Sub-Markets in Health: An Analysis of Patient Care, Diagnostics and Financing Submarkets in a City in South India: Trivandrum

Abstract

Rationale The role of market in health care provision and financing in India is well-known. But, market characteristics vary with respect to each sub-markets ultimately resulting in sub-optimal health care. Health care pricing and the financial burden of treatment depend on the size and characteristics of the market. An analysis of sub-markets enhances the understanding of health care provision and financing thus helping the planning and regulation of the market/sub-markets.

Objective This paper measures and analyses the characteristics of three types of sub-markets - patient care, diagnostics and financing in a city of Kerala.

Methodology This study of five sub-markets (two on patient care, two on diagnostics, and one on financing) was performed in five randomly chosen wards of Trivandrum city. Over 2,350 households, 199 patients, 33 registered medical practitioners, 32 lab administrators, 16 hospital administrators, and 8 Computerized Tomography administrators were included. Interviews with community, patients, health care providers, and administrators and medical records review were the instruments for data collection.

Results Public hospitals held a larger market share (67.0%) in outpatient services; private hospitals catered to 14.5%. Over 40.0% of hospitalization was catered by public hospitals. Share of public sector in diagnostics was 64.3% and top-4 firms accounted for 78.7%. Average number of outpatients per public hospital per day was 878 (range 700-1,055) and it was 127 in private hospitals (range 50-225). Average number of outpatients seen per day by a private practitioner was 19 (range 4-50). Share of private sector in dental care was 57.6% and in ophthalmic care was 9.2%. Proportion of outpatients utilizing allopathic, ayurvedic, and homeopathy care was 86.0%, 9.7%, and 4.3% respectively. About 35.0% of hospitalized people borrowed money or sold assets to cover expenses. Borrowing from high-interest unorganized private lenders was to the extent of 23.4% of total expenditure.

Conclusion The public sector predominance was due to its size, free service component, and the tertiary care nature of the institution. However, patients were more satisfied with the private sector.

Keywords: Health sub-markets, health financing, provision of care