Quality, access to government hospitals are hurdles

An increasing proportion of people are using private health care facilities, rather than public, though the costs in the latter are much more affordable, a countrywide survey on health care access has revealed.

The primary reason, the study goes on to prove, is the absence of doctors and a dissatisfaction with quality standards at state-run, or public hospitals. However, it did add that between 85 per cent and 90 per cent of the patients are willing to shift from the private sector if the situation improved in the public health care facilities.

The study was conducted by IMS Institute for Healthcare Informatics, in over 14,000 households across 12 states (including urban and rural areas).

There has been a steady increase in the usage of private healthcare facilities over the last 25 years for both Out Patient and In Patient services, across rural and urban areas. In 1986 – 1987, the choice for patients in both rural and urban centres was tilted in favour of public hospitals over private hospitals (60 to 40). In 2012, 61 per cent in urban areas had chosen the private sector over the public, and in rural areas, nearly 69 per cent had put their faith in the private sector.

Why? Especially if one considers that costs in the public health care set up are way cheaper than in the private centres. But the patients had their own reasons: the key among them being long waiting periods and non-availability of medicines, apart from non-availability of doctors and infrastructure.

Nearly 44 per cent of patients groused about the waiting period; while 52 per cent said there were no diagnostic facilities in government hospitals. Comparatively, they said, it was easier to meet a doctor in the private sector.

The other serious question that the study covered was the one on access. It has assumed that for a person to have access to healthcare in India, a facility must be reachable within a 5 km and must offer available doctors, drugs and treatment options that satisfy both acceptable cost and quality-of-care standards.

“Even if only one of the components is missing, a patient is unlikely to receive the right treatment in the most appropriate and efficient manner,” the authors state.

They found that in rural areas, only 37 per cent of people were able to access in-patient facilities (within the criteria stated above), and only 68 per cent were able to access out-patient department facilities.

The implication of travelling long distances is the potential loss of a day’s earnings and deferment of treatment in the early stages of the disease. This would only lead to increasing the cost burden over time.

This was in striking contrast to urban areas where access to IPD and OPD were 73 per cent and 92 per cent, respectively. There were more number of health care centres in urban areas, and connectivity was far better. The study recommends that addressing the availability/access issue must be a priority area.

To do so, would also mean tackling the human resource and infrastructure challenge, by either adding skill sets to existing workers, and expanding facilities. The authors have also suggested making higher cost channels more affordable by price regulation, subsidising treatment costs, increasing insurance penetration and including drug reimbursement as a part of insurance.

The primary reason, the study goes on to prove, is the absence of doctors and a dissatisfaction with quality standards at state-run, or public hospitals. However, it did add that between 85 and 90 per cent of the patients are willing to shift from the private sector if the situation improved in the public health care facilities