Public Retreat and Changing Access to Inpatient Hospital Care in West Bengal

摘要

The post-1991 period in India experienced the implementation of various measures of reform including the social sectors and its effect on both the supply and demand side of the economy. Budgetary allocation in health sector has been reduced. Consequently, it has further reduced the consumers’ purchasing powers of health services and raised the problem of health sector inequity. The present study focuses on the pattern of changes in health care access and how the particular type of population is being adversely affected. The study also examines the distribution of changes in various indicators of access to health care across the various socio-economic groups and the regions over the period from 1986–1987 to 2004–2005. The study revealed that the developed states have recorded higher incidences of hospitalization compared to the poorer states. All kinds of free service facilities have decreased in public hospitals drastically over the period from 1986–1987 to 2004–2005. The high-income states have reported faster decline in access to free medicines and free ward facilities. On the other hand, poorer states have also reported drastic declines in access to free medicine in public hospitals. The demand for public hospital has declined significantly over the period, but the rate of decline is much higher in developed states compared to middle- and low-income states. As far as the figures in West Bengal are concerned, it is noted that the demand for hospitalization has increased among the poor in both the urban and rural areas, whereas it has decreased among the richer section. Access to various free service facilities such as diagnostic test services, X-ray, ECG facilities, free medicine and hospital wards facilities in public hospitals have been reduced drastically across the socio-economic groups in West Bengal. Poor, backward and illiterate households are grossly affected due to the withdrawal of public subsidies. However, access to free surgical operation facilities was less affected compared to other services. On the other hand, the larger towns experience faster exit of public facilities compared to smaller and medium-sized towns. The study also reveals that the households of rural areas are less likely to use private health facilities, but the rate of decline in the use of public facilities seems to be faster in the rural areas compared to medium and larger towns in West Bengal. The study has been organized through both the correlation and cross-tabulation methods using the three rounds of the National Sample Survey Organization (NSSO) unit record data.