Why the Indian patient is caught between the devil and the deep sea -Sanjay Kumar and Pranav Gupta
A 2014 NSSO report shows that the majority of Indians prefer to consult private practitioners rather than public hospitals and those who do visit public hospitals often do so out of compulsion
First it was Gorakhpur. Now it is Farrukhabad. The death toll in Uttar Pradesh’s government hospitals—from what appear to be preventable causes—has been mounting over the past month. Similar incidents have been reported from other states, pointing to the deep state of crisis in India’s healthcare system.
The rot in public hospitals has been apparent for some time now. Data from a National Sample Survey Office (NSSO) report conducted in 2014 showed that the majority of Indians prefer to consult private practitioners rather than public hospitals. A comparison with the earlier NSSO round shows that the proportion of patients using public facilities has increased only marginally in rural areas despite the expansion in rural public health facilities financed by the National Rural Health Mission (NRHM) over the past decade.
Those who do visit public hospitals often do so out of compulsion. A 2013 survey conducted by the Centre for the Study of Developing Societies (CSDS) showed that 47% of the people who visit a public hospital do so because they have no other choice. Among those who visit public hospitals despite having the choice of private care, most do so because of affordability. This is despite the fact that 52% of the respondents thought that the quality of government hospitals had improved compared to earlier.
Does the poor state of public hospitals suggest that the answer to India’s healthcare woes lies in private care? Several policymakers have suggested so in the wake of the Gorakhpur tragedy. While this may seem an attractive solution in the face of the crisis in public healthcare, the evidence in favour of private medical care is thin.
Private medical care is more expensive, often involving unnecessary tests and procedures, and is on average no better than public care in much of the developing world. This suggests that the average Indian patient is stuck between the devil and the deep sea when it comes to healthcare.
According to a 2016 World Health Organization (WHO) report, 57.3% of allopathic doctors in India do not have a medical qualification. In rural areas, this number is greater than 80%. How does one reconcile this with rising footfalls in private clinics? A World Bank paper by Jishnu Das and others offers some answers. The paper is based on an audit of private and public health providers in rural Madhya Pradesh. The authors found that even though private-sector doctors were much less qualified than public-sector ones, they were more likely to give adequate time to patients and even performed better in fulfilling a standard diagnostic checklist.
However, this study is based on outpatient consultation and does not account for in-patient services.
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Tagged with: Access To Health Access To Healthcare National Sample Survey Organisation National Sample Survey Organisation (nsso) Out-of-pocket Health Expenditure Public Health National Sample Survey Public Expenditure On Health