Public-private partnership in health care of India: A review of governance and stewardship issues

Abstract

Indian health care is characterized by a mixed health system and different kinds of delivery structure. Mixed health systems can be defined as involving ‘centrally planned government health services that operate side-by-side with private markets for similar or complementary products and services’.1 Public health care delivery system includes teaching hospitals, secondary level hospitals (at district and subdivisional level), first-level referral hospitals (community health centres/rural hospitals), dispensaries, primary health centres, sub-centres and health posts. The private sector, both for-profit and not for profit, however, is the dominant sector and services range from 2-bed facilities to 1000+ bed hospitals.2The private provisioning of health care has grown from a mere 5 to 10 percent during India’s independence era to 82 percent of outpatient visit, 52 percent of inpatient expenditure, and 40 percent of births in institution.3 A report of the task force on Medical Education for the National Rural Health Mission in India determined that the private sector provides 58 percent of hospital buildings, 29 percent hospital beds, and 81 percent of the doctors in India.