Health Policy and Planning, Vol 14, 26-37, Copyright © 1999 by Oxford University Press
R Bhat
Supply factors, depicted by input market conditions and government
regulations, and demand factors, depicted by financing mechanisms and
utilization patterns, are likely to determine the shape and character of
private medical practice. The interaction of this complex set of factors
will have considerable implications for the cost, access and quality of
services offered by this sector. Understanding these characteristics from a
provider perspective is imperative to influence the behaviour of providers
in this sector. This paper describes some of the important characteristics
of private medical practice using a case study of an urban district in
India, Ahmedabad, and analyzes their implications. Using survey data of 130
private doctors in the allopathic system, the paper describes broad
characteristics of private medical practice using parameters such as growth
of private practice, patient load and referrals within the sector, payment
methods, and determinants, patient concerns, and risks associated with
private practice. The paper presents views on the prevalence of various
undesirable practices in the private medical sector. It also discusses the
awareness of providers about selected important regulations.The findings
suggest that growing capital intensity due to cost of location, medical
equipment and technology, and financial sources of capital investments are
some unfavourable environmental factors experienced by private providers.
The findings also indicate a high prevalence of various undesirable
practices and low awareness of the objectives of important legislation
among practicing doctors. Lack of awareness of important and relevant
legislation raises serious questions about the implementation of these
laws. The paper identifies the strong need for instituting and implementing
an effective continuing medical education programme for practicing doctors,
and linking it with their registration and continuation of their license to
practice. The paper also suggests that cost of health care, access and
quality problems will worsen with the growth of the private sector. The
public policy response to check some of the undesirable consequences of
this growth is critical and should focus on strengthening the existing
institutional mechanisms to protect patients, developing and implementing
an appropriate regulatory framework and strengthening the public health
care delivery system. The study also discusses various other policy
implications arising.
ARTICLES
Characteristics of private medical practice in India: a provider perspective
Indian Institute of Management, Ahmedabad, India
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