax: + 44 (0) 20 7299 4637
Contact the contributor: John.Cleland@lshtm.ac.uk

London School of Hygiene and Tropical Medicine, UK

Other related links:
'Health care seeking and expenditure by young Indian mothers in the public and private sectors', Health Policy and Planning 16(1): 55-61, by J. Bhatia and J. Cleland, 2001

'Women, reproductive health and the private sector in India'

'Reproductive healthcare - India's private practitioners go back to school'

'Working with private health providers to improve quality'

'Reform for all: health care reform in two Indian states'

'Healthcare reform in Tamil Nadu. Strengthening the government's role'

See id21's collection of links relevant to health systems and economics.