Accessibility character of private and public HCIs.

Some general patterns have emerged from the review of available evidence on geographic spread and patient composition of health care institutions in private and public sectors, respectively. We found that public sector HCIs have a wider geographic spread compared to the private sector HCIs, which tend to be located in urban areas. 150 private HCIs randomly sampled for this study were from 19 cities or villages. The 106 randomly sampled public HCIs were from 76 cities or villages. Economic development of an area tends to improve the overall availability of health care facilities both in public and private sector. The geographic spread of private sector HCIs is more restricted compared to the public sector HCIs. The private sector HCIs have grown mostly in areas with higher levels of socioeconomic development. Although economic development does appear to some extent influence the public sector health care capacity, geographic distribution of public sector HCIs appear to have been comparatively better than in case of the private sector.

Available evidence on socioeconomic composition of patients suggest that the public sector HCIs tend to serve more number of socioeconomically poorer patients compared to similar sized institutions in the private sector. National level estimates for all India and state level estimates for Andhra Pradesh, available from various studies are consistent with this observation that the share of patients from socioeconomically poor households is comparatively higher in case of public sector HCIs. Within the private sector the nonprofit health care institutions tend to be more accessible to socioeconomically poorer sections compared to the forprofit health care institutions. Review of studies in the US where a mixed health system is in place suggests similar differences in accessibility characteristics of forprofit, nonprofit and public health care institutions.