Utilization of Outpatient Care Services in Odisha

Abstract

Background: Comparative studies analysing the user’s perception about the services and reasons for selecting a public or private facility are crucial for improving service delivery. In India, there is considerable debate regarding public versus private sector. In this context, this study examines the factors determining utilization of either public or private health care institutions in Odisha. Methods: The study is based on primary data collected from the outpatients visiting public and private health care institutions in the two districts of Odisha. Information on socio economic status (SES) and patient’s perception on service delivery were collected through a questionnaire. Association between health care utilization either from a public or private facility and the predicator variables–SES and facilities related variables was determined using multivariate logistic regression analysis. Results: A higher proportion of patients belonging to the low SES utilized public facility than the private facility. The scheduled tribes (STs) were five times more likely to visit public facility than the general caste (OR = 5.042, CI = 1.0538–24.130). Physical accessibility was main the reason to access a public facility. However, quality of care remained a major constraint in the public facility. Due to quality reasons, patients were 50 per cent less likely to utilize a public facility (OR = 0.506, CI = 0.289–0.886). Conclusion: This study concludes people from the low SES are more likely to visit a public health facility than private. However, due to quality reasons the likelihood of visiting a public health facility is reduced significantly. Further, people incur expenditure out of their pocket on drugs and diagnostic tests in the public health system. Therefore, only physical access may not ensure higher utilization unless quality is ensured to protect the interest of the poor in the public health care system.