Research Project

Fostering Reforms in the Private Health Sector (2005 Onwards)

Research Area : Health Legislation and Patients' Rights

The aim is to study the access to healthcare with an equity lens,quality of health care in both public and private health sectors and policy level advocacy to improve access to health care. CEHAT is involved in a situational analysis of Quality of Care in Private Nursing Homes, development of standards for the private sector by collective process and inputs from research findings, advocacy and capacity building to ensure minimum standards in nursing homes. SATHI is involved in a quantitative household survey to identify inequities in health care access and in setting up a Health Equity and Rights Watch to monitor access to health care at field level. Download Presentation Issues and Challenges in Regulation of Private Sector: Study of Private Hospitals in Maharashtra

Objectives

  • To assess the physical standards and quality of care provided by the private hospitals in Maharashtra
  • To understand the problems and the concerns regarding the existing BNHRA and Accreditation among the nursing homes in Maharashtra

The study was conducted across 261 private hospitals from 10 districts of Maharashtra namely Nashik, Nandurbar, Pune, Satara, Thane, Ratnagiri, Osmanabad, Aurangabad, Amaravati, and Gadchiroli. Greater Mumbai was included for its unique features of complete urbanization, rapid expansion of the private medical sector, the huge population base with a high standard of living and very high real estate prices.

Key Findings

  • The study highlights the tremendous growth across all regions in Maharashtra whether developed, developing or metro city like Mumbai.
  • The study also dwells on the changing profile of private practitioners. 89.7% (234) of the owners are from allopathic system of medicine. In the less developed districts, 96.8 %( 30) of the hospitals belong to the allopathic system of medicine.
  • The developed districts and Mumbai provide considerable medical, surgical and maternity services, but the hospitals in less developed districts predominantly provide medical services. More than 55% of the hospitals in less developed districts do not provide maternity and surgical services. This indicates the lack of available services for maternal and surgical care in the less developed regions.
  • The bed occupancy was 58%. In the sample, bed occupancy was found to be the highest in the hospitals in developed districts, followed by Mumbai. The highest bed occupancy (71%) was in hospitals with 21-30 beds. As against 51% bed occupancy noted by Nandraj and Duggal (1997) which indicates a higher utilization of the private health sector
  • The study showed 86.2 %( 225) of the hospitals’ owners being sole proprietors. While 13.4 % of the hospitals are owned in partnership, they are largely concentrated in Mumbai. The first owners are predominantly men (91%). Amongst second owners, 53% are women.
  • Nearly 86.6 %( 226) of the hospitals are housed in self-owned buildings and the rest of the hospitals are housed in rented buildings.
  • Around 40% (105) of the doctors are involved in multiple facility practices, which is more common in developed districts than in less developed districts. The trend towards multiple facility practice is highest amongst large hospitals that have more than 15 beds.
  • Nearly 54% (141) of the hospitals do not have a Duty Medical Officer. The study shows that the less developed areas and small hospitals are worse off. Only 17.7% (21) of the hospitals have DMOs from the allopathic system, while the rest belong to other systems of medicine, mostly to the Ayurveda system.
  • The average availability of nursing staff for each hospital in the sample is 4.8. The study highlights that the developed regions have the largest presence of the nursing staff which includes Mumbai and the developed districts. It is also higher amongst medium and large sized hospitals. Similarly there is shortage of other qualified staff like midwives, wardboys/Ayabais,Lab. Technicians and X-ray technicians.
  • The study has revealed that the level of physical standards has improved over time but the information provided to patient and record maintenances has not improved to that proportion. Only 37.2 %( 97) of the hospitals provide information about the services available at the hospital. 61.7% (161) of the hospitals reported that they have some grievance handling mechanism
  • Approximately 60 % of the hospitals reported that they provided some form of emergency- medical/surgical/accidental care. The most commonly provided emergency services are surgical emergencies. (62.7 %)
  • Forty nine percent (130) of the hospitals have staff trained to deal with emergency situations. Only one hospital with 21-30 beds located in a developed district has staff trained for Cardio Pulmonary Resuscitation.
  • Overall, it is evident that unqualified and untrained staff is entrusted with the job of providing emergency services.
  • Low awareness among the hospital owner regarding BNHRA, its minimum requirements. Similarly the knowledge about the Accreditation/self - regulation is also found low among the hospital owners

Team: Ritu Khatri, Padma Deosthali, Sushma Gamre, Chandrima Chatterjee, Shilpa Sonar, Suchitra Desai, Habihulla Ansari, Amita Pitre and Varsha Zende Supported by:International Development Research Centre (IDRC),Canada