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The Primary Health Care approach to the Health
for All (HFA) goal envisages a referral system that fosters easy
movement of patients between institutions based on patient’s
need and availability of optimal care facility in different
institutions. Information collected from private and public HCIs
in AP suggests that an informal but active referral system exists
to meet patient needs. The system is sustained by professional
contacts of physicians, shared knowledge about the service
character of different type of HCIs. Domain specific regulation of
health care services, like state licensing requiring conformity to
standards of care, definition of services and compliance of
ethical norms is lacking. This could be the reason why unfair
competition was cited as an important obstacle faced by
owner-managers of private HCIs. Private HCIs also reported
obstacles on account of high and cumbersome tax regime and poor
governance such as corruption of public officials. Electricity,
followed by water supply and drainage were reported as important
infrastructure constraints faced by private HCIs.
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