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Public financing and provision of health care
services has been the mainstream of health policy for nearly half a
century of post independence India. Early planners of health care
delivery system for India were concerned about availability of
resources for provision of National Health Service. The idea of public
provision for all types of health care services was reinforced by the
fact that the size of private sector was insignificant at the time of
independence. All plans and policy statements by government of India
have remained silent on the role of private health care institutions,
until the National Health Policy, 1983 made a mention about the
existence of "private and voluntary organisations active in the
health field". Many factors have contributed to an interest in
the structure and dynamics of private health sector in India. Firstly
the private health sector has grown in many parts of the country,
particularly in the areas experiencing agricultural, industrial and
service sector developments. The private health care institutions and
services have grown in the absence of explicit policy to define their
role. The vision for a National Health Service allowed for the
existence of small private sector providers to meet the demands of
people who would be willing to pay for their services. Since a
comprehensive National Health Service is yet to take shape, more and
more people are willing to pay for services from the private health
sector, leading to its growth. The general economic reforms with its
emphasis on privatisation have also contributed to policy interest in
private institutions and services in the health care sector. Growth of
private forprofit health care institutions in an unregulated market
has raised concerns about exploitation of consumers (High Court of AP,
1999) and quality of care. Concerns have also been raised about
utilisation of tax concessions by the state and responsiveness of
private corporate health care institutions to the needs of poor (AP
legislative Assembly, 1996). Several studies have established the
rapid expansion of the private sector in both the provisioning and
financing of health care services in India. But there is a paucity of
information regarding the manner in which different parts of the
private health markets operate, the incentives and the motivation and
systems which form the basis for their sustenance. This study seeks to
understand the structure and dynamics of the private health sector in
Andhra Pradesh, in order to provide insights for meaningful policy
intervention to define the role of private health sector and realise
its potential in improving the population health status. Government
has responsibilities beyond the public provision of health services.
Because of it’s concern for the health of the population and for the
poor in particular, government is caretaker for the societal goals of
ensuring access to an affordable, appropriate high quality health
services. To what extent can the private health sector support these
goals? This study would help in identifying: (a) how national and
state health policies can clarify the roles for the public sector
interactions with different parts of the private sector; (b) enhance
opportunities and overcome constraints to enable the private sector to
fulfill social goals; and (c) possible avenues for cooperation between
the public and private sectors.
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