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 Structure and Dynamics of Private Health Sector

Implications for India's Health Policy

Contents

 

Chapters

Page

1. Private health sector and state health policy in India. An introduction

1

 
2.  Materials and methods for a study on the structure and dynamics of private health sector in Andhra Pradesh.
Sampling of health care institutions for the study. Data collection formats and the
questionnaires. Secondary data analysis and review of literature. Summary of materials and methods

7

 
3. Motivations, establishment, and growth of private health care institutions.
Overseas experience with institutional forms in private sector. Forprofit response to demand for services. Proprietary and corporate health care institutions. Nonprofit health care institutions in the US and other industrialised countries. Indianexperience with institutional forms in private sector. Private and voluntary health care institutions in India. Nonprofit HCls in India. Motivations, establishment, and growth of private health care institutions in AP. Motivating circumstances and incorporation status of Pvt HCls. Period establishment and growth of HCls in Andhra Pradesh. Growth in size of HCls after establishment. Summary of Evidence about institutional forms in health.

17

 
4.  Accessibility characteristics of private and public sector HCls.
Geographic distribution of health care institutions. Review of literature about geographic distribution of health care institutions. Findings from the present study about the geographic spread of private and public HCls in AP. Socioeconomic character of patients treated by private and public health care institutions. Review of overseas literature about socioeconomic character of patients treated by private and public health care institutions. Review of Indian literature about socioeconomic character of patients treated by private and public health care institutions. Findings from the present study about Socioeconomic character of patients treated by private and public health care institutions. Findings from the present study about accessibility of private and public HCls. Summary of evidence about accessibility characteristics of private and public HCls.

35

 
5.  Health seeking behaviour and patterns of resort to private or public HCls.
Factors affecting pattern of resort to different HCls. Pattern ofresort to private and public HCls for ambulatory care. Pattern of resort to Private and Public HCls for hospital care. Socio Economic status and Pattern of resort to health care. Summary . of evidence about health seeking behaviour.

49

 
6.  Efficiency of health care institutions (HCls) in private sector
Studies comparing efficiency of health care institutions in private forprofit, nonprofit and public sector.Findings from the present study about capacity utilisation by private and public HCls in AP. Summary of evidence about efficiency of private forprofit, nonprofit and public HCls.

61

 
7. Quality of care characteristics of private and public health care institutions
A framework for assessment of healthcare quality. Review of overseas literature on healthcare quality and ownership of HCls. Healthcare quality in private and public HCls in India. Structure and process quality characteristics of private health care institutions in AP. Premises and floor space. Practice guidelines, and medical records. Patient satisfaction in private and public health care institutions. Owner managers' opinion about interventions for improvement of quality of care in private sector. Summary of evidence about quality of services.

69 

 
8.  Range of services in private and public health care institutions
Nature of services provided by the private sector and medical interventions where private institutions have an advantage. Find- ings from the present study about range of clinical services pro- vided by private and public HCls in Andhra Pradesh. Range of public health related services, participation in national disease control and family welfare programs by private and public HCls in AP. The healthcare diagnostic services market in AP. Intra- mural diagnostic services. Extramural diagnostic services. Avail- ability of auxiliary services in private and public HCls. Sum- mary of evidence about range of services in private and public HCls.

97 

 
9. Human resources and job satisfaction in private and public health care institutions
Staffing and human resource utilisation by private health care institutions in AP. Job satisfaction of health care professionals in private and public sector. Job s.atisfaction and related concepts. Conceptual basis of the health care professional (HCP) questionnaire. Job satisfaction in private and public HCls in AP. Summary of findings about human resource utilisation and job satisfaction in private and public health care institutions.

115

 
10 Financial aspects of private HCls.
Revenue sources for private HCls. Sources of capital for private health care institutions. Rates and charges. Transparency in rates and charges. Fair financing practices. Summary of findings about financial aspects of private HCls.

131

 
11. Patient referral, regulatory environment and infrastructure problems faC.ed by private HCls
Patient referrals. Regulatory environment. Public utility and infrastructure related problems perceived by owner managers of private HCls. Summary of findings about patient referral, regulatory environment and infrastructure problems faced by private HCls.

149

 
12. Alternate Private Practitioners in Andhra Pradesh
Summary

 155

 
13. Experiences from policy interventions in the United States (US) directed or otherwise affecting the private health sector
Licensing and accreditation. Blue cross insurance plans. Tax waivers for health insurance. Capital Subsidy by US Federal Government for Hospital Construction from 1946-74 under the Hill-Burton Programme. Health Services Planning and Certificate-of-Need (CON) Regulation in the US. Health Maintenance Organizations (HMOs). Peer review and practice guidelines. Summary of the US experience of health policy interventions affecting the pri-vate health sector

163

 
14. Policy Recommendations

171

 
15. Execute Summary
Materials and methods. Motivation, and establishment of private health care institutions. Accessibility character of private and public HCls. Patterns of resort to private or public H91s. Efficiency of health care institutions in private sector. Quality healthcare in private and public institutions. Range of services in private and public health care institutions. Human resources utilisation and job satisfaction in health care institutions. Financial aspects of private health care institutions. Patient referral, regulatory environment and infrastructure problems faced by private HCls. Alternate Private Practitioners. Experiences from the United States (US). Policy Recommendations.

 179

 
16. Acknowlegdements

 195

17. References

 197

18. Appendix
Appendix-1.1 Health Care Institution - Basic Information. Appendix-1.2 Additional questionnaire for owner - managers of private health facilities (Hospitals / Nursing Homes). Appendix-1.3 Health Care Diagnostic Facility Questionnaire. Appendix-1.4 Health Care Professional - Personal Question- naire. Appendix-1.5 Questionnaire for Alternate Private Practitioner. Appendix-1.6E Patient Exit Interview-English version. Appendix-1.6T Patient Exit Interview- Telugu version

207 

 

                                                                                                          

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