Research Areas

Impact of Health Sector Reforms - Completed

Impact Of Health Sector Reforms On Hospital Services In Andhra Pradesh - A Study Of Trends In The Structures Of Provision And Utilisation Pattern

Project Director	:	K.V.Narayana
Sponsored by	:	European Commission and coordinated by the Indian Statistical Institute, Kolkata.

Objectives

The overall objective is to study the functioning of health care system and the impact of recent reforms on its accessibility to different socioeconomic groups.

Specific Objectives:

1.	To review the expansion of public, private and voluntary sectors in medical care in the state. The review includes the process of privatisation and corporatisation of medical care and the chronology and content of health sector reforms.

2.	To do an in-depth study of perceptions of providers and users of medical care in the public and private sectors in selected towns in the state. On the providers' side, doctors and other key informants were interviewed to gain insights into the qualitative and quantitative changes in the medical care. Emphasis was on the process of health sector reforms and privatisation.

	The basic objective of in-depth interviews with the users is to investigate into choice of hospitals, direct and indirect costs of treatment and their impact on the family, quality of care in terms of satisfaction with treatment and overall experience with hospitalisation.

Methodology

While the objective 1 is based on a review of existing studies and government documents, the objective 2 is pursued through in-depth interviews of providers and case studies patients.

The study is undertaken in Eluru and Mahbubnagar towns, the headquarters of West Godavari and Mahbubnagar districts which are at the extreme ends in the levels of development in Andhra Pradesh. In each town, the study covered the government district hospital and a group of private hospitals, clinics and diagnostic centres.

Findings

Nature of Private Sector

The private sector has outgrown the size of the public sector through the direct and indirect state patronage. Still there is no regulation on quality and cost of care in the private hospitals by the state or any other professional agency.

While the small towns in the state witnessed a sharp increase in the number of small private hospitals and diagnostic centres, particularly after introducing economic reforms during 1990s, the city of Hyderabad experienced the arrival of big corporate hospitals promoted by the Non Resident Indian doctors (settled in USA) and private industry.

Public Sector

Due to lack of adequate resources, there was stagnation in the size and degeneration in the quality of care in the public hospitals. With the initiation of the SAP in 1990s, there was further decline in per capita public expenditure on health services in AP, despite all the talk of safety net.

Introduction of user charges and subcontracting of services to the private sector are the main elements of health sector reforms. The health sector reforms are only a part of drastic reforms in other major sectors undertaken as a part of Andhra Pradesh Economic Restructuring Project (APERP) and the overall impact on the health conditions of people and their access to medical care depend more on the changes proposed outside the health sector. For instance, while exempting the white ration card holders i.e. the poor from the user charges in the government hospitals, it proposes to drastically reduce the number of white card holders to half in the state. The net affect would be to reduce the percent of population eligible for free treatment.

However, as a result of huge investments in civil works, equipment, medical supplies, there was substantial improvement in the quality of care in the government hospitals at the secondary level. It is attracting more and more patients and some doctors have already complained that it has adverse impact on the quality of care. Because of widespread unmet need for medical care among the poor, the improvement in the functioning of secondary level hospitals is attracting more and more patients. It only indicates the necessity of further expansion of medical facilities in the public sector. Otherwise, the recent improvements in the quality are not sustainable.