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Let us summarise the available evidence on
patterns of resort to private and public HCIs. All the four nation
wide surveys conducted during the 1980s and 1990s show that
majority of people (60% to 80%) resort to the private HCIs for
ambulatory care. In rural areas, however, significant number of
people (10% to 20%) turn to the Primary Health Centres or Sub
centres for ambulatory care. The level of resort to private HCIs
for ambulatory care, has remained constant or marginally increased
between the 1980s and 1990s. However, there are notable regional
exceptions to this trend. For example, in Andhra Pradesh, the
level of resort, for ambulatory care, to public HCIs increased
during this period. In rural areas of AP the number of people
resorting to public HCIs increased from 12% in 1986-87 to 22% in
1995-96. In urban areas of AP, the increases was comparatively
less, from 16% in 1986-87 to 19% in 1995-96. There is some
evidence to suggest that the proportion of people who do not seek
any ambulatory care in times of need is higher in states spending
comparatively less money on public health services. For inpatient
care, traditionally more people have been resorting to the public
hospitals. Till about 1993, about 60% of people needing inpatient
services resorted to the public sector. The situation appears to
be changing. By 1995-96 the proportion of people resorting to
public hospitals for inpatient services reduced to about 43% with
a corresponding increase for the private sector. We have found in
this study that private hospitals and nursing homes have grown at
a much faster rate in numbers and bed capacity during the 1980s
and 1990s. This would appear to be the most plausible explanation
for the increase in resort to private hospitals during the 1990s.
Estimates of pattern of resort to private and public HCIs by
socioeconomic status reveal that people from poorer households
tend to rely more on public HCIs. As socioeconomic status
increases more and more people resort to the private HCIs. At the
all India level, people in rural areas tend to rely more on the
public sector. In AP, however, the rural-urban difference is not
so much.
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