Hospitals form an important arm of the healthcare delivery system. Though the focus of various National programmes may be on primary health but secondary and tertiary public hospitals form one of the largest expenditure category in the national health budget. Over the past decade, inspite of the complexity of hospitals having increased many fold, not many changes have been made in the management structure of public hospitals.
Public Health Expenditure (Rs. Million) in Urban Areas
80percent of households prefer to use private sector treatment in India for minor illnesses, and 75percent of households prefer to go to the private sector for major illnesses (M.Uplekar, V.Pathania, & M.Raviglione). Numerous other studies have confirmed the dominance of the private sector and the reasons for this dominance: government health services entailed longer waiting periods, arrogant behaviour of doctors and non-availability of medicines (Ananthakrishnan). Even though the treatment in public hospitals is free, the patients have to pay for tests, and bear the incidental costs of boarding and lodging (Pasricha, 2006).
|Chart: Sources of Utilization|
of Health Care Services, Maharashtra (Adapted from “Health And Healthcare In Maharashtra: A Status Report”, Ravi Duggal,
A significant dilemma is faced by middle income groups who can spend on healthcare but not as much as charged in good private tertiary setups; while in case of treatments in government hospitals the quality of services provided is too bad to meet their expectations. The middle class comprises to around 25 to 30 percent of the total population of India.
|Major State-wise Average|
Total Expenditure (Rs.) Per Hospitalisation by
Type of Hospital for Rural and
Urban Areas in India
Quality of service should not be denied just because the direct consumer is not asking for it; but concrete measures towards quality assurance are necessary because lots of money is being spent in providing the infrastructure and bearing the administrative costs in the public hospitals. A few state governments (Gujarat, Kerala) are coming up with answers to these questions by taking concrete actions towards quality assurance and commitment for continuous quality improvement.